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Cervical Cancer

Cervical Cancer

Chronic Human Papillomavirus (HPV) infection is identified as the causative factor for more than 90% of cervical cancer cases. Regular screening reduces the cervical cancer risk.

Overview

Cervical cancer arises from the cells lining the cervix, which is an opening between the vagina and the womb. Cervical cancer is the second most common cancer and accounts for 22.86% of the total cancer burden among Indian women. It is most commonly seen among women who are in their 30s and 40s.
 
Chronic Human Papillomavirus (HPV) infection is identified as the causative factor for more than 90% of cervical cancer cases. More than 100 types of Human Papillomavirus have been identified, and of these, about 15 of them are high-risk types with the potential to cause various types of anogenital cancers, namely cervical, vulval, vaginal, anal and penile cancers, along with oropharyngeal cancers. 
 
Of all, HPV-16 and HPV-18 types are observed to cause 70% of cervical cancer cases and precancerous lesions.

Types

Based on the type of cell that it originates from, cervical cancer is categorised into two types:

1. Squamous cell carcinoma: This is the most common type of cervical cancer. This arises from the skin-like cells (squamous) that line the cervix.

2.  Adenocarcinoma: This is a rare form of cervical cancer that forms in the glandular cells (cells producing mucus) within the cervical canal.

Symptoms

Cervical cancer is a slow-growing cancer, which is reported to take 10-20 years to develop. In the early stages, it may not have any symptoms. As the disease progresses, the symptoms become apparent. Of all, vaginal bleeding is the first symptom to appear. Other symptoms of cervical cancer include:

  • Intermenstrual bleeding (bleeding between normal periods)
  • Bleeding after sexual intercourse (post-coital bleeding)
  • Vaginal discharge with an unpleasant odour 
  • Discomfort or pain during sex

The above symptoms are associated with other common and less severe conditions too. Therefore, if any of these symptoms are seen, women must immediately see their doctor for appropriate intervention.

Causes

In most cases, cervical cancers are caused due to Human papillomavirus or HPV infection, which is a common infection of the reproductive tract in women. HPV infection is largely transmitted through sexual contact. Most of these infections and the precancerous lesions that are caused due to the infection clear up spontaneously through the body’s natural defence mechanism. In a few cases, however, HPV infections become chronic and cause precancerous lesions, which eventually become cervical cancer. Following are other risk factors that are associated with cervical cancer:

  • Weaker Immune System: Women with the weaker immune system are more susceptible to cervical cancer. Having HIV or other immunocompromised conditions may be associated with increased cervical cancer risk.
  • Smoking: The risk of cervical cancer is reported to be two times higher among women who smoke. Smoking also leads to compromised immunity, which is also a risk factor.
  • Age: The risk of developing cervical cancer increases with age. It is mostly diagnosed among women aged between 35 and 44. Around 20% of the cases are seen among women aged over 65.
 
Poor hygiene, a history of chlamydia infection or herpes, family history of cervical cancer, socioeconomic factors, excessive usage of oral contraceptives and a diet low in fruits and vegetables are other risk factors that are associated with cervical cancer.

Diagnosis

There are various methods to detect and diagnose cervical cancer:
 
a. Physical Examination: To start off, the doctor may recommend a vaginal examination to check for the signs of cervical cancer. If an abnormal growth is suspected, additional tests may be recommended. 
 
b. Colposcopy: This procedure assists a more detailed examination of the cervix. A special tool called a speculum is inserted into the vagina to get a magnified view of the cervical wall. If precancerous lesions are observed during this procedure, a sample for biopsy may also be collected.
 
c. Biopsy: Biopsy may help in arriving at a definitive diagnosis. The sample collected is examined under the microscope to check if the cells are cancerous. 
 
d. Imaging tests: If cancerous growth is confirmed during the biopsy, the doctor may recommend a few imaging tests to understand the extent of the disease. Commonly recommended imaging tests include CT scan, MRI scan, chest X-ray and ultrasound scan. Blood tests may also be recommended along with these tests.

Treatment

Different treatment options available for cervical cancer management include surgery, radiation therapy and systemic therapies, such as chemotherapy, immunotherapy and targeted therapy. The treatment plan is made based on the stage and nature of the disease and the overall condition of the patient.
 
a. Surgery: Surgery is the main line of treatment for cervical cancers.
 
  • Removing the tumour only: In the early stages of cervical cancer, the disease can be successfully managed by operating the tumour along with a small portion of healthy tissues surrounding it. This treatment option preserves fertility.
  • Trachelectomy (removal of the cervix): A few early-stage cervical cancers are treated through trachelectomy or the removal of the entire cervix with some surrounding tissue. However, the uterus remains intact, and women may have no problems getting pregnant after this procedure.
  • Hysterectomy (removal of cervix and uterus): This procedure removes the cervix, uterus, part of the vagina and nearby lymph nodes. This procedure reduces the risk of recurrence. 
  • Palliative surgery: This surgery is recommended in advanced stages in order to ease the pain and other symptoms caused by the disease. The main goal of this surgery is to improve the quality of life for patients.
 
b. Radiation Therapy: Radiation therapy is used to destroy the cancer cells by delivering high-energy radiation beams towards them. The radiation destroys the DNA structure and stops the cancer cells from growing and multiplying. Radiation therapy may be recommended externally (through linear accelerator) or internally (brachytherapy). It may also be recommended to ease the symptoms of the disease in advanced stages.
 
c. Systemic Therapy: Systemic therapies are administered to find and attack tumours throughout the body including the ones that are too small to detect. These are usually recommended in advanced stages.
 
  • Chemotherapy uses anti-cancer drugs which destroy the tumour cells by stopping their growth and multiplication. Lately, concomitant chemoradiotherapy is being widely preferred for cervical cancer management.
  • Immunotherapy uses the body’s own immune cells to launch an attack against cancer cells. During this procedure, the immune cells are extracted and modified to identify the cancer cells and attack them.
  • Targeted therapy destroys the tumour cells by targeting cancer-specific genes, proteins or the cellular environment that are contributing to tumour growth and survival. Through its precise approach, it reduces damage to healthy tissues.

Frequently Asked Questions

1. Is cervical cancer common in India?
 
Cervical cancer is one of the most common cancers among Indian women. This is largely due to the higher prevalence of HPV infection and lack of screening. 
 
2. Can cervical cancers be prevented?
 
Despite being most common, cervical cancer is one of the easily preventable cancers. Preventive measures such as vaccination and screening can help in reducing one’s risk of developing cervical cancer.
 
Getting vaccinated against HPV reduces one’s risk of developing HPV infection and cervical cancer as well. Although vaccination reduces one’s cervical cancer risk remarkably, it does not offer 100% protection, and therefore, screening is necessary.
 
Screening is another method to reduce your cervical cancer risk. Screening tests available for cervical cancer include Pap test and colposcopy. Pap test is the common screening method wherein the cervical cells are collected using a specialised instrument called the Ayre’s spatula and examined under the microscope for any abnormalities.
 
Another test used for cervical cancer screening is colposcopy. During the procedure, a special instrument known as a colposcope is used to get a lighted and magnified view of the cervix lining. This procedure helps doctors have a closer look at the cervix and find if there are any abnormal lesions.
 
If abnormalities are found, the doctor may recommend additional tests; and if there are no abnormalities found, you will be asked to continue with the screening at the said interval.
 
3. Are cervical cancers treatable?
 
Yes, cervical cancers are treatable. Cervical cancer is one of the slow-growing cancers and can be detected in the early stages.
 
Multiple treatment options available for cervical cancer include surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy.
 
4. Do oral contraceptives cause cervical cancer?
 
Yes, reports suggest that prolonged usage of oral contraceptives increase the risk of cervical cancer development. However, this risk may decline if the usage of oral contraceptives is reduced or stopped.
 
5. Is brachytherapy effective for cervical cancers?
 
Yes, brachytherapy is extremely effective for cervical cancers. In fact, in a few cases, early-stage cervical cancers can be treated with brachytherapy alone.