Even though cervical carcinoma is largely preventable, it is the 4th most common cancer in women, with an estimated 350,000 deaths worldwide in 2022. While the early onset of cervical cancer has no symptoms, advanced cases can present with abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. 

Fortunately, precancerous conditions can be caught before they turn into cancer through regular Pap smears and HPV testing, and treatment will depend on the stage of the tumour and the individual. 

In this guide, we will discuss all the possible causes and also differentiate the warning signs, the diagnostic approach, and the various treatment options available for women who have cervical cancer.

What is Cervical Carcinoma? 

Cervical carcinoma (ca cervix) is a malignancy originating in cells of the cervix, the narrow lower portion of the uterus at its junction within the vagina. Unlike most other types, this cancer usually grows slowly over the years, beginning as dysplasia, which is the presence of abnormal cells in cervical tissue. 

If not treated, these abnormal cells may become cancer cells that spread deeper into the cervical layers and the surrounding tissues. The cervix comprises 2 portions: the ectocervix and the endocervix. The final layer of the ectocervix is covered with flat squamous cells that can be seen on a gynaecological examination. 

There is a canal from the vagina to the uterus, and the endocervix is lined with columnar glandular cells producing mucus. Cervical cancers commonly start at the squamocolumnar junction (transformation zone), where the two cell types meet.

Cervical carcinoma is the result of human papillomavirus (HPV) infection in 99% of the cases worldwide. Vaccination or regular screening prevents most cervical cancer. This window provides a significant opportunity to detect and treat the cancer through Pap smears and HPV testing because the cancer progresses slowly from precancerous changes to invasive disease.

Causes of Cervical Carcinoma 

Human papillomavirus (HPV) causes most cervical carcinomas from continued infections with HPV high-risk types (16, 18) that represent approximately 70% of the overall causative HPV types worldwide. These changes damage the DNA (deoxyribonucleic acid) of cells in the body, which begins to divide and grow without standard control. 

They are abnormal cells that may develop into tumours that ultimately spread into adjacent tissues and, later in advanced stages, metastasise to other sites. HPV is present in nearly all cervical cancer cases. Still, the interval from HPV infection to cervical cancer is usually many years to many decades, implying that additional influences determine progression.

Risk Factors of Cervical Carcinoma

1. HPV Infection 

The fundamental risk factor for cervical cancer is human papillomavirus (HPV) infection. These high-risk HPV types can persist in the body for years and can lead to gradual changes in the cells that may progress to become cancer. The HPV risk can be reduced through regular screening and vaccination.

2. Smoking 

In women with HPV, tobacco use increases the level of cervical cancer risk by a substantial margin. Cigarette smoke contains carcinogens that damage DNA inside cervical cells, which makes it difficult for the local immune response to fight off HPV infections and increases the chances precancerous changes will turn into invasive cancer. 

3. Multiple Sexual Partners 

Exposure to HPV increases with having multiple sexual partners. Likewise, having a partner with numerous previous sexual contacts increases the risk. This factor is related to cumulative exposure over a person’s lifetime to HPV rather than to sexual activity per se.

4. Early Sexual Activity 

Before age 18, starting to have sexual intercourse increases one’s risk of cervical cancer because the developing cervix is more vulnerable to HPV infection and subsequent DNA damage. Due to the more exposed transformation zone during adolescence, the increased vulnerability of this area to carcinogenic agents is magnified. 

5. Other Sexually Transmitted Infections 

Different types of infections, including chlamydia, gonorrhoea, syphilis, and HIV, cause inflammation and break down local immunity, facilitating HPV persistence. It increases risk, mainly because HIV suppresses immune surveillance that would ordinarily clear HPV infections.

6. DES Exposure 

Women whose mothers took diethylstilbestrol (DES) during pregnancy are at increased risk of clear cell adenocarcinoma of the cervix. From the 1940s to 1971, this synthetic estrogen that was prescribed to prevent miscarriage was used to cause cellular changes that made people more vulnerable to cancer.

7. Long-term Oral Contraceptive Use 

Using oral contraceptives for more than five years increases the risk slightly of cervical cancer. The hormonal influence seems to help HPV cause cellular changes, although the risk is still low compared to the benefits for most women.

Symptoms of Cervical Carcinoma

As the disease is typically asymptomatic, screening is essential at this stage, mainly because the cancer is not clinically detectable. Symptoms only occur when the disease has progressed beyond the initial stages; when they do, they indicate that the disease has progressed.

• Bleeding: Bleeding after intercourse, post-menopausal bleeding or between menstrual periods may represent early-stage symptoms. 
• Longer Menstrual Cycles: Women may notice heavier or longer than regular menstrual cycles. A watery vaginal discharge with a strong odour (sometimes blood) also may occur. 
• Pelvic Issues: Unfortunately, many women have pelvic pain or discomfort during sexual intercourse, but that’s believed to be attributed to other conditions.
• Pain During Urination: Painful bowel movements that can be accompanied by rectal bleeding. The discomfort or difficulty urinating may become so severe that urination is painful or blood is present in the urine. 
• Backaches: A persistent dull backache may develop, which has no relation to physical activity. 
• Other Symptoms: Later stages of the cancer can be indicated by abdominal pain, leg swelling, and unexplained fatigue as the tumour progresses to surrounding tissues and organs. These symptoms usually indicate that the cancer has spread to nearby structures or lymph nodes.

Diagnosis of Cervical Carcinoma

Diagnosis of a cervical carcinoma begins with HPV or an abnormal Pap smear test. However, there are more tests conducted to confirm the presence of precancerous cells, which include:

1. Screening Tests 

Early detection of cervical cancer depends heavily on screening forms. The Pap smear test collects cervical cells to find abnormalities that indicate precancerous changes, and HPV testing identifies high-risk viral types that are linked to cancer development. Most providers recommend co-testing (testing for both combinations) for comprehensive screening, especially for women past 30.

2. Colposcopy 

If screening results are abnormal, colposcopy allows a magnified examination of the cervix to look for abnormal areas. The most common form of cervical cancer screening is an outpatient procedure using a colposcope, a specialised microscope with a bright light, to view cellular changes invisible to the naked eye and thus allow a physician to identify the most worrisome areas for biopsy. 

3. Biopsy Procedures 

Tissue samples collected from cervical biopsies are eventually brought for definitive diagnosis through microscopic examination. Punch biopsy of visible lesions; endocervical curettage for sampling of the cervical canal; LEEP (Laser Endometrial) for complete removal of a more extensive tissue; and cone biopsy for removal of a cone-shaped sample requiring deeper tissue analysis.

4. Advanced Imaging 

Imaging studies are used to determine the disease’s extent from the time cervical cancer is confirmed. Computed Tomography (CT) scans evaluate the spread to organs nearby, while MRI (Magnetic Resonance Imaging) shows more detailed soft tissue views. 

PET-CT (Positron Emission Tomography-Computed Tomography) scans measure metabolically active cancer cells throughout the body, which is helpful in finding distant metastases. 

5. Staging Process 

Also referred to as ‘disease extent staging,’ the process uses all of the diagnostic information to define disease extent, help choose a treatment approach, and predict prognosis. In modern staging, tumour size and depth of invasion, lymph node involvement, and distant metastases are considered, along with other factors, to achieve a comprehensive assessment with personalised therapy planning.

Treatment Options for Cervical Carcinoma 

Cervical Carcinoma is treated multidisciplinary using various treatment options that depend on the disease stage, tumour characteristics, patient age and fertility preferences. Surgical Interventions include:

• Conisation 

Conisation removes a cone-shaped tissue section containing the abnormal cells with minimal impact on fertility in early-stage microinvasive cervical carcinoma. This procedure serves a diagnostic and therapeutic purpose for women wishing to have future pregnancies.

• Radical Trachelectomy 

It is a fertility-sparing procedure that removes most of the cervix and the surrounding tissues and preserves the body of the uterus. Radical trachelectomy is a surgical option for select patients with early-stage cervical carcinoma who desire to retain their fertility and who should have oncologic outcomes at least equivalent to radical hysterectomy. 

• Hysterectomy 

Very early-stage carcinoma of the cervix can be removed with a simple hysterectomy, which means removing the uterus and cervix. Radical hysterectomy removes the uterus, cervix, and part of the vagina as well as the surrounding tissues in more advanced cases. This procedure often includes lymph node dissection for adverse effect studies and planning of adjuvant therapy decisions. 

• Radiation Therapy 

There are 2 types of radiation therapy: external beam radiation and internal radiation (brachytherapy). High-energy beams destroy cancer cells. Radiation is the standard primary treatment for locally advanced cervical carcinoma. 

If pathology has high-risk features, patients can receive adjuvant radiation after surgery. Image-guided techniques have greatly improved radiation precision by maximising tumour coverage and sparing surrounding healthy tissue.

• Chemotherapy 

Systemic drugs used to kill rapidly dividing cells are administered during chemotherapy. The management is primarily platinum-based (typically cisplatin) for cervical carcinoma. Chemotherapy may be given together with radiotherapy (chemoradiation) to maximise radiotherapy’s effect.

FAQs about Cervical Carcinoma

1. Can cervical cancer be cured? 

Early detection and treatment can make cervical cancer treatable and curable, and surgery or radiotherapy are the primary treatment options. 

2. What is the survival chance of cervical cancer? 

In 5 years after diagnosis, the overall 5-year relative survival rate for cervical cancer is about 67%. The rates are markedly higher (91%) and lower (60% and 19%) depending on whether the cancer is diagnosed early. The survival rate with advanced disease to distant organs is 19%.

3. How quickly does the cervical cancer spread? 

Cervical cancer begins to grow very slowly. If the cells in the cervix begin to change, it will take several years for the abnormal cells to become invasive cancer cells. In most cases, cervical cancer is found after age 50.

4. Is stage 4 cervical cancer curable?

At Stage IVB, cancer has moved to other parts of the body beyond the pelvis. In general, stage IVB cervical cancer is not considered curable.

5. What is the most appropriate treatment for cervical cancer?

Cervical cancer is treated most effectively by surgery (hysterectomy), chemotherapy, radiation, or in some cases, all of these therapies together.

Conclusion

Cervical carcinoma is one of the most significant health problems arising from HPV infection, with a known route from HPV infection to invasive disease. Regular screening remains the backbone of prevention, with leading indications offering increasingly effective treatments, from minimally invasive surgeries to advanced immunotherapies. 
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