Cancer cervix is cancer that affects the cervix, the mouth of the uterus which connects to the vagina. It is the second most common cancer amongst Indian women, second only to Cancer breast. As per Globocan, in India in 2020, there were 9.4 % of cancers due to Cancer cervix and 18.3% of new cases were added. In absolute numbers, 96,922 cases were added and 60,078 women lost their lives to cancer cervix. Due to the magnitude of the disease, it is important we are well aware of this deadly cancer and take an active part in prevention.
Our goal by 2030 is “90-70-90 “which implies that health care workers must vaccinate at least 90 % of girls by the age of 15, screen 70 % of women by the age of 35 years and treat 90 % of women afflicted by this ominous malignancy. And if we put our efforts towards it, it should be achievable.
What causes cervical cancer?
Unlike many cancers whose causative factors we don’t really know, cervical cancer is caused by the Human Papilloma Virus (HPV) This virus is also responsible for causing anogenital warts, vulvar and vaginal cancer. There are many types of HPV, some are the high-risk types that cause 70-80 % of cancer cervix. These viruses are sexually transmitted , extremely common and in a majority of cases, women acquire this during sexual activity. However the body is able to produce immunity against them, eliminating them from the body; in a small percentage of cases, however, these remain in the cervical cells, producing changes in their DNA and going from premalignant to malignant phase over 10-15 years. These are the viruses that need to be screened for. Screening should also be done for changes in the cervical cells by programmes like taking Pap’s smears, HPV DNA tests to screen for high-risk types of HPV and in relevant cases even colposcopy.
What are the risk factors for cervical cancer?
Women with multiple sexual partners
or having partners who have multiple partners, smokers, women with other Sexually Transmitted diseases, patients with low immunity like patients of AIDS, intravenous drug users, women who have had many children, who started sexual activity at a very early age and who had childbirth at a very young age are all at high risk.
What are the types of Cancer cervix?
There are mainly two types of cancer cervix
- Squamous cell cancers – originate from the flat cells on the outer surface of the cervix close to the vagina. Most cancers are of this type.
- Adenocarcinomas- which arise from the cervical glands lining the cervical canal.
- Sometimes both types of these cells are involved and at other times, rarely other types of cells are noted to cause it.
What are the symptoms?
Early cancer cervix has no symptoms. However, at a later stage, there may be irregular bleeding like post-coital bleeding ( after intercourse) bleeding at times other than your regular periods or postmenopausal bleeding.
There may be a foul-smelling, often yellowish, pinkish or blood-tinged discharge and in late stages, pelvic pain as cancer spreads to other pelvic organs.
If cancer has spread to distant organs like the liver, lungs, bladder and rectum, these too may be involved.
Diagnosis :
- Screening with Pap’s smears every 3 years after the age of 21 till 65 years of age or with Pap’s smear along with HPV virus screening, once every 5 years in women between 30-65 years of age.
- If there are abnormal changes seen in the cells of the cervix, a Colposcopy or magnified imaging of the cervix may be ordered by your gynaecologist. A biopsy of the suspicious areas may be taken which may be used to confirm or rule out cancer as well as the type of cancer.
- Once confirmed, staging of cancer may be done using X-rays, CT scan, MRI, PET scan and also direct visualisation of other organs like the bladder or rectum using endoscopy.
- For early-stage suspicious areas, your doctor may perform colonisation or removal of a cone-shaped area of the cervix containing the abnormal areas, else an electrical wire loop may be used to obtain a small tissue sample.
Treatment
- Treatment depends on many factors like the type of cancer, stage, age of the patient, other comorbidities.
- The options available are surgery, radiotherapy, chemotherapy or a combination of these.
- Surgery in the early stages may be the removal of cancer by taking out a cone of the cervix ( conisation) ,
- removal of the cervix ( trachelectomy) or maybe a hysterectomy in which there is the removal of the cervix and uterus with a cuff of the vagina and also the draining lymph nodes. Minimally invasive hysterectomy is also an option depending on eligibility factors decided by your doctor.
- Immunotherapy and only palliative treatment are needed in more advanced cancer that has metastasised.
- Regular follow up is also required even after treatment.
How can you prevent cervical cancer?
By screening, as indicated above and vaccinating young girls 9-26 years of age, and in some carefully selected cases up to 45 years of age. This HPV vaccine is given in 2 doses if the girl is less than 15 years of age and in 3 doses if she’s crossed her 15 th birthday. It is highly effective with minimal side effects and is available with most gynaecologists and paediatricians.
Also, practice safe sex and stop smoking.
Remember that this deadly disease is easily prevented by screening and vaccination and if picked up early, cervical cancer can easily be treated. Early treatment saves many lives – just be educated, aware and empowered. Remember Cancer cervix is largely PREVENTABLE.
