WHAT IS CERVICAL CANCER IN WOMEN ?

Cervical cancer develops when the cells of cervix (i.e mouth of uterus) starts multiplying and go out of control. All sexually active females are at risk of developing this cancer.

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What are the Causes of Cervical Cancer ?

Almost 99% of cervical cancer are linked to infection with HPV (Human Papilloma Virus). It is a virus that is transmitted through sexual contact. Although most HPV infections resolves spontaneously and cause no symptoms ,but in few cases it remains in body and cause persistent infection. This persistent infection of Human Papilloma Virus in the cervix may lead to cervical cancer.

Is Cervical cancer treatable?

When diagnosed early , cervical cancer is one of the most successfully treated cancer. But for this it should be diagnosed early and this can be done by various screening tests such as paps smear, HPV DNA test that are easily available as opd procedures.

Cervical cancer can be prevented and treated if caught early

When the cervical cancer is diagnosed in late stages and has spread to uterus, urinary bladder, vagina, pelvis, bladder, rectum or to distant organs like liver, lungs, lymph nodes the prognosis is not good. But it can be controlled with appropriate treatment and palliative care.

What are the symptoms of cervical cancer?

The symptoms of cervical cancer depend on the staging of cancer. In the early stages, there are no symptoms or maybe may be vague symptoms off and on like vaginal discharge or intermenstrual bleeding which the female may initially ignore.

What are the Signs and symptoms of Cervical cancer

The more advanced level Cervical cancer signs and symptom’s are ?

• Post coital bleeding – The female may experience vaginal bleeding after having sexual intercourse.
• Post menopausal bleeding – Some may experience vaginal bleeding years after menopause.
• Watery bloody vaginal discharge which may be heavy or foul-smelling.
• Pelvic pain or pain during intercourse.
• other symptoms specific to the sites involved by the cancer cells like lung, liver, bladder.

If you experience any of the symptoms you should immediately contact your doctor.

What is the main cause of Cervical Cancer?

HPV i.e Human Papilloma Virus is the main cause of cervical cancer.It is a virus that is sexually transmitted from one person to another.About 99% of cervical cancers are linked to infection with HPV.

More than half of the sexually active females are infected with HPV at one point of time.But the immune system of the body usually eliminates the infection ,often within 2 years.And so most of the HPV infection resolves spontaneously ,but in some it may persist whole life and may cause cervical cancer in later life.

You can reduce your risk of developing cervical cancer by screening test to detect early cancer and by HPV vaccine which will give protection against HPV infection.

When is Cervical Cancer awareness month is Observed ?

Cervical Cancer month is observed in the month of January

How cervical cancer is diagnosed?

Screening tests can help detect cervical cancer and precancerous cells that may one day develop into cervical cancer. So for early diagnosis of this cancer, screening tests plays a major role.

If you are perceiving any of the symptoms mentioned above then cervical cancer is suspected. Your doctor will do a P/S examination of your cervix. A special magnifying instrument (colposcope) can be used to check for abnormal cells by staining them with a specific dye and thus differentiating the normal cells from abnormal cells. Then a biopsy from these abnormal cells can be taken and sent for histopathology.

Biopsy

Biopsy taken is known as colposcopic directed biopsy.It can be:

• Punch biopsy, in which small samples of cervical tissue are taken by pinching off with forceps
• Endocervical curettage, which uses a small curette or a thin brush to scrape a tissue sample from the cervix.

In case if the punch biopsy or endocervical curettage report is not normal, then following tests are done:-

• Electrical wire loop, which uses a thin, low-voltage electrified wire to obtain a small tissue sample.
• Cone biopsy (conization), in this deeper layers of cervical cells for laboratory testing. A cone biopsy is done in a hospital under general anesthesia.

Staging

If the biopsy reports suggest that you have cervical cancer, further tests are done to determine the extent (stage) of cervical cancer. Stage of the cancer is a key factor in deciding the treatment.

Staging exams include:

• Imaging tests. Tests such as X-ray, CT, MRI and positron emission tomography (PET) to determine whether the cancer has spread beyond your cervix or not.
• Proctoscopy and cystoscopy may be needed to see the further extent of spread of cancer.

Treatment of cervical cancer

Treatment for cervical cancer depends on several factors, such as the staging of the cancer, any associated medical problems,age of patient,spread to different organs of body. Surgery, radiation, chemotherapy or a combination of the three may be used depending on the above factors.

Surgery

Early-stage cervical cancer is typically treated with surgery. Type of surgery depends upon the stage of cancer and the size of cancerous mass and whether the patients wants future child bearing.

Types of surgeries that are done are:-

• CONE BIOPSY–  For a very small cervical cancer, it might be possible to remove the cancer entirely with a cone . The rest of the cervix is left intact thus making it possible for the patient to consider becoming pregnant in the future.
• TRACHELECTOMY-Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue.
• HYSTERECTOMY– Radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes is done to remove the cancer.A hysterectomy can cure early-stage cervical cancer and prevent recurrence.
  

After the surgery , radiotherapy and chemotherapy / brachytherapy may be required depending on the statging and spread of the cancer.For locally advanced cervical cancer, low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy might be recommended to help control symptoms of very advanced cancer.

What are the risk factors for cervical cancer?

Almost all cervical cancers are caused by HPV infection which is sexually transmitted. Some of the HPV strains may also cause genital warts.

So HPV infection is the major risk factor for development the of cervical cancer. Other things that increase your risk of cervical cancer are:-

1. Early sexual activity- Females who start their sexual activity early in life are more at risk of cervical cancer.
2. Many sexual partners – Chance of acquiring HPV infection and thus cervical cancer increases if you have more than one sexual partner. The greater your number of sexual partners, the greater is your chance of HOV infection.
3. Other Sexually transmitted infections STI – STI like syphilis, gonorrhea, AIDS, chlamydia increases your risk of HPV infection.
4. Weakened immune system- If the immunity of a person is low there are fewer chances that the HPV will get cleared from the body. The chances are likely that it will persist in the cervix and may cause cervical cancer in later life.
5. Smoking – It is known to be associated with squamous cell carcinoma of the cervix.
6. Multiparity – Giving vaginal birth to more than 3 children increases the risk of cervical cancer.

What can I do to reduce the risk of cervical cancer?

After discussing the risk factors for cerviacal cancer,it will be easy to understand the ways by which you can reduce your risk of cervical cancer.

Various steps that you can take are for reducing the chances of Cervical Cancer

HPV vaccine

Since Human Papilloma Virus HPV have been the major cause of cervical cancer, a vaccine against this virus has a significant role in reducing the risk upto 99% especially if taken at an early age.

Cervical cancer age limit

HPV vaccine can be taken from the age of 10 years to 45 years of age.

If vaccination is started before the age of 14 years ,then 2 dose schedule is recommended. For those who start their vaccination after 14 years, vaccine is given in a 3 dose schedule.

HPV vaccination prevents new HPV infections but does not treat the existing infections from this virus. So the vaccine works best when given before the start of any sexual activity. For this reason, you should get yourself screened even if vaccinated with this vaccine.

Routine paps test

It is a small OPD procedure which can be done in clinics and hardly takes about 5 min. Routine paps smear is recommended at the age of 21 years and is repeated after every 3 years. It can be combined with HPV DNA test and then it is repeated every 5 years.Paps smear help detect early precancerous lesions of cervix that may develope into cancerous cells.

Know more about Paps smear test – What is paps smear test and how it is done?

• Practice safe sex – Risk of HPV infection and thus cervical cancer can be reduced by using barrier contraceptive. Condoms also significantly reduce the risk of STIs. One should limit the number of sexual partners.

What should I know about screening?

The paps smear test and the HPV DNA test screening help to prevent cervical cancer and in early diagnosis of any lesion that may progress to cervical cancer at later age.

• The Paps smear test is a simple procedure done in the clinic. Under direct visualization of the cervix, cells from the cervix are scraped using a cytobrush and are examined under a microscope to see if there are any abnormal-looking cells. If precancerous cells are found, they are treated accordingly.

• HPV DNA test looks for the Human papilloma virus that can cause these changes in cells.

Getting screened for cervical cancer helps prevent the disease.

So the question comes in mind of all of us WHAT IS THE IDEAL AGE FOR SCREENING?

• Screening by the above tests should start at the age of 21 years .If only paps test is done for screening ,then every 3 years you should get your paps test done if previous results were normal.
• Co testing: If both paps test and HPV test is done then testing is required every 5 years if the results are normal.

Know more: More about paps test and how to prepare yourself for this test

WHAT IF MY RESULTS ARE ABNORMAL?

If your test results shows cells that are not normal then your doctor will let you know the treatment required.In most cases treatment prevents cervical cancer from developing. But regular follow up with your doctor is a must.

WHAT IF RESULTS ARE NORMAL?

If your test results are normal then the chance of getting cervical cancer in the next few years is very low. You should follow up to get the test repeated after 3/5 years depending upon whether you opted for paps test or co testing respectively.

Summary

So from all the above discussion we can conclude that early diagnosis by screening with paps test and HPV DNA test can detect any precancerous lesions of the cervix. If detected early these precancerous lesions can be treated effectively.

• All young girls above 10 years of age till 14 years should get their 2 doses of HPV vaccination.
• All females of more than 15 years till 45 years should get themselves vaccinated with the 3 dose schedule.
• If you experience any of the symptoms mentioned above ,then immediately contact your doctor.Do not hesitate to discuss your problem.
• Choose a healthy lifestyle, quit smoking, be loyal to your partner, take all precautions to prevent yourself from STIs.

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