Q & A with Dr. Rani Bhat

Understanding cervical cancer

Cervix is also known as the neck of the womb and is situated at the lower end of the womb. Cervix is cylindrical in shape made up of muscles and is situated between two opening known as internal orifice and external orifice. Cervix is divided into two parts know as ectocervix and endocervix. Ectocervix is that part of the cervix which is seen in the vagina and endocervix is that part of the cervix that is situated inside your body and not seen during internal examination.

What is cervical cancer?

  • Our body is made up of millions and 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 changes there can be interference in this orderly process and cells grow disproportionately and eventually turn into tumor.
  • 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 in India. Cervical cancer is the second most common cancer seen in Indian women and it accounts for 22.86% of all cancer seen in women. As per Globocon 2018 data, there have been 96,922 new cases of cervical cancer registered and about 60,078 deaths due to cervical cancer. Median age noted in the data was 38 years (ranged from 21-67 years).

What causes cervical cancer?

  • Cervical cancer is caused by a simple virus known as human papillomavirus (HPV).
  • There are many types of human papillomavirus, most of these viruses are harmless, but some high-risk virus can lead to cervical cancer and some can also cause genital warts.
  • This virus is passed from one person to another through sexual contact. Most sexually active women and men will have HPV infection at some point in their lives, but very few will develop cervical cancer.
  • This viral infection will not cause any symptoms, so you will not know if you have this infection. Important for you to remember is that you don’t have to get yourself checked to see if you have HPV infection, because this infection gets cleared on its own and doesn’t require any treatment. Sometimes this virus doesn’t clear and stays in your body for a long period of time causing changes in the cervix that can eventually lead to 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 you 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 they are:

  • Women with many sexual partners, or whose partners have had many partners. These group of women are at risk of having HPV in their body for long period of time.
  • Women who started having sexual intercourse at a very early age.
  • Women who have low immunity (for example, those who are taking immunosuppressive drugs after kidney/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.

Above-mentioned risk factors increase your chance of getting cervical cancer. If you have a risk factor doesn’t mean you will get cervical cancer. Sometimes people develop cervical cancer with no risk factors.

What are the symptoms of cervical cancer?

In initial stages you may have no symptoms but as cancer advances you may have symptoms such as abnormal vaginal bleeding, and this bleeding could be:

  • Bleeding after sexual intercourse (postcoital bleeding)
  • Bleeding in-between your periods (intermenstrual bleeding)
  • Bleeding after menopause (menopause means stopping of monthly menses for more than a year)

Sometimes an early symptom could be vaginal discharge, which has unpleasant smell and may be blood tinged. If cancer spreads to other parts of the body other symptoms can develop such as loss of appetite, loss of weight, body pain, tummy pain, etc.

What should I do if I have symptoms of cervical cancer?

If you have any of the symptoms mentioned above or changes in your body that you are worried about, it’s important for you to see a gynecological oncologist. Getting your symptoms checked at the earliest and sooner cancer is diagnosed; the more likely you are to recover from it.

What test will be required for diagnosis?

 1. To confirm the diagnosis

  • Doctor will usually do a vaginal examination (internal examination) if you have symptoms that may possibly be like cervical cancer.
  • If she sees an abnormal cervix a small biopsy may be taken to confirm the diagnosis.
  • Colposcopy: here doctor uses a large microscope that helps her to look more closely at the surface of your cervix and to check if there are any abnormalities on your cervix.

2. Assessing the extent and spread

  • Once you have been diagnosed to have cervical cancer then further tests may be advised to assess if the cancer has spread to other organs such as: ultrasound scan / CT scan / MRI scan / chest X-ray / blood tests or other tests.
  • This assessment is called staging of the cancer, done to check the extent of cancer spread and to know the stage.

How is cervical cancer treated?

Treatment option will be based on factors like stage of the cancer, age of the patient and whether she wishes to preserve her fertility. The treatment options are as follow:

  • Cone Biopsy: A portion of the neck of the womb (cervix) is removed in the shape of a cone. This treatment is offered to women who are in early stages of cervical cancer.

  • Radial Trachelectomy: This mode of treatment is offered to women who have very early stage of cervical cancer and wish to retain their womb to become pregnant. This is a surgical technique that involves removal of only the neck of the womb (cervix) along with surrounding tissue (parametrium) leaving behind the uterus (womb), hence gives an opportunity for you to become pregnant. This surgery can be performed through keyhole or open surgery.

  • Simple Hysterectomy: This mode of treatment is offered to women who have very early stage of cervical cancer and do not wish to retain their womb. In simple hysterectomy, the entire uterus and cervix, both ovaries and the tubes are removed. It is performed either by vaginal route, keyhole surgery (laparoscopic or robotic) or open surgery.
  • Radical Hysterectomy: If you are in stage 1 you will be advise to have radical hysterectomy (womb, cervix, both ovaries and tubes) along with lymph glands and surrounding tissues (parametrium) will be removed. This can be either a keyhole surgery (laparoscopic or robotic) or an open surgery.

In some cases radiation and or chemotherapy may be required, depending on your stage.

Radiation

Radiation is a machine, which uses high-energy X-rays to kill cancer cells and stop their growth. There are two ways of having radiation treatments:

  • Brachytherapy: you get radiation through your vagina.
  • External beam radiation therapy: radiation is given from above your tummy.

Chemotherapy

  • In chemotherapy medicines are used to kill or slow the growth of cancerous cells. It’s usually given through an IV injection.
  • You will be told that you need chemotherapy with radiation; this type of treatment is called chemo-radiation.
  • Adding chemo during radiation makes the radiation to be more effective. You might also get only chemotherapy treatment if your cancer has spread to other organs.

Follow-up after treatment

You should strictly follow-up with your doctor as per their advice. In addition to receiving treatment for cervical cancer your success of treatment will depend only when you have regular follow-up.

To know more about Cervical cancer & Treatment options : www.drranibhat.com/treatment/gynecologic-oncology-conditions/cervical-cancer/