Cervical Squamous Cell Carcinoma, or CESC, is the most prevalent type of cervical cancer. It originates in the thin, flat cells, known as squamous cells, that line the outer surface of the cervix, which is the lower part of the uterus that connects to the vagina. This form of cancer accounts for the majority of cervical cancer diagnoses, with adenocarcinoma being a less common type that develops from different cells within the cervical canal.
Underlying Causes and Risk Factors
The development of nearly all cases of cervical cancer is initiated by a persistent infection with high-risk types of the human papillomavirus (HPV). HPV is a common virus transmitted through sexual contact, and while most infections are cleared by the body’s immune system, some high-risk strains can endure. HPV types 16 and 18 are identified as the cause of about 70% of cervical cancers, as the virus can alter cervical cells, leading to uncontrolled growth.
A persistent HPV infection can cause precancerous changes in the cervical tissue, a condition known as cervical intraepithelial neoplasia (CIN). While HPV is the primary cause, other factors increase the risk of the infection progressing to cancer. These factors create a more favorable environment for a persistent HPV infection to develop into CESC and include:
- Smoking, which damages the DNA of cervical cells and weakens the immune response to HPV.
- A compromised immune system from conditions like HIV or immunosuppressant medications.
- Long-term use of oral contraceptives in individuals with HPV.
- Having multiple full-term pregnancies.
Recognizable Symptoms
In its earliest stages, cervical cancer often produces no noticeable symptoms. Because the initial cellular changes are microscopic, the cancer can develop undetected until it grows larger and invades nearby tissue.
When symptoms do begin to appear, they often involve abnormal vaginal bleeding. This can manifest as bleeding between menstrual periods, after sexual intercourse, or after menopause. Menstrual periods may also become significantly heavier or last longer than is typical for the individual.
Another common sign is an unusual change in vaginal discharge, which might become watery, bloody, and potentially have a foul odor. As the tumor grows, it can cause discomfort in the pelvic region or pain specifically during sexual intercourse. Because these symptoms can indicate other conditions, their persistence warrants a medical evaluation.
Diagnostic and Staging Procedures
The Papanicolaou (Pap) test looks for precancerous cell changes on the cervix, while the HPV test specifically detects the presence of high-risk human papillomavirus DNA. These screenings can identify issues long before any physical symptoms emerge, making them important for early detection.
If a screening test yields an abnormal result, the next step is a colposcopy, which uses a magnifying instrument for a close-up view of the cervix. During the colposcopy, a biopsy is performed by taking a small sample of cervical tissue for laboratory analysis. A biopsy is the definitive method to confirm a diagnosis of cervical cancer.
Once a cancer diagnosis is confirmed, staging begins to determine the extent of the disease. Staging describes the size of the tumor and whether it has spread beyond the cervix. Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system, from Stage I (cancer confined to the cervix) to Stage IV (cancer has spread to distant organs). To accurately stage the cancer, imaging tests such as CT scans, MRI, and PET scans are used to visualize the tumor and check for metastasis.
Primary Treatment Modalities
Treatment for CESC is highly dependent on the cancer’s stage. For early-stage disease confined to the cervix, the primary approach is surgery. When preserving fertility is a consideration, options include a cone biopsy or a radical trachelectomy (removing the cervix but leaving the uterus intact). For other early-stage cases, a hysterectomy, the surgical removal of the uterus and cervix, may be recommended.
For locally advanced disease that has spread to nearby pelvic tissues, the standard treatment is combined radiation therapy and chemotherapy (chemoradiation). Chemotherapy drugs are used to make cancer cells more sensitive to radiation. Radiation therapy may involve external beam radiation, targeting the pelvic region, and brachytherapy, where a radioactive source is placed directly near the tumor.
Advanced or metastatic cancer is treated with systemic therapies that travel through the bloodstream. The main treatment is chemotherapy, often using a combination of drugs. Newer treatments include targeted therapy, which attacks specific vulnerabilities in cancer cells, and immunotherapy, which helps the body’s immune system recognize and attack the cancer.