Stages of cervical cancer- Types

What is Cancer staging?

Cancer staging is the process of determining the spread of Cancer. The stage of Cancer helps the doctor determine the spread of Cancer to other organs and how it can be controlled.

It also helps determine the survival rate, the treatment and suggestions for any new drugs. The staging of Cancer depends on the following information.

• The location of tumour/Cancer in the body.
• The size of the tumour/Cancer.
• The spread of Cancer/tumour to nearby organs.
• The grade of tumour—the abnormal cells, its growth and spreading rate.

The staging system followed by the National Cancer Institute is the TNM staging system. The TNM staging system is mostly used by many hospitals.  

The TNM staging system is explained below.

The T explains the size and the extent of the tumour. It usually refers to the main tumour or the primary tumour.

The N denotes the lymph nodes that have been affected by Cancer.

The M denotes metastasis—The tumour from the primary affected organ has spread to other organs or parts of the body.

When the stages of Cancer are described using the TNM system, there will be numbers after each letter. For example, —T3N1M0 and T1N0MX.

• The TX denotes that the main tumour cannot be measured.
• T denotes that the main tumour cannot be found.
• T1, T2, T3 and T4 denote the size of the tumour and the extent to which the tumour has grown. The larger number denotes the growth and severity of the tumour. Further details can be provided with numbers and alphabets like T2a and T4a.

Types of Cervical Cancer

Cervical Cancer usually starts in the cervix and the cells lining the cervix and the lower part of the uterus. When the cells in the cervix start to grow uncontrollably, Cancer occurs and spreads to other parts.

The types of Cervical Cancer are squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma

The cells covering the outer surface of the cervix, which are flat and skin-like, are called squamous cells. The abnormal growth of these cells causes Cancer.

Squamous cell carcinoma occurs in the outer part of the cervix and projects into the vagina. Most cervical cell Cancers are squamous cell carcinoma. Squamous cell carcinoma develops from the exocervix.

Adenocarcinoma

Adenocarcinoma is a type of Cancer that occurs in the glands that produce mucus. Adenocarcinoma is less common when compared to squamous cell carcinoma.

The cervix contains a passage that has glandular cells and is scattered throughout the passage called the endocervical canal.

The commonly affected organs of adenocarcinoma are the prostate, breast, lungs, stomach, oesophagus and colon or rectum. These adenocarcinomas can outgrow and infect other organs like lungs, brain, bone and bone marrow.

Stages of Cervical Cancer

The stages of Cancer help to determine the treatment for the affected patient. Also, it determines the severity of Cancer.

The stages of Cancer are denoted by stage 1-stage 4. Stage 0 is the precancerous stage and is also called carcinoma in situ.

Stage 0 has three types local, regional and distinct. Regional denotes the spread of Cancer to other organs close to the cervix, vagina and pelvis.

Local denotes that Cancer did not spread to other organs and is only present in the cervix. Distant denotes the spread of Cancer from the cervix to other organs and outside of the pelvis.

The early stage of Cancer is denoted by stage 1, and the locally advanced stage is denoted by stage 2 and stage 3. The advanced stage of Cancer is denoted by stage 4. The stages of Cervical Cancer are briefed below.

Stage 1

In stage 1, the tumour is present only in the cervix and is not spread to other organs. Stage 1 Cancer will only be visible through a microscope. The tumour is less than 4 cm.

Stage 2

In stage 2 of Cervical Cancer, the tumour would have grown outside the cervix but not more than the walls of the pelvis or the lower part of the vagina.  

The tumour would have also outgrown the uterus. Mostly, in stage 2 of Cervical Cancer, the tumour size would be more than 4 cm.

Stage 3

In stage 3 of cervical Cancer, the Cancer would have spread to the pelvic wall and vagina. The grown tumour sometimes blocks the ureter, which can cause an enlarged kidney called hydronephrosis.

Stage 4

As the number increases, the severity of the Cancer increases. Stage 4 of cervical Cancer is also called distant metastasis. Cancer would have spread to distant organs like the brain, lungs, bone and bone marrow.

Symptoms of Cervical Cancer

The symptoms of Cervical Cancer are elaborated below.

Vaginal bleeding

In advanced Cervical Cancer, patients affected may experience vaginal bleeding. The vaginal bleeding may occur after intercourse or after menopause.

Sometimes, menstruating women may experience heavy bleeding, pain during intercourse and unexplained pelvic or back pain.

Unusual vaginal discharge

Unusual vaginal discharge is another prominent symptom of Cervical Cancer. Watery vaginal discharge with an odour may also denote Cervical Cancer. However, sometimes an underlying health condition may also result in such symptoms.

Pelvic pain

Pelvic pain may denote an advanced stage of Cancer. Prolonged pain should be immediately considered under medical treatment.

Pain during sexual intercourse

Pain during sexual intercourse or bleeding after intercourse also denotes that a person is affected by Cervical Cancer.

Diagnosis of Cervical Cancer

Early diagnosis helps to prevent Cancer from spreading to other organs and are easy to treat. For some people, the symptoms may occur early, and the diagnosis occurs.  

But in most cases, the symptoms show up for many days or when Cancer has reached its advanced stage. The list of diagnostic tests is given below.

Pap test

A pap test is also called as a pap smear. The test collects a sample of cells from the affected person’s cervix and surrounding organs like the uterus and cells from the top of the vagina. This test is mostly done for women.

A pap smear test helps to identify the changes in the cervical cells and also detect any formation of Cancer cells. Diagnosis of the abnormal cells is the first stage of preventing Cancer.

HPV DNA test

An HPV DNA test is a test to detect human papillomavirus. The virus spreads through sexual contact. People infected will not exhibit any symptoms. However, they will be able to spread the infection to others.

The human papillomavirus falls under two categories—high risk and low risk. Low risk causes no disease, and the HPV DNA test is not recommended for the low-risk disease as they will be visible through the naked eye.

The test will be done with the patient lying on a table with the patient’s feet placed in a stirrup. The professional will place an instrument in the patient’s vagina.  

The instrument will help to open the vagina a little, and the professional can see the cells inside. The cells will be collected gently, and then they will be sent for further processing.

The test will check for the genetic material of the virus. The HPV DNA test will also detect the specific strain that causes Cancer.

Punch biopsy

A punch biopsy uses a sharp material to remove a small piece of the skin. The punch biopsy consists of a hollow, circular and sharp instrument.

The removed tissue from the skin will be checked under the microscope for any signs of abnormal cell growth or disease.

The skin will be removed from areas like the cervix, skin and vulva. The procedure takes about 15 minutes to complete.

Imaging tests

Imaging tests like X-ray, CT scan, MRI and positron emission tomography (PET) are used to detect cervical Cancer in patients. It also helps to identify any abnormal growth in cells.

The imaging tests give a clear view of the spread of Cancer and the metastasis of Cancer.

Treatments of Cervical Cancer

The treatment differs from one person to another and also on the stage of Cancer. The early the diagnosis, the higher chances of cure. However, if Cancer has reached an advanced stage, there will be no cure, and it requires treatment throughout life.

Surgery

The doctor will recommend two types of treatment. Ablation is a procedure to destroy Cancer cells at cold temperature or with the help of a laser. This will not require any surgery.

Cryosurgery is a type of ablation technique. The technique uses a cold metal probe that will be placed directly on the cervix to destroy the abnormal cells. The cold metal will freeze the abnormal cells and kill them.

Cryosurgery is used to treat cervical intraepithelial neoplasia (CIN). After the surgery, the patient might experience a watery brown discharge for a few weeks.

Laser ablation is a technique that focuses a laser beam directly on the abnormal cells. The laser beam will be sent through the vagina, and the cells will be vaporised.

The laser ablation will be performed with the patient being administered with general anaesthesia. This technique is also used to treat cervical intraepithelial neoplasia.

The other procedure will be excision. Conization is a procedure to remove the precancerous cells. The surgeon will remove abnormal cone-shaped cells from the cervix. The tissues removed will be the precancerous cells and Cancer cells.

This will stop Cancer cell’s growth and prevent them from regrowing. The treatment has a success rate as it can remove the Cancer cells completely.

Radiation therapy

Radiation therapy uses high-energy x-ray beams to kill the Cancer cells and is administered to patients depending on the Cancer stage. Sometimes, it is also given as a part of surgery to remove the cells that cannot be removed through surgery.

Sometimes, patients might require only radiation therapy to kill the Cancer cells. The two types of radiation therapy used to treat Cervical Cancer are— external beam radiation and brachytherapy.

External beam radiation involves high-energy x-ray beams from a machine. The energy will be directed at the Cancer cells outside the body. This procedure is mostly painless.

Brachytherapy or internal radiation therapy provides high-energy beams near the Cancer cells. The brachytherapy only travels a short distance.  

The radiation source is placed near the vagina, and the high-energy beams are passed. Brachytherapy is mostly used in combination with external beam radiation, and in rare cases, it is administered all alone.

Chemotherapy

Chemotherapy is administered through the vein or mouth. The chemotherapy drugs enter the bloodstream once administered. These drugs will circulate throughout the body and kill the Cancer cells present in the body.

Patients with Cancer in the advanced stage will be administered radiation and chemotherapy together. This treatment is called concurrent chemoradiation.

Chemotherapy is also used when Cancer comes back and spreads to other organs.

Some of the common chemo drugs used are  

• Cisplatin
• Paclitaxel
• Topotecan and  
• Carboplatin

Targeted therapy

Targeted therapy uses drugs that specifically target the Cancer cells and the proteins that help these Cancer cells to grow, spread and multiply at an increased rate.

Examples of targeted therapy include monoclonal antibodies. These antibodies control the growth of Cancer cells and suffocate them without food ending up killing the Cancer cells.

The targeted therapy also helps to improve immune function and boosts the immune system. Bevacizumab is an angiogenesis inhibitor that inhibits the protein VEGF (vascular endothelial growth factor).  

The VEGF protein helps in the formation of new blood vessels. The bevacizumab drugs inhibit the formation of new blood vessels and block the tumour from growing.

Immunotherapy

Immunotherapy is given to patients to boost their immune system. By doing this, the immune system will identify the Cancer cells effectively and kill them during the early stages.

Immunotherapy concentrates on the proteins that enhance the immune system. Monoclonal antibodies are also used in immunotherapy.  

The monoclonal antibodies block a protein on the Cancer cells that helps to mask itself from the human immune system. When the protein is blocked, the immune cells will easily identify and kill the Cancerous cells.

When to see a doctor?

Keep a check on your health. If you have any abnormal symptoms, consult your doctor immediately. If you have any symptoms listed below, you might require immediate medical attention.

• Vaginal bleeding,
• Bleeding after intercourse,
• Vaginal discharge with a foul smell,
• Pain during intercourse,
• Bleeding or blood spots after menopause and  
• Severe back pain or pelvic pain.

Conclusion

Cervical Cancer may be caused due to human papillomavirus. The human papillomavirus spreads through skin-to-skin contact and oral sex. This virus can cause Cervical Cancer.

Besides the human papillomavirus, Cervical Cancer can be caused due to smoking and HIV infection. The treatment for Cervical Cancer depends on the stage of Cancer and can be cured with early diagnosis.

With improved medical facilities, Cervical Cancer can be controlled, and people affected with Cervical Cancer lead a happy life with proper treatment.  

FAQs