About cervical cancer

By: Michie Manlusoc, GCSOM, MBS 2019
Mentor: Darina Lazarova, PhD

After breast cancer, the second most common cancer to affect and kill women is cervical cancer. I know this to be true because on the morning of Thursday April 11, 2019 I was rushed to the emergency room for surgery to repair a vaginal tear that was causing extensive internal bleeding. To this day I am not sure how long I was in surgery, but when the general anesthesia wore off, I found myself lying face up on a hospital bed alone. IV’s and various machines were dangling from all my limbs and a urinary catheter bag was at my side. In the next moment I realized I was not alone when I caught a glimpse of the surgeon and another red headed doctor standing at the edge of my bed. Both of their faces looked gravely serious and then they spoke. That was the very moment I found out I had a rare aggressive cervical cancer that was causing the bleeding and I was to begin my cancer treatment the very next day. So indeed, I do know a little bit about cervical cancer from personal experience. My goal for writing this blog post is not only to educate people about cervical cancer. I wrote this to show others that just because you get diagnosed with a cancer does not mean you should give up and stop living your life.

First, let’s talk generally about cancer itself before plunging into cervical cancer, specifically. The word cancer comes from the Greek word for crab. When I got a CT PET scan, I remember looking at the pictures of my cervical tumor. It did look like a crab: a large central body with attached veins radiating outward. The veins around the tumor are dangerous because they are responsible for feeding the cancer so it can continue to grow, leeching nutrients from the host body. These veins also can provide a pathway for the cancer cells to travel to other parts of the body, spreading the cancer. This is called metastasis. The other thing about cancer that is scary is its ability to adapt and survive in many different cell types and tissues in the body. For that reason, there are many different cancers. The type of cancer a person has depends on both the cell or tissue it affects and in which organ.

In the case of cervical cancer, the cancer is located in the women’s lower region of the womb. This is the cervix. The cervix connects the womb to the birthing canal. There are two main types of cells in the cervix: squamous and glandular cells. The squamous cells are shaped like flattened fried eggs. They are located on the outer lining of the cervix near the vagina. The cervical glandular cells are deeper in the cervix and are shaped like long columns attached to a basement layer on one side. These cells make mucus. The mucus lubricates the cervix, vagina, and provides a layer of protection for the tissues so they do not get infected. The chance of getting cervical cancer increases when the cervix gets infected by HPV virus and a chlamydia bacterial infection. These infections damage the cervix and its tissues and can eventually grow into cervical cancer. Since both HPV and chlamydia are sexually transmitted, women can reduce their risk of cervical cancer by limiting the number of sexual partners they have and to also visit their gynecologist regularly for pelvic exams and Pap smears. The Pap smear is a test that can check to see if there is anything abnormal is going on within the womb.

Since there are two types of cervical cells, there are also two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Most patients with cervical cancer have squamous cell carcinoma which is good, in a sense, because it is more common, and the cancer treatment is more standardized. The other type, adenocarcinoma, affects only 10-20% of women with cervical cancer. It is more difficult to treat because it does not respond to radiation therapy as well as squamous cell carcinoma. There are other types of cervical cancer, but they are rare accounting for not more than 5% of cervical cancer cases. But I think it is important to mention these other rare types because these cervical cancers are found in younger women, spread the cancer faster around to other organs, and also kill more women quickly. I also mention this because my own cervical cancer was a rare type and I remember my medical oncologist telling me how lucky I was to have it diagnosed early. 
You might be thinking: how does a woman know if she might have cervical cancer? There are tell tale signs to look out for, namely: If you have spotting between your menstruation cycle and a heavier than usual period, bleeding after sexual relations, an overflow of watery smelly or thick vaginal discharge, pelvic pain, pain during sexual intercourse, feeling very tired or fatigued, lower back pain, and/ or frequent stomach aches. If you have a combination of these symptoms, especially the spotting, it would be wise to visit your doctor and get it checked. 

Cervical cancer treatment, like other cancers, is somewhat complicated because it depends on many different things such as the patients age, their current physical health, the cell type that has become cancerous, the size of the tumor(s), the location of the tumor(s), the stage of the cancer, and whether or not the cancer has stayed in one area or has travelled to other parts within the body. Early stage cervical cancer is generally treated by surgical removal of the tumor or removal of the cervix and/ or womb. Later staged cervical cancers, cancer with large tumors, or cervical cancer that has spread locally to lymph nodes are treated with a combination of external radiation, internal radiation (called brachytherapy), and chemotherapy, usually with a drug called Cisplatin. The number of treatments is customized to the patient and their condition by the radiation oncologist and medical oncologist.

My own cervical cancer treatment lasted for three months. It consisted of external radiation daily Monday through Friday, chemotherapy every Thursday, and six sessions of internal radiation. I also had 2-3 sessions of IV iron from becoming anemic from the cancer treatment that was supposed to help me get better. According to my doctor, I went through all the textbook side effects of cancer treatment with the exception of losing my hair. The two worst side effects of cervical cancer treatment were the chronic fatigue and everything I tried to eat tasted like metal and made me vomit. I felt nauseous and vomited nearly every day for three months. And the chronic fatigue was difficult because I was being treated for cervical cancer concurrently with completing my master’s degree and I could barely remember anything because I was too tired to stay awake or pay attention. But I made the best out of a bad situation and I endured. 
On Tuesday, June 11, 2019, I completed my last cervical cancer treatment. My cancer is in remission. Once I was a cervical cancer fighter and now, I am a cancer survivor. I completed my MBS and I begin medical school soon. Maybe one day I will become an oncologist. I certainly have firsthand experience with the complexities of cancer. I hope by reading this you learned a little bit of cervical cancer and a little bit about me. Thank you.