Cervical cancer is a type of cancer occurring in humans due to the abnormal growth of cells that arises in the cervix.

1. Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that
have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen.
Later symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse.
While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.
Cervical cancer is the third most common cancer worldwide and the fourth leading cause of
cancer-associated mortality in women. Accumulating evidence indicates that long non-coding
RNAs (lncRNAs) and circular RNAs (circRNAs) may play key roles in the carcinogenesis of
different cancers; however, little is known about the mechanisms of lncRNAs and circRNAs in
the progression and metastasis of cervical cancer. The complex ceRNA network also lays the
foundation for future research of the roles of coding and non-coding RNAs in cervical cancer.
Tomentosin , a natural sesquiterpene lactone purified from of Inula viscosa L., has anti-proliferative,
telomere shortening, and apoptotic effects on human cervical cancer HeLa and SiHa cell lines.
Tomentosin was found to inhibit the growth of SiHa and HeLa cell lines in dose and time-dependent
mannertomentosin mediate this cytotoxic effect by inducing apoptosis and cell cycle arrest at G2/M
phase. Tomentosin -induced apoptosis involve a mitochondria-mediated signaling pathway.
Types 1-4 of fibroblast growth factor receptors (FGFR) are all expressed in various cancers. FGFR-2
exists in two variants: IIIb and IIIc. FGFR-2 IIIb is mainly expressed in normal epithelial cells, as well as in
oral mucosal, esophageal, gastric, colorectal, pancreatic, pulmonary, breast, endometrial, cervical, and
prostate cancers. The IIIc variant of FGFR is expressed in mesenchymal cells, and during epithelial-
mesenchymal transition (EMT), is expressed in colorectal, pancreatic, bladder, cervical, and prostate
cancers.

3. CAUSES
It has been found that infection with the human papilloma virus (HPV) is the single most
important factor in the development of cervical cancer. This HPV is found in 99.99 percent of
women with cervical cancer. Hence, the phrase “no HPV, no cervical cancer”.
Other risk factors for the occurrence of cervical cancer include:
 Smoking
 HIV infection
 Multiple sexual partners
 More than five deliveries
 Early menarche i.e start of menstruation.
 Late menopause i.e cessation of menstruation
 Young age at first childbirth.

4.  Use of oral conceptive pills.
SYMPTOMS
cervical cancer may not produce no symptoms in the early stages.
Symptoms experienced by patients include:
 Vaginal bleeding which can occur on its own or from contact during sex.
 Foul smelling vaginal discharge
 Pain during sex
 Vaginal mass
In the advanced stages of cervical cancer, the patient may present with:
 Weight loss
 Loss of appetite
 Easy tiredness
 Low blood level (anaemia)
 Swollen legs
 Constipation
 Difficulty passing urine
 Back pain
 Hip pain
DIAGNOSIS
The diagnosis of cervical cancer is by the use of certain laboratory tests
which include:
 Pap smear: this is a screening test done to identify women with cervical cancer. It is
highly effective in doing this but it is not diagnostic of cervical cancer.
 Colposcopy: this is used to confirm cervical cancer. It is done by examining the cervix
with a microscope after it has been coated with chemicals.
 Examination under anaesthesia: this is done in the theatre under sedation. The cancer is
examined and the extent is determined. Also, a sample of it is taken for examination in
the laboratory. It helps to determine the stage of the disease.
 Both Pap smear and Colposcopy can identify women with precancerous changes
TREATMENT
Cervical cancer is one of the most common cancers among women worldwide. It is highly lethal
yet can be treated when found in early stage. Thus, early detection is of significant important for
early diagnosis of cervical cancer. The choice of treatment of cervical cancer depends on the
stage of the disease. In the early stages, treatment is by surgery. The surgery involves removal of

5. the entire womb including the cervix with or without part of the vagina. Some may require
treatment with radiation. In the advanced stages, a combination of the following is used:
 Treatment with radiation (radiotherapy)
 Treatment with toxic drugs (chemotherapy)
Surgery is not useful in the advanced stages. The precancerous stage can be treated by removing
the part of the cervix involved or removing the entire womb if the woman is no longer desirous
of child bearing.
Exosomes have been used as biomarkers in clinical diagnosis. Blood exosomes associated with
cervical cancer can be detected. ATF1 and RAS could be potential candidate biomarkers for
cervical cancer in early diagnosis. ATF1 and RAS genes were found significantly elevated in
tumours of primary and recurrent cervical cancer mouse model, and they were also detected in
the blood exosomes.
Among the clinicopathologic variables, vascular space invasion, histologic type, and tumor size
were verified as strong independent prognostic markers. High p53 protein levels were
associated significantly with markers for aggressive phenotype and survival, also in multivariate
survival analysis, but did not reflect TP53 mutational status.
PTX-NPs were prepared by a solid dispersion method using methoxy poly(ethylene glycol)-
poly(ɛ-caprolactone) (MPEG-PCL), which combined with RT exerted a potent and high efficient
effect against cervical cancer. PTX-NPs possessed a synergistic anti-tumor effect against cervical
cancer when combined with RT.
RH-AR was a safe, curative treatment for patients with recurrent or persistent cervical
cancer.
PREVENTION
Cervical cancer is one of the few preventable cancers. The single most important preventive
measure is to prevent infection with HPV. The best way to do this is to receive immunisation
against HPV. It can be administered between ages nine and twenty six years. However, it is best
given before a woman becomes sexually active as the vaccine is not effective after the person has
been infected with HPV.
As HPV is sexually transmitted, safe sexual practices should be encouraged. These
include:
Abstinence
Use of condoms
Faithfulness

6. Treatment of STIs
Also, regular Pap smear is recommended for all women to detect pre-cancerous changes and also
early stage of cervical cancer. It can be done from age twenty one. It is advised that at least one
Pap smear is done every three to five years before the age of 60 years in the absence of abnormal
results. Cervical cancer can easily be treated with minimal damage done to fertility if detected in
its pre-cancerous stage or even early stages of actual cervical cancer. As with most cancers,
deaths from late stages of cervical cancer is not uncommon. The increasing popularity of the Pap
smear has helped reduced the cases cervical cancer and deaths from it. It is relatively cheap and
can be done at several hospitals.
Cervical cancer can spread to other parts of the body in advanced cases.
Body organs to which the cancer can spread include:
 Lungs
 Abdomen
 Urinary system
 Digestive tract
 Bones
 Brain
1. PAP smears
Regular Pap smears are still the best way to prevent cervical cancer. Whether you are looking at
just having a Pap smear annually or as part of a broader screening program, we are confident that
we will be able to meet these needs comfortably.
Women who have regular Pap smears are at lowest risk for having cancer of the cervix.
Women who smoke have a higher risk of developing cervical cancer.
 Women who started having intercourse at a young age (younger than 16 years of age at
first intercourse) have a higher risk of developing cervical cancer.
 Being infected with high-risk HPV types for a long period of time can increase a
woman's risk of developing cervical cancer.

7. 2. HPV VACCINES
 HPV only infects humans and prefers to infect the skin cells of the genitals.
 There are some 200 sub-types of HPV.
 Only 15 of these 200 sub-types have been implicated in cervical cancer.
 HPV infection is very common in the general population.
 Most women (>95%) are able to clear this viral infection on their own without the need for
special vaccines or medicines.
 Only a very small percentage of women who are infected by HPV go on to develop cervical
cancer.

8. 3. Colposcopy
Most abnormal Pap smear reports will need to be verified by a simple procedure known as
colposcopy. Images of the cervix are stored digitally as a useful part of your medical record.
These digitally archived images will never fade and can be referred to at any time. This enables
our team of women's cancer specialists to track your progress and recovery and to ensure that
you continue to remain disease-free and well.
 Colposcopy is performed with the aid of a magnifying scope to allow the cervix to be
examined under good light and magnification.
 Colposcopy helps identify areas of the cervix that may undergoing pre-cancerous change
which can then be treated, thus preventing cancer from developing.
 Colposcopy has been around since the early 1920s and still remains one of the most
useful tools in detecting and preventing cervical cancer.
 That a dilute solution of acetic acid (otherwise known as vinegar) is used to help identify
areas of the cervix that have undergone pre-cancerous change.

9. Therapeutic options
Pre-cancerous changes of the cervix are easily treated. All the following options are available at
NUH and can be easily completed in the clinic or as a day surgery. These options include:
 Laser ablation. Where the pre-cancerous changes are completely removed using laser energy.
This can be easily done in the clinic without the need to be put to sleep or for general
anesthesia.
 Cold coagulation. Where heat is applied to the pre-cancerous areas of the cervix cauterizing and
destroying these abnormal areas on the cervix. This procedure is also easily performed in the
clinic.
 LEEP or Loop Electro-Excision Procedure. Where a powered loop device removes abnormal or
pre-cancerous areas of the cervix and cauterizes at the same time resulting in virtually no blood
loss.
 Laser conization
 Needle conization
 Cold knife conization
Prognosis
Here are some some quick facts about outcomes after cervical cancer and pre-cancer treatment.
 Having regular Pap smears effectively identifies when pre-cancerous changes are occurring on
the cervix.
 Pre-cancerous changes are easily and quickly treated in the specialist clinic.
 When pre-cancerous changes are effectively treated, cancer is prevented.
 Early stage cancer when treated, results in a better than 90% chance of completely being cured
of the disease.
 Late stage cancer of the cervix is still a very treatable condition and response rates are good
when both chemotherapy and radiation treatments are given.

10. CASE STUDY

11. REFERENCES
Yim, E.-K., & Park, J.-S. (2007). Biomarkers in cervical cancer. Biomarker Insights, 1, 215–225.
https://doi.org/10.1155/2007/678793
Society, A. C. (2016). Cervical Cancer What is cervical cancer ? American Cancer Society, 4–7.
Coleman, R. L., Keeney, E. D., Freedman, R. S., Burke, T. W., Eifel, P. J., & Rutledge, F. N.
(1994). Radical hysterectomy for recurrent carcinoma of the uterine cervix after
radiotherapy. Gynecologic Oncology, 55(1), 29–35. https://doi.org/10.1006/gyno.1994.1242
Halle, M. K., Ojesina, A. I., Engerud, H., Woie, K., Tangen, I. L., Holst, F., … Krakstad, C.
(2017). Clinicopathologic and molecular markers in cervical carcinoma: A prospective
cohort study. American Journal of Obstetrics and Gynecology.
https://doi.org/10.1016/j.ajog.2017.05.068
Lea, J. S., & Lin, K. Y. (2012). Cervical Cancer. Obstetrics and Gynecology Clinics of North
America. https://doi.org/10.1016/j.ogc.2012.02.008
Anorlu, R. I. (2008). Cervical cancer: the sub-Saharan African perspective. Reproductive Health
Matters, 16(32), 41–49. https://doi.org/10.1016/S0968-8080(08)32415-X
Ibeanu, O. a. (2011). Molecular pathogenesis of cervical cancer. Cancer Biology & Therapy,
11(3), 295–306. https://doi.org/10.4161/cbt.11.3.14686
Parsons, J. (2007). Preventing cervical cancer. Australian Family Physician, 36(3), 101.
https://doi.org/10.1038/nm0796-749
Waggoner, S. E. (2003). Cervical cancer. In Lancet (Vol. 361, pp. 2217–2225).
https://doi.org/10.1016/S0140-6736(03)13778-6
Moore, D. H. (2006). Cervical cancer. Obstetrics and Gynecology, 107(5), 1152–1161.
https://doi.org/10.1097/01.AOG.0000215986.48590.79
Canavan, T. P., & Doshi, N. R. (2000). Cervical cancer. American Family Physician, 61(5),
1369–76. https://doi.org/10.1097/01.AOG.0000215986.48590.79
WHO. (2014). Comprehensive Cervical Cancer Control. December 2014, 364. Retrieved from
http://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-
guide/en/%5Cnwww.who.int
Castellsague, X., Bruni, L., Alemany, L., Diaz, M., De Sanjosé, S., & Bosch, F. X. (2012). The
epidemiology of cervical cancer. In HPV and Cervical Cancer: Achievements in Prevention
and Future Prospects (Vol. 9781461419884, pp. 63–83). https://doi.org/10.1007/978-1-
4614-1988-4_4

12. Karjane, N., & Chelmow, D. (2013). New Cervical Cancer Screening Guidelines, Again.
Obstetrics and Gynecology Clinics of North America.
https://doi.org/10.1016/j.ogc.2013.03.001
Mark Schiff man, Philip E Castle, Jose Jeronimo, Ana C Rodriguez, S. W., & Lancet. (2007).
Human papillomavirus and cervical cancer. Lancet, 370(9590), 890–907.
https://doi.org/10.1016/S0140-6736(07)61416-0
Denny, L. (2011). Cervical cancer treatment in Africa. Current Opinion in Oncology, 23(5),
469–474. https://doi.org/10.1097/CCO.0b013e3283495a3f
Sundar, S., Horne, A., & Kehoe, S. (2008). Cervical cancer. Clinical Evidence, 2008(November),
1–2. https://doi.org/10.1016/S0140-6736(03)13778-6
Basen-Engquist, K., Paskett, E. D., Buzaglo, J., Miller, S. M., Schover, L., Wenzel, L. B., &
Bodurka, D. C. (2003). Cervical cancer. Cancer, 98(9 Suppl), 2009–2014.
https://doi.org/10.1002/cncr.11681
Denny, L. E. (2008). Prevention of cervical cancer. Reproductive Health Matters, 16(32), 18–31.
https://doi.org/10.1016/S0968-8080(08)32397-0
Castellsagué, X. (2008). Natural history and epidemiology of HPV infection and cervical cancer.
Gynecologic Oncology, 110(3 SUPPL.2). https://doi.org/10.1016/j.ygyno.2008.07.045