Understanding Cervical Cancer

Introduction:

The cervix is the lower part of the uterus that connects to the vagina and when cancer occurs in the cervix, it is called as Cervical cancer.

In India, Cervical cancer is the second most common cancer in women and accounts for 22.86% of all cancer cases in women. The number of new cases registered in 2018 of cervical cancer is 96,922, and the number of deaths is 60,078. Most commonly affected women are aged between 15 and 44.

Cervical cancer – Causes:

The exact cause is unclear but according to the doctors and scientists, human papillomavirus (HPV) and its strains are one of the most common cervical cancer causes especially in less developed regions where mostly people report at advanced stages.

Cervical Cancer – Signs & Symptoms:

The early stage of cervical cancer doesn’t show any signs or symptoms, but you can see the symptoms during the more-advanced stage such as:

• Watery or bloody vaginal discharge with a foul odor
• Vaginal bleeding after intercourse, between periods or after menopause
• Pelvic pain or pain during intercourse

Cervical Cancer – Types:

There are two main types of cervical cancer:

• Squamous cell carcinoma: This cancer begins in the thin, flat cells, lining the outer part of the cervix which projects into the vagina. Most cervical cancers are squamous cell carcinomas.
• Adenocarcinoma: This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.

Cervical Cancer – Risk factors:

There are several risk factors for cervical cancer which include:

• Multiple sexual partners – The greater the number of sexual partners, the greater the chance of acquiring HPV
• Early age sex – Having sex at an early age increases the risk of HPV
• Existing Sexually transmitted infections (STIs) – If you have other STIs such as chlamydia, gonorrhoea, syphilis and HIV/AIDS, then you have increased chances of having HPV
• Smoking – Smoking results in squamous cell cervical cancer
• Immuno-compromised conditions – Having conditions that makes body’s defence system weak like HIV-AIDS, etc.
• Contraceptive pills – Long term use of birth control pills

Cervical Cancer – Prevention

Cervical cancer is preventable and treatable when detected early!

This has been possible because of the screening tests and vaccines available for now-a-days. Early detection and treatment of cervical cancer is associated with long survival and good quality of life.

Cervical cancer could be prevented by avoiding risk factors, undergoing screening tests and following a few measures such as:

• HPV Vaccines Vaccination is available for girls and women ages 9 to 26.

The HPV vaccine is recommended for girls above nine years of age with a shot of two dozes that protect them against the infection.

The state government of Punjab has decided to include the HPV vaccine in the state immunization programme in Bhatinda and Mansa districts.

• Screening tests– Have routine Pap tests as it can detect precancerous conditions of the cervix and can be monitored or treated to prevent cervical cancer.
• Safety is priority – Use condom, have fewer sexual partners and delay intercourse to reduce the risk of cervical cancer.
• Avoid smoking – Smoking is one among the high-risk factors for cervical cancer. Try not to smoke or at least avoid smoking to keep yourself protected.

Cervical cancer – Diagnosis:

Cervical cancer is treated successfully if detected early.The recommended age for women to begin screening for cervical cancer and precancerous changes is at age 21.

The screening test for cervical cancer includes:

• Pap test:The Pap test or Pap smear test is the most common test that detects early changes in cells that can lead to cervical cancer. In this test the doctor scrapes and rushes cells from the cervix which are then examined in a lab for abnormalities.
• HPV DNA Test:This test involves testing cells collected from the cervix. This test is an option for women age 30 and older or younger women with an abnormal pap test. This test is equally sensitive to that of cytology (Pap test). It is now-a-days suggested to be implemented as a screening tool especially in low-resource settings due to its easier implementation than cytologic screening.

If a doctor suspects cervical cancer, then he starts a thorough examination of the cervix which is done using an instrument called colposcope. There are various methods of obtaining the tissue such as:

• Punch biopsy:This method uses a sharp tool to pinch off small samples of cervical tissue.
• Endocervical Curettage:A small, spoon-shaped instrument is used to scrap a tissue sample from the cervix.
• Electrical wire loop:A thin, low-voltage electrical wire to obtain a small tissue sample is used to obtain a sample from the cervical tissue.
• Cone Biopsy:This test helps obtain the deeper layers of cervical cells for testing. This is performed in the hospital setting under general anaesthesia. This procedure involves removal of a cone-shaped wedge of tissue from the cervix, later examined under a microscope, hence the name ‘cone biopsy’. The person undergoing this procedure might feel mild cramps and bleeding after this procedure.

When it is confirmed that you have cervical cancer, then doctor perform more tests to determine the stage of cancer. The stages of cervical cancer are:

• Stage 1:Cancer is confined to the cervix.
• Stage 2: Cancer is present in the cervix and upper portion of the vagina.
• Stage 3:Cancer has moved to the lower portion of the vagina or to the pelvic side wall.
• Stage 4: Cancer has spread to nearby organs, such as a bladder or rectum.

Cervical Cancer – Treatment

Treatment for cervical cancer depends on many factors such as stages of cancer and other health problems. The treatment involves:

Surgery: Cervical cancer in early stage can be treated with surgery called as hysterectomy (removal of the uterus).

Hysterectomy is of two types:

• Simple Hysterectomy:In this, the cervix and uterus are removed along with cancer.
• Radical Hysterectomy: In this, the cervix, uterus, part of the vagina and lymph nodes in the area are removed with cancer.

Radiation: It uses high-powered energy beams such as X-rays or protons to kill cancer cells. It can be given externally by directing a radiation beam at the affected area of the body or internally by placing a device filled with radioactive material inside the vagina only for a few minutes.

Systemic therapy for cervical cancer:The types of systemic therapies used for cervical cancer include:

• Chemotherapy:  This technique USES medications which are usually injected into a vein to kill cancer cells.
• Targeted therapy: This therapy targets the cancer’s specific genes or the tissue environment that contributes to cancer growth and survival. Advantage with this therapy lies in its precision and sparing/limiting damage to healthy cells.
• Immunotherapy: Immunotherapy acts by boosting the body’s natural defences system and help it fight cancer. The molecules used are either body’s products or prepared in the laboratory and functions to target, improve and/or restore the normal functioning of the defence system.

Need to create awareness about Cervical Cancer!

A lack of knowledge of cervical cancer and the Pap smear test is the main reason for increased rate of cervical cancer in North India. Many women do not have a clear understanding of the meaning of an abnormal cervical smear and the need for the early detection of cervical cancer.

Women, specially at rural areas, need to be made aware of the hazards of cervical cancer and educated about the importance of early detection tests and their availability. Many rural awareness programmes have had been focussing on these points. It has been observed in surveys younger women have more awareness and knowledge about cervical cancer, its risk factors, signs and symptoms, etc.Awareness should be spread regarding to reporting and consulting a gynaecologist for any gynaecological problems. This not only helps in early detection of any underlying gynaecological serious pre-cancerous or cancerous conditions. Women should be educated about increased availability of HPV vaccination, cervical screening and diagnostic services on a population or community basis.

Knowledge of the women about cervical cancer and awareness about its prevention are the key factors that determine their utilization of screening services.

HPV prevalence among cervical cancer patients in India has varied from 87.8% to 96.67%. It is important to make people aware of cervical cancer and the purpose of Pap smear screening. The incidence and mortality of cervical cancer can be reduced by screening women for precancerous lesion and by administration of human papilloma virus vaccine to adolescent girls.

To conclude, the key message to convey to patients is that cervical cancer is highly preventable if detected early. If HPV infections are left untreated, it can lead to serious changes to cells in the cervix, leading to precancerous condition. Since its early stages show no apparent symptoms, the problem could advance to serious conditions and go unnoticed. But with the technological advancements and the availability of screening tests and vaccines makes the early detection and treatment of cervical cancer, a success.