Q & A with Dr. Rani Bhat

Can cervical cancer be prevented?

Do you know that every sexually active women is at risk of developing cervical cancer? and do you also know that cervical cancer can be easily prevented?

What is cervix & where is it situated in the body?

Cervix is also known as neck of the womb, and it is situated at the lowermost portion of the womb(uterus). It is cylindrical in shape and connects the vagina and uterus.

Cervix is divided into two portions

  • The part of the cervix that is present in the vagina and which can be seen during an internal examination is known as the ectocervix. There is a small opening in the center of the this ectocervix known as external orifice.
  • The part of the cervix which extends from ectocervix to the uterus in the shape of tunnel is know as endocervix or endocervical canal. The small opening present at the junction of endocervical canal and uterus is known as internal orifice.

What are the functions of cervix?

  1. Cervix produces mucus secretion (jelly like) and it changes in consistence according to menstrual cycle such as immediately after your menstruation you will not have any cervical mucus secretion but at the time of ovulation, which corresponds to mid cycle of menstruation there will be mucus secretions, during these days you will generally feel wet. This cervical mucus helps the sperms to move from the vagina into the uterus. Again, before menstruation the cervical mucus decreases. If you carefully keep a watch on these dry and wet days it can help you to conceive. Sometimes women use these dry and wet days a method of contraception too, for eg., by not having sexual intercourse during wet days can prevent pregnancy. Note: this is not reliable method of contraception.
  2. Cervix acts like a barrier and prevents infections ascending up into the uterus.
  3. During delivery cervix dilates to almost to 10 cm to allow the baby to pass through.
  4. During monthly menstruation, the cervix will open to permit passage of menstrual blood.

What kind of problems can arise in cervix?

Cervix is prone to develop some abnormalities such as

  • Cervicitis: inflammation of the cervix is known as cervicitis, usually caused by infection such as chlamydia, gonorrhoea, and herpes.
  • Cervical incompetence: this means weakness of cervix. Cervix is made up of muscles and the tone of these muscles should be strong during pregnancy to hold the baby in the uterus. If cervical muscles become weak for any reasons then cervix will open prematurely during pregnancy and can lead to repeated abortions or premature deliveries. Previous operations or procedures on the cervix are often responsible for cervical incompetence.
  • Cervical dysplasia: also known as Cervical Intraepithelial Neoplasia (CIN): When there is HPV infection in the vagina for a long period of time they can  cause changes in the cells lining the cervix and can lead to a pre-cancerous condition known as cervical dysplasia.
  • Cervical cancer: when cervical dysplasia or cervical intraepithelial neoplasia is not identified and treated appropriately then it can lead to cervical cancer.
  • Cervical polyps: small fleshy growth on the cervix is known as cervical polyp and these are non-cancerous. This can sometime causes irregular bleeding or bleeding after sexual intercourse.
  • Cervicitis: inflammation of the cervix is known as cervicitis and again this is non-cancerous condition. This condition can cause excessive vaginal discharge and sometime bleeding after sexual intercourse.

What is cervical cancer?

  • Our body is made up of millions of cells. Usually, cells have a life span and they die when they get old or damaged after which new cells are formed and take their place.
  • Sometimes due to genetic / environmental changes there can be interference in this orderly process and cells grow disproportionately and eventually turn into cancer.
  • Cancer can happen anywhere in the body, when cancer appears on cervix it is known as cervical cancer.

How common is cervical cancer in India?

 

According to Indian statistic’s, it is said that one women dies of cervical cancer every 8 minutes. Cervical cancer is the second most common cancer seen in Indian women.

Cervical cancer is a preventable disease as it has a well-defined, long pre-malignant phase, which can be easily detected by regular Pap smear tests and follow up. Unfortunately, most women in India are not aware about the screening methods and thus end up getting cervical cancer.

What causes cervical cancer?

  • It’s important to remember that every sexually active woman is at risk of developing cervical cancer. Some rare type of cervical cancer can also happen in women who are not sexually active.
  • Cervical cancer is caused by a simple virus known as human papilloma virus (HPV).
  • There are more than 150 related human papilloma viruses, most of these viruses are harmless, but some high-risk virus can lead to cervical cancer and some can also cause genital warts.

How do people get HPV infection?

HPV is a viral infection and is generally transmitted through intimate skin-to-skin contact. You can get HPV infection by having vaginal, anal, or oral sex with someone who has this virus. It commonly spreads from one partner to another during vaginal or anal sex. HPV infection is such a common infection that nearly all men and women who are sexually active will get it at some point in their lives. You can develop cervical changes years after being infected, making it hard to know when you first became infected.

In most cases, HPV goes away on its own without any treatment and does not cause any health problems. But when HPV stays in your body for a long period of time it can cause health problems like genital warts and cervical cancer.

Though most sexually active women acquire HPV infection, why’s that only few develop cervical cancer?

HPV generally clears away from your body without any treatment. If this virus stays in your body for a long period of time it can causes changes in cervix and may lead to cancer. There are some risk factors as to why HPV doesn’t clear from body such as:

  • Women with many sexual partners, or whose partners have had many partners in the past.
  • Women who started having sexual intercourse at a very early age.
  • Women who have low immunity (for example, those taking immunosuppressive drugs after kidney or liver transplant surgery or in women who are HIV positive)
  • Women who smoke are about twice more likely to develop cervical cancer than non-smokers. In particular, if women smoke and have HPV infection, the risk is greater, because smoking suppresses immune system.
  • Long-term use of oral contraceptives increases the risk of developing cervical cancer (≥5-8 years). Consult your doctor if you are taking or before taking oral contraceptives pills.
  • Women with history of sexually transmitted diseases are at risk of having persistent HPV infection.

Does cervical cancer develop overnight?

No, cervical cancer doesn’t develop overnight. Before cancer can develop there is a condition called precancerous condition and it is known as cervical dysplasia or cervical intraepithelial neoplasia. After being exposed to HPV infection, cells of the cervix will undergo some changes and develops cervical dysplasia (precancerous condition).

Remember precancerous conditions is not cancer. But, if this condition is not identified and treated they can turn into cancer. It is said that if pre-cancer condition is untreated it may take about 10 – 15 years for it to turn into cervical cancer, but in rare cases this can happen even in less time.

How to identify precancerous conditions of the cervix?

A well-proven way to identify precancerous condition of cervix is by doing a simple test on to the cervix called Pap test (or Pap smear). Along with Pap smear test we also check for the presence of human papilloma virus.

Pap smear test is a screening test for cervical cancer. You may wonder what is the meaning of screening? By definition screening means checking your body for cancer before you have symptoms.

Pap smear test is a cervical cancer screening test and in this test the cells from the cervix are collected and looked at under a microscope to find any abnormalities. A Pap test is a simple test which can be done during your routine pelvic examination. Along with Pap smear test, HPV test will be done on the same sample of cells collected.

How to prevent cervical cancer?

Cervical cancer can be prevented by:

  1. Safe sex: Limiting the number of sexual partners and by avoiding sex with people who have had many other sex partners in the past. By limiting number of sexual partners you may lower your risk of exposure to HPV.   But you ought to remember that HPV infection is very common, so having sexual activity with even one other person can put you at risk.
  2. Using condoms: now using condoms can provide some protection against HPV but they can’t prevent infection completely that’s because they don’t cover every possible HPV-infected area of the genital area. Having said that, condoms still provides some protection against HPV, and they also help protect against HIV and other sexually transmitted infections. So, using condom can decrease your exposure to HPV.
  3. Quit smoking: smoking decreases your immunity and this helps HPV to stay in your body for long period of time, hence not smoking is another important way to reduce the risk of cervical cancer.
  4. Get vaccinated: yes, vaccines are available to prevent cervical cancer. These vaccines will protect against HPV infections commonly linked to cancer, as well as some types that can cause anal and genital warts. HPV vaccination will not treat an infection that is already present in your body but will prevent new infection. Hence, to be most effective, the HPV vaccines should be given before a lady is sexual activity.
  5. Screening: Last but not the least is by going for your Pap smear test regularly.