About Author: Dr Mehul Bhansali, Director & Senior Consultant Surgical Oncologist, Jaslok Hospital & Research Centre, Mumbai. With over 30 years of overall experience, Dr Bhansali is an honorary Consultant in surgical Oncosurgery. He has been attached to Jaslok Hospital since 1997. After finishing his MS general Surgery from KEM he underwent Oncosurgery training from the TATA memorial hospital for 8 years. Has many publications to his name in various national and international journals.
Cervical cancer is a cancer arising from the cervix which is the part of the body in a woman that connects the uterus (womb) to the birth canal. It usually starts in the area called as transformation zone which is the junction between the endocervix and the outer part of the cervix. This area is usually very susceptible to wear and tear especially with multiple births and various other factors.
Cervical cancer is one of the commonest cancers in India and globally it is the fourth most common cancer. It is often associated with poor hygiene and seen more commonly seen in the lower- and middle-income countries.
There are a variety of risk factors that predisposes women to develop cancer of cervix. The following are few of them –
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HPV virus infection – HPV 16 and 18 are the most common types of HPV virus associated with causing ca cervix. It accounts for 95% of the cases of ca cervix. The human papilloma virus usually does not cause any symptoms and most women do get infection at some point in their life and most of the times this virus may get cleared on its own as well (90%) but many times when it does not, it leads to cancer of the cervix.
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HIV virus is also a strong associated cause in ca cervix. A woman with HIV virus is 6 times more prone to develop cervical cancer compared to a woman without HIV. It accounts for 5% of cervical cancer cases. It usually takes 15 to 20 years to develop cervical cancer in a woman with normal immunity but this period shortens to 5 to 10 years in women with weakened immune system as seen in HIV infection.
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Smoking tobacco causes increased cervical cancers too.
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The other risk factors are multiparity, i.e giving birth to 4 or more children.
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Multiple sexual partners as this predisposes one to higher chance of getting HPV infections in addition to other STDs as well.
Symptoms of Cervical Cancer
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Post coital bleeding – bleeding after intercourse is a characteristic symptom in cervical cancers. Other than this, there can be bleeding in between periods of unusually heavy bleeding as well.
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Discharge – may be blood stained or foul smelling many times due to secondary bacterial infections.
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There may be increased tiredness and fatigue. This is mainly due to the constant blood loss that makes the woman anaemic due to low haemoglobin.
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In advanced cases, there may be lower abdominal pain or a dragging sort of pain. Sometimes the lady can also have lower backpain as well.
Diagnosis
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Pap smear – This is a very simple test where in the cells from the cervix are taken by a spatula and examined under the microscope to see any pre-cancerous or cancerous cells by a pathologist. It is an excellent modality for screening for cervical cancer as well. It helps in detecting pre-cancerous growths as well called as Carcinoma intraepithelial neoplasia (CIN)
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Biopsy – This is the examination of tissue removed from the growth and helps in confirming the tissue diagnosis to establish cancer of the cervix.
The other investigations are the imaging modalities- MRI of the pelvis to understand the exact spread and extent of the disease in the pelvis. The other imaging used commonly is Ultrasonography and CTscan of abdomen and pelvis to see the local spread of the disease.
Treatment
Very early diseases can be removed surgically and then the patient is kept on routine follow ups. The surgery is a Radical Hysterectomy. This surgery can also be done laparoscopically depending on the surgical expertise available.
The diseases of stage 1B2 onwards are good candidates for radical radiotherapy along with concurrent chemotherapy (usually given in the day care and a minor chemotherapy) along with the external radiation. These days are excellent radiation techniques like Rapidarc and VMAT techniques that help in delivering very focused and precise radiation to the target and at the same time sparing the normal surrounding structures. This helps in better disease control and minimal side effects thereby improving the quality of life of patients.
Cancer of the cervix is a very treatable disease even in the advanced cases and hence it is very important to know the early signs and symptoms of this disease for better outcomes and cure.
Prevention
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HPV vaccination – This is one of the most important prevention strategies because 90 to 95 percent of cervical cancers are due to HPV viruses and hence HPV vaccine helps to prevent cancer in this subset of patients. The ideal age to get vaccinated as per WHO is 9 to 26 years, ideally before sexual exposure happens. Gardasil and Cervarix are the vaccines available against HPV
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Living a healthy lifestyle is of utmost importance. Avoiding smoking is essential to prevent cervical cancer.
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Safe sexual practices and using barrier methods of contraception (condom) is very important to prevent HPV virus infection as well as HIV and other STDs.
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Eating healthy food rich in fruits, vegetables and antioxidants also does give some protection against developing cancers.
