Narayana Health Care

Cancer is a  group of diseases in which body cells start to grow abnormally and form a mass called a tumor. A tumor can be benign (non-cancerous) or malignant (cancerous) in characteristics.

Cancer is the second largest cause of mortality across the world. It causes immense physical, emotional, and financial burdens on patients and their families. Early detection and prompt treatment can significantly improve the survival rates in cancer patients.

Cervical cancer is the fourth most common type of cancer in women worldwide. It is the uncontrollable growth of the cells of the cervix lining (the cervix is the lower part of the uterus that connects to the vagina).

Causes of cervical cancer

There are many causes of cervical cancer:

• Human papillomavirus (HPV) infection: HPV infection is the most common cause of cervical cancer. HPV16 and HPV18 strains of HPV are frequently associated with cervical cancer. Multiple sex partners and starting sexual intercourse at an early stage of life can cause a higher risk of getting HPV infection.
• Immune deficiency: Lower immunity can put women’s higher risk of developing cervical cancer. Immunodeficiency can occur by immunosuppressant during organ transplantation, HIV infection, or treatment of other cancers.
• Lifestyle factor like smoking increases the risk for cervical cancer.
• Genital herpes, syphilis, chlamydia infection in women are also risk factors for cervical cancer.
• Women who use oral contraceptives regularly for a long time may have higher chances of developing cervical cancer.

Symptoms of cervical cancer

In the early stage of cervical cancer, women generally do not experience any symptoms. But in later stages, cervical cancer can show many signs and symptoms:

• Unexplained pain in the pelvis and hip area
• Longer menstruation period
• Bleeding between menstruation periods
• Discomfort and bleeding during sexual intercourse
• Bleeding after menopause
• Increase in vaginal discharge
• Sometimes, the vaginal discharge may have blood.
• Presence of foul smell in vaginal discharge

Sometimes these symptoms can be seen in many other diseases like infection, so proper screening is necessary to rule out any other possibility.

Diagnosis of cervical cancer

Most of the time, cervical cancer is diagnosed accidentally by routine screening in women. Screening tests are not diagnostic tests; only diagnostic investigations can confirm any precancerous or cancerous changes in the cervix.

Screening tests:

• Pap smear test
• HPV strain testing

Diagnostic tests:

• Bimanual pelvic examination
• Colposcopy
• Biopsy

If the biopsy shows the spread of cervical cancer to nearby organs, then further imaging tests are performed to confirm metastasis. Metastasis is the spread of cancer cells to parts other than the region of origin. Imaging tests to confirm metastasis are:

• Pelvic examination under anesthesia
• X-ray
• CT scan
• MRI
• PET scan
• Cystoscopy to see if cancer has spread to the bladder
• Sigmoidoscopy to detect if cancer has spread to the rectum

Treatment options for cervical cancer

Cervical cancer is one of the most successfully treated cancers if detected early. Late-stage cervical cancers can also have a good prognosis with treatment and palliative care.

Treatment of cervical cancer depends on many factors such as; the type and stage of cervical cancer, possible adverse effects, overall patient’s health, and treatment mode preferred by the patient. Treatment options are:

• Surgery: Surgery is the treatment of choice in early-stage cervical cancer. The type of surgery best suited for cancer depends on the size of the cancer, the cancer stage, and consideration of future pregnancy.
• Radiation therapy: Radiation is mostly a combination therapy. The radiation oncologist can prescribe radiotherapy after surgery if chances of recurrence are high. The radiation oncologist can also prescribe radiotherapy with chemotherapy as the treatment of choice for locally advanced cervical cancers.
• Chemotherapy: In chemotherapy, medical oncologists prescribe drugs to destroy cancer cells. Drugs are either tablets or liquid given through veins (intravenous).
• Palliative treatment: The doctor may prescribe palliative or supportive treatment to reduce pain and other symptoms of cancer.
• Immunotherapy: The oncologist may prescribe these drugs to boost your immune system to fight against cancer cells. The patient gets immunotherapy in the advanced stages of cervical cancer when other treatment modalities are not working.

Prevention of cervical cancer

We can prevent the occurrence of cervical cancer through various primary and secondary techniques, such as:

Primary prevention: As we know, the most common cause of cervical cancer is HPV infection. So vaccination against HPV is the most effective primary prevention. Vaccination is very effective when given to a person before a person becomes sexually active. Vaccination of both boys and girls is essential to prevent HPV transmission.

Secondary prevention: Regular screening tests and treating any precancerous lesions will prevent most cervical cancers. The most common screening tests are Pap smear and HPV. According to ACS 2020 guidelines, regular screening between 25- 65 years is essential. A person may not require screening tests for cervical cancer after 65 years. The recommended frequency of Pap smear test is every three years while that of HPV test is every five years. Treating any detected precancerous lesions with excisional methods also comes in secondary prevention.

Regular pelvic examination and screening are essential for every woman. Proper treatment and nutrition care improve the outcome of the treatment of cervical cancer.

Dr. Rohit Ranade | Consultant – Gynaecology – Oncology, Oncology, Robotic Surgery | Mazumdar Shaw Medical Center, Bommasandra, Bangalore