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All about Cervical Cancer

One of the most common causes of cancer in women, cervical cancer can be prevented. Here are the symptoms, causes, and preventive measures.

Did you know that even though cervical cancer is the only cancer detectable at a pre-cancerous stage through easy diagnostic measures, roughly 510,000 cases of cervical cancer are reported worldwide each year! In India alone, it is the most common form of cancer in women, with more than 130,000 new cases reported each year. Not only that, but according to WHO, 74000 Indian women die annually from this disease. 

What is cervical cancer?

Cervical cancer is a disease caused by the abnormal growth and division of cells that make up the cervix (the portion of the uterus attached to the top of the vagina). Ninety percent of the cervical cancers arise from the flattened/ squamous cells covering the cervix. Most of the remaining 10% arise from the glandular, mucous-secreting cells of the cervical canal leading into the uterus.

What causes cervical cancer? 

The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form it is 100% treatable, usually without the need for a hysterectomy (surgical removal of the uterus). Dysplasia, depending on its severity, can resolve without treatment, particularly in young women. However, it often progresses to actual cancer called ‘carcinoma in situ’ (CIS) if it has not spread, or ‘microinvasive’ if it has spread only a few millimeters into the surrounding tissue but not into the lymph channels or blood vessels. 

Risk factors for cervical cancer 

• Early age at first sexual intercourse 

• Multiple sexual partners or partners who have multiple partners

• Infection with the virus that causes genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia and subsequent cancer. Fortunately, not all women who have had HPV infection or genital warts develop cervical cancer. Other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV.

• There is a small increased risk of abnormal Pap smears among women who take birth control pills. It is because such women are more sexually active, are less likely to use condoms, and have more frequent Pap smears in order to be prescribed the birth control pill.

• Women whose immune systems are weakened - such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system - may be at a higher risk. 

• Infections with genital herpes or chronic chlamydia infections, both sexually transmitted diseases, may increase risk.

Symptoms of cervical cancer 

Cervical cancer in its earliest and most treatable stages: 

1. Persistent vaginal discharge, which may be pale, watery, pink, brown, blood streaked, or dark and foul-smelling 
2. Abnormal vaginal bleeding, especially between menstrual periods, after intercourse or douching, and after menopause, which gradually becomes heavier and longer 

Cervical cancer at an advanced stage:

1. Loss of appetite, weight loss, fatigue 
2. Pelvic, back, or leg pain 
3. Leaking of urine or faeces from the vagina 
4. Bone fracture 

Diagnosing cervical cancer

Pap smears screen for cervical pre-cancers and cancers. The Pap smear test consists of cells wiped or brushed off the cervix and placed on a microscope slide. This is usually done at the time of a pelvic examination, though not every pelvic exam includes a Pap smear.

Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix. 

Biopsy, colposcopy, or sometimes the use of LASER (a loop electrode) or other instrument allows a diagnosis to be made.

When cervical cancer is found, additional tests - such as X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) - are used to determine how far the cancer has spread and what stage the disease is in.

Treating cervical cancer

Treatment of cervical cancer depends on the type of cancer, the stage, the size and shape of the tumour, the age and general health of the woman, and her desire for future childbearing.

In its earliest stages, the disease is curable by removing or destroying the pre-cancerous or cancerous tissue. This can often be performed without removing the uterus or damaging the cervix so that a woman is still capable of having children.

In other cases, a removal of the uterus (hysterectomy) is performed, with or without removal of the ovaries. In more advanced disease, a radical hysterectomy may be performed which removes the uterus and much of the surrounding tissues, including internal lymph nodes. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the urinary bladder and rectum, are removed.

Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred. A variety of chemotherapeutic drugs, or combinations of them, are used. Sometimes radiation and chemotherapy are used before or after surgery.

Cervical Cancer Preventive measures

• There are two ways to prevent cervical cancer - the first is to prevent infections with HPV, the second is to get regular Pap smears that will detect pre-cancerous conditions and HPV. Both of these can be treated and the progression to cervical cancer is arrested.

• Pre-cancers are completely curable when followed up properly. To reduce the chances of cervical cancer, girls less than 18 years of age should avoid sexual activity or always use condoms. HPV infection causes genital warts. These may be barely visible or several inches across. If a woman sees warts on her partner's genitals, she should avoid intercourse. To further reduce the risk of cervical cancer, women should limit the number of their sexual partners, avoid sexually promiscuous partners, and discontinue any tobacco use. 

• Condoms may help prevent the transmission of HPV.

• Annual pelvic examinations, including a pap smear, should begin when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. All abnormal findings should be followed up with colposcopy and biopsy.

Cervical Cancer Statistic

About 510,000 cases of cervical cancer are reported each year with nearly 80% occurring in developing countries. Cervical cancer is the most common form of cancer in India, with more than 130,000 new cases reported each year and 74,000 women dying annually from the disease, according to the World Health Organization. Cervical cancer accounts for an estimated 24 percent of India's cancer cases among women, compared with 20 percent for breast cancer. 

Staggering figures and so tragic too, because at the end of the day it is a preventable disease. Its as easy as going for regular annual check ups.

QUICK FACTS

Causes
1. A virus that can remain dormant for years, sometimes even 15-20 years
2. Early sexual activity
3. Several sexual partners
4. High risk males (who have had more than one partner)
5. Early childbirth
6. Multiple pregnancies

When should a woman have Pap smear?
1. At 18 years or as soon as she is sexually active
2. If there is continuous white discharge
3. Persisting leg pain
4. Post coital bleeding
5. Hereditary factors
6. Best time have the test is 10-20 days after the first day of menstruation

Good news 
1. Long lead time and easy to diagnose
2. Easy to reach and does not require expensive and invasive tests
3. Screening is risk free
4. The test is easy to administer with minimal discomfort

Note: The contents of this web site are for informational purposes only and are not intended to be used for medical advice.