CERVIAL CANCER

• Cervical cancer develops in a woman's cervix, which is the entrance to the uterus from the vagina
• Cervical cancer usually develops slowly over time
• Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue
• Cervical cancer is exclusively caused by infection with Human Papillomavirus (HPV)
• Types 16 and 18 of HPV have a higher risk of causing cervical cancer, while types 6 and 11 have a very low risk
• The most common type of cervical cancer is Squamous Cell Carcinoma, which develops from the cells in the ectocervix
• The rare type of cervical cancer is Adenocarcinoma or Mesonephroma, which develop in the glandular cells of the endocervix
• Globally, cervical cancer is the fourth most common leading cause of cancer death in women with an estimated 604,000 new cases and 342,000 deaths in 2020
• The highest rates of cervical cancer incidence and mortality rate are in low and middle-income countries
• Cervical cancer is caused by infection with human papillomavirus (HPV), with types 16 and 18 being the most common types that cause cervical cancer
• Even if a patient gets infected with HPV, 90% of HPV infections are cleared by the host immune system within two years of infection
• There are several different types of cervical cancer:

  • Squamous Cell Carcinoma: the most common type, accounting for up to 80-95% of cases
  • Adenocarcinoma or Endocervical Adenocarcinoma: the second most common type, accounting for approximately five to 20% of cases
• Risk factors for cervical cancer include sexual history, oral contraceptives, smoking, age, socioeconomic factors, family history of cervical cancer, and Diethylstilbestrol (DES) intake
• Signs and symptoms of cervical cancer include watery or bloody vaginal discharge, vaginal bleeding, changes in menstrual periods, difficulty or painful urination, diarrhea, fatigue, weight loss, backache, and pelvic/abdominal pain
• Cervical cancer is highly preventable and curable if caught early through HPV vaccination, routine cervical cancer screening, and appropriate follow-up treatment when needed
• Treatment options for cervical cancer include radiation therapy, chemotherapy, surgery, targeted therapy, and immunotherapy
• Prevention methods for cervical cancer include HPV vaccination, cervical cancer screening (Pap test and cervical test), condoms, and HPV vaccine
• The most common side effects of the HPV vaccine are usually mild and include pain, redness, or swelling in the arm, fever, dizziness, headache, nausea, muscle or joint pain
• Side effects of vaccination may include:

  • Pain, redness or swelling in the arm where the shot was given
  • Fever
  • Dizziness or fainting
  • Headache or feeling tired
  • Nausea
  • Muscle or joint pain
• Specimen collection methods:

  • Liquid-based method: involves transferring cells into a vial of preservatives for further processing in the laboratory. Allows easier interpretation, filtering of excess debris, and fewer unsatisfactory results. Can be used for cytology, HPV testing, and gonorrhea and chlamydia testing.
  • Conventional method: involves transferring cervical cells from the transformation zone directly to a slide and fixing the specimen. Specimen interpretation may be difficult with the presence of blood, discharge, and lubricant use.
• • Self-collection: preferred choice for women and has been shown to be as reliable as samples collected by healthcare providers
• Laboratory methods for cervical cancer diagnosis:

  • Colposcopy: identifies abnormal cells in the cervix using a colposcope inserted in the vagina
  • Biopsy: tissue sample removed from the cervix and viewed under a microscope for signs of cancer
  • Laboratory tests like CBC and Blood Chemistry Study to measure various substances in the blood
• Laboratory methods to confirm the agent:

  • Pap Smear (Pap Test)
  • Polymerase Chain Reaction (PCR)
  • In Situ Hybridization (ISH)
  • Immunohistochemistry (IHC)
  • DNA Hybridization
  • Transcription-Mediated Amplification (TMA)
• Patient characteristics and medical history:

  • Age: 54 years old
  • Menopausal status: Postmenopausal for 2 years
  • Medical history: 10 years of oral contraceptive usage, 20 years of smoking
  • Symptoms: progressive vaginal discharge with odor, vaginal spotting after intercourse, right back pain, right leg swelling
  • Physical Examination: 5cm irregular fungating mass arising from cervix
• Blood picture findings:

  • Hemoglobin (Hb) decreased due to long-term blood loss from vaginal spotting
  • Hematocrit (Hct) decreased showing anemia
  • White Blood Cells (WBC) slightly elevated indicating persistent inflammation
  • Platelets normal
  • Mean Corpuscular Volume (MCV) decreased due to microcytosis
  • Mean Corpuscular Hemoglobin (MCH) decreased due to chronic blood loss
  • Mean Corpuscular Hemoglobin Concentration (MCHC) decreased
  • Red Cell Distribution Width (RDW) increased indicating abnormalities in red blood cell size
• Koilocytes:

  • Squamous epithelial cells with structural changes due to HPV infection
  • Cells have an eccentric, hyperchromatic, and enlarged nucleus
• Irregular distribution of chromatin and prominent enlargement of the nucleus are signs of cervical cells being invaded by cancer cells

  • Keratinizing cells of the cervix with aberrant cells and fiber-shaped cells with condensed nuclei and spindle shape
• Human Papillomavirus (HPV)

  • HPV 1 - Associated with plantar warts
  • HPV 2 and 4 - Associated with common warts of the hands
  • HPV 6 and 11 - Associated with genital warts, oral and upper respiratory tract warts
• SURGERY


  Sometimes used to treat cervical cancer
• COLD KNIFE CONIZATION


  Uses a scalpel to remove cone-shaped piece of tissue from the cervix and cervical canal
• SENTINEL LYMPH NODE BIOPSY


  Removes the lymph node during surgery. If cancer cells are found, more lymph nodes will be removed through separate incision.
• TOTAL HYSTERECTOMY 


  Removes the uterus and cervix
• CHEMOTHERAPY


  Uses drugs to stop the growth of cancer cells
• IMMUNOTHERAPY


  Biomarker tests can be used to help predict the response to certain immunotherapy drugs
• HPV VACCINE


  Protects and prevents against genital warts and most cases of cervical cancer
• 11 TO 12 YEARS OLD


  Recommended ages for HPV caccine
• SPECULUM


  Inserted in the vagina to view cervix via coloscope
• COLOSCOPE


  Instrument the magnifies the area
• Progesterone is an endogenous steroid and progestogen sex hormone
• Progesterone


  Belongs to a group of steroids called progestogen, major progestogen in body