While developed nations have almost won their battle against Cervical Cancer, developing nations like India are still lagging. According to a 2018 survey, it is the 3rd most common and 4th deadliest cancer in India.
What is the cause of cervical cancer?
Almost 90% of Cervical Cancer is caused by high risk HPV (Human Papilloma Virus) infection. HPV is commonly found in the vaginal flora of women, but is usually harmless and clears away on its own. However, there are some risk factors which result in the persistence of infection and this causes some oncogenic changes in the cervix resulting in Cervical Cancer. The risk factors are:
- Poor Hygiene
- Multiple sex partners
- Prolonged use of Oral Contraceptive Pill
- Increased number of child births
- Co-existence of HIV infection
Are there any measures to prevent from acquiring it?
Screening: The WHO recommends screening of women aged between 30 to 49 years, either through visual inspection with acetic acid (VIA) in low resource setting or by conventional PAP-smear testing every 3-5 years. In higher centres, HPV virus testing is available to be done every 5 years. In United States and United Kingdom, screening is recommended from 21 years onwards and should continue till 60-65 years.
Vaccination: Vaccines are also available against high risk HPV viruses. Three doses to be given to school going girls of 9-13 years to achieve maximum immunity. But vaccines will not provide complete immunity. Thus, the integration of both a screening program and vaccination has the potential to virtually eliminate the burden of Cervical Cancer.
What precautions can one take to prevent occurrence?
Better hygiene, use of barrier contraceptives during intercourse, avoiding multiple sex partners, and refraining from smoking are few simple steps that could prevent Cervical Cancer.
What is the available treatment?
Pre-cancerous lesions of cervix can be managed by Colposcopy guided ablative or excision procedures done at OPD basis. Treatment of Invasive Cervical Cancer depends on the stage of the disease. For early stages surgery is recommended. Radical Hysterectomy with pelvic node dissection is a surgery of choice and can be done by open, laparoscopic or robotic techniques. For locally advanced cases, Radiation Therapy is recommended. For distant metastasis the available treatment option is Palliative Chemotherapy where we only alleviate the symptoms of the patient.
How good/bad is the prognosis?
Survival rate is very good compared to other female cancers; for Stage-1 it’s almost 80-90%, for Stage-2 its 60-70%, for Stage-3 its 40-50% and even for Stage 4 (last stage) it’s almost 30%. Cervical Cancer is the only female cancer which is not only completely preventable but also completely curable if detected and treated upon in the early stages.
It is time to put behind the stigma, shame and superstitions and make everyone aware about a cancer which is not only completely preventable but also curable.
The author, Dr Kaustav Basu, is a Consultant Gynaecologic Oncosurgeon at Narayana Superspeciality Hospital, Howrah.