Cervical cancer is the most common malignancy of the cervix and a major public health problem among women. It ranks second in incidence after breast cancer.
Etiology (Causes)
- Unknown (Idiopathic) Causes
- Human Papillomavirus (HPV)
Infection –
Types 16, 18, 31, 33, 45
- Sexually Transmitted
Diseases (STDs)
- Multiple Sexual Partners
- Early Onset of Sexual
Activity
- Poor Genital Hygiene
- Low Socioeconomic Status
- Smoking
- Immunosuppression (HIV,
Organ Transplant Patients)
- Chronic Cervicitis
Pathology
Types of Cervical Cancer
1.
Squamous Cell Carcinoma (85-90%)
o Originates from squamous
epithelium
o Commonly seen in ectocervix
2.
Adenocarcinoma (10-15%)
o Arises from glandular epithelium
o Commonly affects the endocervical
canal
3.
Mixed Tumors
o Adenosquamous Carcinoma
o Neuroendocrine Tumors
Spread of Cervical Cancer
- Direct Extension → To uterus, vagina,
bladder, rectum
- Lymphatic Spread → To pelvic lymph
nodes
- Hematogenous Spread → To lungs, liver,
bones
- Peritoneal Seeding → Rare but possible
Staging of Cervical Cancer (FIGO
Classification)
1.
Stage 0 – Carcinoma in situ (Cervical
Intraepithelial Neoplasia - CIN III)
2.
Stage I – Cancer confined to the cervix
o Stage IA –
Microscopic disease
o Stage IB –
Clinically visible tumor
3.
Stage II – Cancer spreads beyond the cervix but not
to the pelvic wall
o Stage IIA –
Involves upper
vagina
o Stage IIB –
Involves parametrium
4.
Stage III – Cancer extends to the pelvic wall or
lower vagina
o Stage IIIA –
Involves lower
third of the vagina
o Stage IIIB –
Causes hydronephrosis
or affects pelvic
wall
5.
Stage IV – Distant metastasis
o Stage IVA –
Involves bladder
or rectum
o Stage IVB –
Distant organ
metastasis
Clinical Features of Cervical Cancer
Early
Symptoms
- Postcoital Bleeding
- Intermenstrual Bleeding
- Heavy Menstrual Bleeding (Menorrhagia)
- Excessive White Discharge
(Leukorrhea)
- Foul-Smelling Vaginal
Discharge
Advanced
Symptoms
- Irregular Vaginal Bleeding
- Pelvic Pain & Lower
Backache
- Weight Loss, Anemia, Fatigue
- Bladder Symptoms → Dysuria, Hematuria
- Rectal Symptoms → Constipation, Rectal Bleeding
Investigations for Cervical Cancer
1.
Routine Blood Tests – CBC, Renal Function Tests
2.
Pap Smear (Cervical Cytology
Screening) – Detects precancerous
changes
3.
Colposcopy & Biopsy – Confirms diagnosis
4.
HPV DNA Testing – Identifies high-risk HPV strains
5.
Pelvic Ultrasound & MRI – Determines tumor spread
6.
Cystoscopy & Proctoscopy – Evaluates bladder
& rectal involvement
7.
Serum Tumor Markers – SCC Antigen (for squamous cell carcinoma)
Treatment & Management of Cervical Cancer
1.
Surgical Treatment
- Cone Biopsy – For early-stage cancer
- Radical Hysterectomy
(Wertheim’s Procedure) – Removes uterus, cervix, parametrium, and upper vagina
- Pelvic Lymphadenectomy – Removes lymph nodes
2.
Radiation Therapy
- External Beam Radiation
Therapy (EBRT) –
For locally advanced cases
- Brachytherapy (Intracavitary
Radiation) – For
stage IIB-IVA
3.
Chemotherapy
- Platinum-Based Chemotherapy
(Cisplatin, Paclitaxel) – Used in advanced or recurrent cases
4.
Palliative Care
- Pain Management (NSAIDs,
Opioids)
- Nutritional Support
- Psychological Counseling
Complications of Cervical Cancer
- Metastasis to Lungs, Liver,
and Bones
- Pelvic Fistula Formation
(Vesicovaginal, Rectovaginal Fistula)
- Severe Anemia &
Malnutrition
- Obstructive Uropathy →
Hydronephrosis & Renal Failure
Prevention of Cervical Cancer
1.
HPV Vaccination
- Cervarix & Gardasil
Vaccines
(Administered before sexual debut, ideally at 9-14 years)
2.
Regular Screening
- Pap Smear (Every 3-5 Years
in Women >21 Years)
- HPV DNA Testing
3.
Lifestyle Modifications
- Avoid Multiple Sexual
Partners
- Maintain Good Genital
Hygiene
- Quit Smoking
Keynote Symptoms of Cervical Cancer
- Irregular, foul-smelling vaginal discharge (often blood-stained)
- Postcoital bleeding (bleeding after intercourse)
- Pelvic pain or lower backache
- Weight loss, fatigue, and anemia due to blood loss
- Painful or difficult urination (if cancer spreads to the bladder)
1.
Carcinosin
Indications:
- For patients with a family
history of cancer
- Early-stage cervical cancer
with precancerous changes
Keynote Symptoms:
- Weakness and exhaustion, especially in
the evening.
- Sensitive and perfectionist
personality.
- History of suppressed emotions or
grief.
- Bluish discoloration of the skin.
- Intolerance to fatty foods and milk.
2. Conium Maculatum
Indications:
- Cervical cancer with
hardness and induration of the cervix
- Slow-growing tumors with
sharp, lancinating pain
Keynote Symptoms:
- Hard nodules or lumps in the cervix.
- Vertigo, especially when lying down or
turning the head.
- Pain in the cervical region extending
to the thighs.
- Weakness and trembling, especially in
elderly women.
- Worse from suppression of sexual
desires.
3. Kreosotum
Indications:
- Excessive, offensive vaginal
discharge with ulceration of the cervix
- Cervical cancer with burning
pain and acrid discharges
Keynote Symptoms:
- Burning, acrid leucorrhea causing
intense itching.
- Corrosive, foul-smelling vaginal
discharge.
- Bleeding between periods or after
intercourse.
- Severe burning pain in the cervix and
vagina.
- Worse at night and from washing with
cold water.
4. Hydrastis Canadensis
Indications:
- Cervical cancer with thick,
yellowish vaginal discharge
- Weakness and emaciation due
to chronic illness
Keynote Symptoms:
- Thick, sticky, yellow vaginal
discharge.
- Weakness with a sense of weight and
dragging in the pelvis.
- Wasting away despite a good appetite.
- Pain radiates to the thighs and lower
back.
- Worse in the evening and from motion.
5. Thuja Occidentalis
Indications:
- Cervical cancer linked to
Human Papillomavirus (HPV) infection
- For precancerous lesions and
warty growths on the cervix
Keynote Symptoms:
- Warty excrescences or cauliflower-like
growths on the cervix.
- Profuse, offensive vaginal discharge
with staining.
- Pain in the cervix extending to the
thighs.
- Sensation of something alive moving in
the abdomen.
- Worse from damp weather and at night.
General Management Tips for Cervical Cancer
- Maintain good genital hygiene.
- Include anti-inflammatory foods (turmeric, green tea) in the
diet.
- Regular screening (Pap smear & HPV testing) is essential.
- Consult
an oncologist for proper evaluation and adjunct treatments.
