Cervical Cancer

Cervical cancer is the second-most common cancer in women around the world.  Cervical cancer can occur at all ages, but commonly seen in women between the ages of 30 and 45 years. Most cases of cervical cancer are due to a common sexually transmitted infection called human papilloma virus (HPV). The virus affects the cells cervix causingsome change and these changes can be picked up on screening such as Pap smear. If these changes are not identified and treated, then over a period of time they can turn into cancer. Cervical cancer is only cancer that can be prevented with vaccination and with a regular screening test.

Where is cervix situated in the body?

Cervix, also known as the neck of the womb and is the lowermost part of the womb (uterus).

Cervix is a tubular structure and has two parts – ectocervix & endocervix. It also has two openings known as internal & external os/orifices.

The cells lining the ectocervix is known as Squamous epithelial cells and the cells lining then endocervix is known as glandular cells.

Cancer arising from the squamous epithelial cells is known as squamous cell carcinoma (SCC) and cancer form glandular cells is known as adenocarcinoma.

What are the causes?
  1. It is caused by a simple viral infection called Human Papillomavirus infection (HPV), thereare many strains but in particular, HPV 16 and HPV 18, are found in over 99% of cervicalcancers. This is a common infection seen in the majority of sexually active women. This infection gets cleared on its own and doesn’t require any treatment. Sometimes this virus doesn’t clear from your body and can stay for a long duration of time and causes changes in the cervix and can eventually lead to cervical cancer.

  2. Women with many sexual partners, or whose partners have had many partners, are more at risk of developing                       cervical cancer.

  3. Women who started having sexual intercourse at a very early age.

  4. Women with a history of sexually transmitted diseases.

  5. Women who give birth at an early age.

  6. Long term use of oral contraceptives increases the risk of developing cervical cancer (≥5-8 years), consult your                

      doctor when you are taking oral contraceptive pills.

  7. Women who have low immunity (for example, those who are taking immunosuppressive drugs after kidney / liver            

     transplant or women who are HIV positive) may be at increased risk of developing cervical cancer.

  8.Women who smoke are about twice more likely to develop cervical cancer than non-smokers. In particular, if            you smoke and have HPV infection, the risk is greater, because smoking suppresses your                  

     immune system allowing the persistence of HPV infection.

  9.The biggest risk factor is non-attendance for cervical cancer screening. 

What are the symptoms?
  1. In initial stages you may have no symptoms at all.

  2. As cancer advances, you may have abnormal vaginal bleeding
    such as:

    • Bleeding between normal periods (intermenstrual
      bleeding).

    • Bleeding after having sex (postcoital bleeding).

    • Bleeding after menopause (stopping of monthly menses
      for more than one year).

  3. Sometimes an early symptom could be vaginal discharge that smells unpleasant and tinged with blood.

  4. If cancer spreads to other parts of the body, various other symptoms can develop.

What tests will be required for diagnosis?
  1. To confirm the diagnosis:

    • The 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 will be taken to confirm the diagnosis.

  2. Assessing the extent and spread:

    • Once you have been diagnosed to have cervical cancer then further tests may be advised to assess if cancer has spread to other organs such as, an ultrasound scan, a CT scan, an MRI scan, a chest X-ray, blood tests, or other tests.

    • This assessment is called the staging of cancer, done to assess the extent of the spread of cancer.

What are the treatment options?

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 follows:

Surgery:

  • 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 along with surrounding tissue leaving behind the womb, hence gives you an opportunity for you to become pregnant. This surgery can be performed through keyhole or open surgery.

  • Total Hysterectomy with bilateral salpingo-oophorectomy: 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 total hysterectomy, the entire uterus and cervix, both ovaries and the tubes are removed. It is performed either by vaginal route, keyhole surgery (laparoscopic or laparoscopic assisted robotic) or open surgery.

  • Radial Hysterectomy with bilateral salpingo-oophorectomy: If you are in stage 1 you will be advised to have radial hysterectomy (womb, cervix, both ovaries and tubes) along with lymph glands and surrounding tissues (parametrium) will be removed. 

These surgeries can be performed either by a keyhole surgery (laparoscopic or laparoscopic assisted robotic) or an open surgery.

Open Surgery

Laparoscopic Surgery

Robotic Surgery

Radiation Therapy: 
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: Radiation is given through your vagina.

  • External beam radiation therapy: radiation is given from above your tummy.

Chemotherapy:

  • In chemotherapy treatment drugs 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 chemo with radiation; this type of treatment is called chemo radiation. Adding chemotherapy 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.

Can we prevent cervical cancer?

 Yes and this is the only cancer that can be prevented by 

  • Taking HPV vaccination

  • Going for regular Pap smear test

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