Cervical Cancer

What is cervical cancer ?

It refers to the cancer of the uterine cervix i.e; the lower part of the uterus which extends slightly into the top of the vagina.

How common is the cervical cancer?

Cervical cancer is the most common cancer in Indian women and second most frequent cancer in worldwide. Every year about 1.3 lakh new cases of cervical cancer are diagnosed in our country and about 74,000 women die of this disease.

CERVICAL CANCER : WHAT ARE THE RISKS AND SYMPTOMS :

Cervical cancer often occurs at the ages of 40 and 55 ages. Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue.

  • A cervical tumour usually starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear which multipies ‘out of control’.
  • The initial pre – cancerous’ abnormality of cervical cells is usually caused by a prior infection with the Human Papilloma Virus.

Risk factors :

  • Multiple sexual partners
  • Personal history of persistent sexually transmitted viruses such as herpes infection or human papillomas virus ( HPV )
  • A weakened immune system
  • Smoking
  • Unsupervised Long term use of oral contraceptives

WHAT ARE THE WARNING SIGNS AND SYMPTOMS ?

Very early-stage cervical cancer may have no symptoms. This means it’s important to attend regular cervical screening|, so that any cell changes can be picked up early.

  • Contact spotting or bleeding
  • Increased / blood stained vaginal discharge
  • Abnormal bleeding between menstrual periods or excessively heavy periods
  • Post menopausal vaginal bleeding

Consult a specialist immediately if you experience any of the above symptoms though these may be present in conditions other than Cancer Cervix.

Preventing cervical cancer

Regular screening| is the best way to reduce the risk of cervical cancer.

  • Primary prevention : HPV vaccines have the potential for preventing cervical cancer. Routine vaccination with proper counseling is recommended for the female ages 11 to 26. Please consult your gynecologist and understand the risk and benefits.
  • Secondary prevention : By diagnosing and optimally treating the precancerous conditions of cervical cancer.

Cervical screening

This is an important way of detecting early changes in cells of the cervix so that treatment can be given to prevent a cancer developing. It involves taking a sample of cells from the cervix using a test known as a liquid-based cytology..

If abnormal cells are found during your cervical screening test, you will be referred for a colposcopy to have a biopsy taken.

HPV

  • The human papilloma virus is a common virus. More than 100 different types of HPV have been identified and each is known by a number. HPV affects the skin and the mucosa (the moist membranes that line the body, such as the insides of the mouth, throat, anus and cervix).
  • Some types of HPV cause harmless skin warts (papillomas) that can appear on the hands and feet. Types 6 and 11 affect the genital area and can cause genital warts, but they don’t cause cervical cancer. These types are called low-risk HPV.
  • Other types of HPV are known to increase the risk of developing particular cancers and are referred to as high-risk HPV. HPV infection of the cervix is mainly diagnosed in women as a result of the cervical screening programme|. A woman may be told she has HPV when she receives her cervical screening result. If HPV infection is present, changes in the appearance of the cells can sometimes be seen when they are looked at under a microscope during the screening process.

Some women who have an abnormal smear test result will attend a colposcopy clinic, where their cervix will be examined using an instrument like a microscope (a colposcope). During the examination, the nurse or doctor can apply a solution to the cervix that makes cells infected with HPV turn white. Most women have HPV at some point in their lives without it causing any harm. There is no treatment for HPV, but our own immune systems can usually get rid of it quickly by themselves. The most important thing women can do is have regular cervical smear tests. These will pick up any abnormal cell changes, which can be easily treated before they develop into cancer.

Assessment for cervical cancer

Cancer of the cervix can be treated with either surgery, radiotherapy, chemotherapy or a combination of these treatments.

To confirm the diagnosis:

  • A doctor will usually do a vaginal examination if a woman has a symptoms which may indicate cervical cancer
  • The doctor may feel an abnormal cancer
  • If cervical cancer, is suspected , a colposcopy is advised
  • For this test a speculum is gently put into the vagina so the cervix can be seen in detail using a magnifier (colposcope)
  • The test takes about 15 – 30 mins
  • During colposcopy it is usual to take a small piece of tissue from the cervix(biopsy). The biopsy sample is then examined under a microscope to look for cancer cells.

Assessing the extent and spread :

  • CT scan
  • An MRI scan
  • A chest X-ray
  • An ultrasound scan
  • Blood test or other tests
  • This assessment is known as ‘staging’ of the cancer. The aim of staging is to find out :
  • How much the tumour has grown, and whether it has grown to other nearby structures such as the bladder or rectum.
  • Whether the cancer has spread to local lymph glands.
  • Whether the cancer has spread to other areas of the body.

Treatment for cervical cancer

Treatment depends on the stage of the disease.

  • When the illness is in its initial stage, surgery may be employed and may or may not be complemented by radio and chemotherapy.
  • In cases where the disease has become more severe, but limited to the cervix, concomitant treatment with radiotherapy and chemotherapy is done, which will subsequently allow the completion of curative surgery. In more advanced cases, the combination of radiation and chemotherapy may provide good control of the disease.
  • If the disease is no longer limited to the pelvis, and even when it has affected distant organs such as the lung, chemotherapy will have the task of trying to contain the disease and provide symptomatic improvement.

Key Points

  • Cervical cancer is the easiest female cancer to prevent with regular Pap smears and follow-up.
  • Cervical cancer occurs most often in women over age 30.
  • Cervical cancer is not infectious and cannot be passed on to other people.
  • All women should begin cervical cancer screeningwhen they are 21 years old..
  • Primary prevention of cervical cancer is now available in the form of HPV vaccines