Carcinoma of Cervix

Overview of Carcinoma of Cervix

The cervix is the most common site for female genital cancer. Among women dying from malignant disease of all kinds, the cervix is the organ primarily involved in 5%. Statistics vary considerably from country to country and from race to race.

So, in African and Asian women living in poor conditions the incidence and relative mortality rate of carcinoma of the cervix may be four or five times higher than those seen in developed countries. With the modern shifts in populations and migrations, the extent of the problem may fluctuate in the same area from time to time.

Ratio:

It used to be said that for every case of carcinoma of the endometrium there are three or four of invasive carcinoma of the cervix.

But in western communities this is no longer true and the ratio is approaching 1:1. One explanation of this is that more women are living to a later age which gives them more chance of developing carcinoma corporis.

Cancer cervix is the most common cancer in women of the developing countries where screening facilities are inadequate.[1]

Causes of Carcinoma of Cervix

Social and Economic Factors i.e.: –                                            

• women living in poor conditions, with a low income and indifferent education.
• Invasive carcinoma of the cervix is 20 times more common amongst the wives of unskilled laborer’s than it is in those of professional men.

The possible operating factors are i.e.: –

• Low standards of cleanliness
• Coitus or marriage at an early age
• Frequency of sexual intercourse
• Promiscuity of both partners 

Coitus i.e.: –

• The sexually active woman is 2–4 times more likely to develop cancer of the cervix than is the sexually inactive woman.
• The earlier the age of first intercourse, the more the partners, and the more promiscuous the partners, the greater the risk.
• To account for the relationship of cervical cancer to sexual activity, it was once postulated that smegma lying beneath the prepuce of the male phallus is carcinogenic, and this concept was linked with the possible protection offered by circumcision and the increased danger due to poor hygiene.
• Yet smegma was never shown to be carcinogenic, and the male phallus exposed to it continually did not develop malignant disease.

Childbearing i.e.: –

• Invasive cancers occur in multipara.
• High parity means frequent coitus during many years, starting at a young age, and is often associated with poor socioeconomic conditions.

Cervical Irritation and Infection i.e.

• Cervical trauma,
• Chronic cervicitis and ectopy

 Oestrogen i.e.                              

• While excessive and unbalanced oestrogen stimulation favours the development of cancer of the cervix.
• the disease occurs commonly after ovarian activity has ceased — even after surgical removal of both ovaries.

 Predisposing Histological States i.e.

• Certain histological changes in the cervix which have alleged to be “precancerous”, or which sometimes confused with cancer, include basal cell hyperplasia, squamous cell metaplasia and CIN. Of these, only CIN II-III are likely to be significant forerunners of invasive carcinoma.

Squamous Cell Carcinoma i.e.

• Squamous cell carcinoma usually starts in the area of the squamous-columnar junction (transformation zone) as described above. Occasionally, however, it arises in the endocervix, sometimes deep to the lining.
• Even if not all squamous cell growths begin in reserve cells, those developing in the endocervix almost certainly do. Squamous cell carcinoma of the cervix seen in the micro invasive and invasive forms.
• Some invasive cancers of the cervix are hypertrophic or exophytic, producing a cauliflower-like mass; others are mainly eroding and ulcerative or infiltrative an early growth can simulate an erosion. The squamous cell carcinoma has histological features similar to those of an epithelioma in any site except that pearl formation is unusual.

Proportion

• About 20% of the tumours of the well-differentiated type (often known as “large cell keratinising tumours”). Moderately differentiated tumours (large cell nonkeratinizing tumours) constitute about 60% of the total. The remaining 20% are poorly differentiated (small cell non keratinising tumours).
• However, biopsies taken from different areas of the same tumor often show different degrees of differentiation and different predominant cell types. Two distinctive histological variants of cervical squamous cell carcinoma merit mention; some, usually of the well differentiated type, have cells which contain abundant glycogen and thus appear as “clear” cells, whilst occasionally the poorly differentiated tumours assume a spindle-shaped cell form and so resemble a sarcoma.[1]

Types of Carcinoma of Cervix

Cervical cancers and cervical pre-cancers are classified by how they look in the lab s with a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma

• Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the exocervix.
• Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).

Adenocarcinomas

• Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from glandular cells.
• Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix.(6)

Risk factor of Carcinoma of Cervix

A risk factor is anything that increases a person’s chance of developing cancer.

Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.

The following factors may raise the risk of developing cervical cancer:

Human papillomavirus (HPV) infection:

• The most important risk factor for cervical cancer is HPV. HPV is a common infection. Most infections occur after people become sexually active, and most people clear the virus without problems.
• There are over 100 different types of HPV. Not all of them are linked to cancer. The HPV types, or strains, that are most frequently associated with cervical cancer are HPV16 and HPV18.
• Starting to have sex at an earlier age or having multiple sexual partners puts a person at higher risk of being infected with high-risk HPV types. HPV vaccines can prevent people from developing certain cancers, including cervical cancer.

Immune system deficiency:

• People with a lowered immune system have a higher risk of developing cervical cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, treatments for other types of cancer, or from the human immunodeficiency virus (HIV), which is the virus that causes acquired immune deficiency syndrome (AIDS).
• When a person has HIV, their immune system is less able to fight off early cancer.

Herpes:

• People who have genital herpes have a higher risk of developing cervical cancer.

Smoking:

• People who smoke tobacco are about twice as likely to develop cervical cancer compared with people who do not smoke.

Age:

• People younger than 20 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s.
• People past this age group remain at risk and need to have regular cervical cancer screenings, which include a Pap test and/or an HPV test.

Socioeconomic factors:

• Cervical cancer is more common among groups of people who are less likely to have access to screening for cervical cancer. Those populations are more likely to include Black people, Hispanic people, American people, and people from low-income households.

Oral contraceptives:

• Some research studies suggest that oral contraceptives, which are birth control pills, may be associated with an increased risk of cervical cancer and may be associated with higher-risk sexual behavior.
• However, more research is needed to understand how oral contraceptive use and the development of cervical cancer are connected.

Exposure to diethylstilbestrol (DES):

• People whose mothers were given this drug during pregnancy to prevent miscarriage have an increased risk of developing a rare type of cancer of the cervix or vagina.
• DES was given for this purpose from about 1940 to 1970.
• People exposed to DES should have an annual pelvic examination that includes a cervical Pap test as well as a 4-quadrant Pap test, in which samples of cells are taken from all sides of the vagina to check for abnormal cells.(4)

Pathophysiology of Carcinoma of Cervix

High risk strains of HPV, mainly HPV types 16 and 18 had been identified as a potent cause of cancer of cervix. HPV plays main role in pathogenesis of cervical cancer and it is widely related to disrupting cell cycle growth and regulations, summary of these include:

• The high risk HPV E6 and E7 gene products which are involved in viral replication and oncogenesis bind to p53 and prevents its normal activities which is G1 arrest, apoptosis, and DNA repair.

• HPV enters the host cell which are squamous cells of epithelium in cervix, mainly in the junctional zone, between the columnar epithelium of the endocervix and the squamous epithelium of the ectocervix and that is how viral transcription and replication begins.
• HPV infection of the basal layer of epithelium takes place by attachment via different mechanism of entry, this happens by cell surface heparan sulfate, stabilizing proteoglycans and Integrin.

There are other cofactors that cause progression of cervical neoplasia, some of these include:

• HLA type
• Immunosuppression, since response to HPV infection is cell mediated.
• Use of oral contraceptives had been identified to play an important role in
• Smoking which disrupts immune response.
• History of promiscuous sexual activity in male partner
• Early age sexual activities
• Co-infection with herpes simplex virus type 2, cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), and HHV-7, which cause promotion of infection with HPV and plays an initiation role.(5)

Clinical Features 

Spreading of Carcinoma of Cervix

• By this mechanism the growth spreads to the body of the uterus, the vaginal wall, the bladder, and the cellular tissues of the broad and uterosacral ligaments. Direct invasion of the rectum is rare because the pouch of Douglas intervenes.
• In the broad ligament the growth surrounds and constricts the lower ends of the ureters but does not invade them. Similarly, when it reaches the pelvic wall and the sacral plexus, it causes sciatic pain but the nerves and their sheaths are never demonstrably penetrated.

Lymphatic Permeation and Embolism i.e.

• Spread by the lymphatics in the bases of the broad ligaments and in the uterosacral ligaments is an early feature, the nodes most commonly involved being the obturator, external iliac and those at the bifurcation of the common iliac vessels. Others are the internal iliac, common iliac, sacral and ultimately the para-aortic nodes.

Bloodstream i.e.

• This route much less frequently use but embolic metastases are occasionally seen in the ovary, brain, bones and lungs.
• The occurrence of distant metastases without simultaneous involvement of the lungs explain by the transfer of cancer cells by the vertebral venous plexus [1]

Sign and symptoms of Carcinoma of Cervix

Women with early cervical cancers and pre-cancers usually have no symptoms.

Symptoms often do not begin until the cancer becomes larger and grows into nearby tissue.

The most common symptoms i.e.

• Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, or having (menstrual) periods that are longer or heavier than usual. Bleeding after douching may also occur.
• An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
• Pain during sex
• Pain in the pelvic region

Signs and symptoms seen with more advanced disease can i.e.:

• Swelling of the legs
• Problems urinating or having a bowel movement
• Blood in the urine.[3]

Clinical examination of Carcinoma of Cervix

Physical examination of patients with early cervical cancer is usually unremarkable. However, patients with advanced cancer may have the following findings:

Appearance of the patient

• Patients with cervical cancer are Lethargic and pale

HEENT

• Lymphadenopathy

Skin

• Pallor

Abdomen

• Discomfort on palpation

Pelvic exam

• Vaginal bleeding
• Cervical mass

Extremities

• Pedal edema (5)

Diagnosis of Carcinoma of Cervix

• Cervical Biopsy-

The diagnosis can only made for certain by microscopic examination of cervical tissue. The site of biopsy is usually clear when the disease is clinically evident.

• Cytodiagnosis-

Although the findings on routine Cytodiagnosis can a means of stimulating the investigation which reveals an early symptomless invasive carcinoma, cytology is not a diagnostic method.

• Colposcopy and Colpomicroscopy-

These techniques can, in the hands of experts, reveal cancer which is not apparent to the naked eye. The diagnosis, however, still has to be confirmed by biopsy, so their chief value is to indicate the sites from which tissue can most profitably be taken for histological examination. [1]

Complication of Carcinoma of Cervix

• Pyometra
• Vesicovaginal
• Vesicocervical fistulas
• Rectovaginal fistula
• Hydro nephrosis and Pyonephrosis
• Uraemia [1]

Treatment of Carcinoma of Cervix

1] Cervical Screening

• Data from many countries have shown that screening with cervical cytology reduces the incidence and mortality from cervical cancer.
• The purpose of a cervical screening programme is to reduce the incidence and mortality of cervical cancer.
• Cervical cytology is the most used method of screening.

2] Screening Guidelines

• This depends on the particular age distribution of deaths from cervical cancer and may be “country specific”. Deaths from cervical cancer are rare before age of 25 years.
• Women can be discharged from the screening programme at the age of 65 if they have had two negative smears in the previous 10.

3] Refer for colposcopy:

For moderate or severe dyskaryosis, query invasive disease or query glandular neoplasia.

• Pap smear has reduced the incidence of cervical cancer by nearly 80 percent and death by 70 percent. Cervical cancer is an entirely preventable disease as the different screening, diagnostic and therapeutic procedures are effective. [1]

Prevention of Carcinoma of Cervix

• One of the easiest ways to prevent cervical cancer is by getting screened regularly with a Pap smear or hr HPV test. Screening picks up precancerous cells, so they can be treated before they turn into cancer.
• HPV infection causes most cervical cancer cases. The infection is preventable with the vaccines Gardasil and Cervarix. Vaccination is most effective before a person becomes sexually active. Both sexes can be vaccinated against HPV.
• Limit the number of sexual partners you have
• Always use a condom or other barrier method when you have vaginal, oral, or anal sex. (7)

Homeopathic Treatment of Carcinoma of Cervix

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Carcinoma of Cervix:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicine of Carcinoma of Cervix

Calc flour

• Either Hard, or firm, growths indicate as the constitutional salt needed.
• remedy is highly efficacious in restoring the lost elasticity of smooth muscles also remove hard tumors of any smooth muscle.
• Uterus, being a smooth muscle organ, is a main target of action of this remedy.
• Moreover, if uterine fibroid with bearing down pains are presented, this remedy could cure the case.
• Specifically for stony hard glands of the breasts are the marked
• Knotted feel over the breasts with deep seated indurated glands that threaten to suppurate are the other features.

Conium

• Especially when Ulceration based on cancerous diathesis.
• Cancerous swelling of stony hardness. Additionally Sharp, stitching pains; usually painless.
• Indicated in tumors with tearing pains at night.
• Patient suffers from chronic ulcers with fetid discharges.
• Conditions that develop generally in old age, bachelors also older people spinsters.
• It is a remedy for any kind of tumors including uterine fibroid that are caused by suppression of unsatisfied sexual desire, either from excessive indulgence or from effects of some sort of injury.

Condurango

• Syphilitic conditions may be compared with the power of Condurango over cancer.
• Moreover, Cancerous tumours or ulcers with painful crack. Breast cancer; nipple so retracted as to be invisible.
• Some small congenital warty excrescences enlarge and look fresh. Besides this, Blotches, pimples, and boils in many parts.
• Condurango has found its chief use as a cancer remedy, especially in cancers originating in epithelial structures.
• Rhagades at muco-cutaneous orifices and warty excrescences are a leading indication for it.
• Cutting, stinging, burning, tingling, constrictive, also piercing pains

Hydrastasis

• Cancers are hard, adherent; skin mottled, puckered.
• Indicated in old tired people with severe debility.
• Cancer of breast, with pain like knives thrust into parts.
• Cancer of stomach; vomits everything except water also milk; emaciation.
• Cancer of tongue, of liver.
• The remedy for tumours in the breast with retracted nipples and cancerous formations on skin that is very unhealthy.

Kali Sulph

• Yellow, thin discharges, skin cancer.
• For those who are better in the cool, or cold, open air.

Lapis Alb

• Repute in uterine cancer.
• Cancer of breast.
• With burning, shooting, stinging pains.
• When ulceration has not set in also associated with scrofulosis (in other words, glands not hard but to a certain extent elastic and pliable).
• Discharge horribly offensive.

Secale Cor

• Inflammation and cancer; vomiting of food with great debility; burning.
• Especially when Cancer and gangrene of uterus; offensive discharge from uterus causing her vomit.

Silicea

• Generally, For those who are generally chilly and seek the warmth.
• It generally held that cancers are incurable by medicine, but their growth may modified, or arrested, by the right medicine.

Diet & Regimen of Carcinoma of Cervix

• Maintaining a diet rich in fruits and vegetables
• High levels of carotenoids
• Foods high in folate like legumes, whole grains, fruits, and vegetables
• Avoiding multiple sexual partners
• Vaccinating both children for HPV [1]

Terminology

Carcinoma of the Cervix (Cervical Cancer):

A type of cancer that originates in the cells of the cervix, the lower part of the uterus that connects to the vagina.

HPV (Human Papillomavirus):

References

1. Jeffcoate-s_Principles_of_Gynaecology_(8th_edition)
2. The Bhanja Homoeopathic Prescriber By K. C.
3. cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/signs-symptoms.html
4. https://www.cancer.net/cancer-types/cervical-cancer/risk-factors
5. https://www.wikidoc.org/index.php/Cervical_cancer_pathophysiology, clinical examination
6. https://www.cancer.org/cancer/cervical-cancer/about/what-is-cervical-cancer.html
7. https://www.healthline.com/health/cervical-cancer#prevention
8. The George Institute
9. Apollo Diagnostics
10. WHO Country Profile 2021
11. Robbins & Cotran Pathologic Basis of Disease, 10th Edition by Vinay Kumar, Abul K. Abbas, and Jon C. Aster (2021)
12. Comprehensive Gynecology, 7th Edition by William’s Gynecology (2017)

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