Cervical cancer is the second most common cancer among Indian women (as per GLOBOCAN 2018).
Cervical cancer is a highly preventable and curable disease since it has a well defined long pre-malignant phase which can be detected by regular screening and follow-up. Unfortunately, most women in India are unaware about the screening.
What is Cervix?
Cervix is the lower part of uterus (womb). Cervix connects the body of the uterus to vagina (birth canal). It is 2-3 cm in length.
Who are at Risk?
All women are at risk for cervical cancer. It occurs most often in women over age 30. Each year, approximately 96,322 women in India get cervical cancer.
The Human Papilloma Virus (HPV) is the main cause of cancer. HPV is transmitted through sexual route. Most sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.
Factors which increase the risk of Cervical cancer are:
Multiple sexual partners
Early age at first sexual activity
Multiple pregnancies/child births (three or more)
Immunocompromised states (like HIV, other STDs
How can it be prevented?
Cervical cancer can be prevented by :
being aware of the risks factors (avoid smoking, use condom during sex, limit your number of sexual partners)
Vaccination against HPV
Regular screening with Pap testing.
HPV vaccine protects against the types of HPV that most often cause cervical cancer. It is recommended for pre-teens (both boys and girls) aged 11 to 12 years, but can be given as early as age 9 and until age 26. The vaccine is given in a series of either two or three shots, depending on age. It is important to note that even women who are vaccinated against HPV need to have regular Pap tests to screen for cervical cancer.
Are there any tests for screening and early detection?
There are two tests that can help prevent cervical cancer or detect it at an early stage:
Pap Smear – This test looks for changes in cells and identifies pre-cancerous lesions or detects cancer in early stage.
HPV test- Detects HPV (virus) that causes precancerous cell changes and cervical cancer.
You should get your first Pap test at age 21. If your test result is normal, you can wait three years for your next test.
If you’re 30 years old or older, you have three options:
You can continue getting a Pap test only. If your test result is normal, you can wait three years for your next test.
You can get an HPV test only. If your test result is normal, you can wait five years for your next test.
You can get both an HPV and Pap test together. If your test results are normal, you can wait five years for your next tests.
What are the common signs and symptoms?
Abnormal vaginal bleeding (bleeding during or after sexual inter-course, in-between periods or in post-menopausal bleeding)
Foul smelling vaginal discharge
Low back pain
See your doctor if you have any of the above symptoms. However, having these symptoms does not necessarily mean you have cervical cancer!
How can it be diagnosed?
If any of the screening tests are found to be positive or if you have symptoms and signs which indicate cervical cancer, then you would need to undergo a pelvic examination by an oncologist or a gyanecologist followed by certain investigations:
Colposcopy: Procedure in which a colposcope (light, magnifying instrument) is used to inspect vagina/cervix for abnormal areas.
Biopsy: Biopsy is done from the visualized abnormal areas in the cervix to confirm the diagnosis of cancer.
Imaging studies: like CT scan, MRI or PET CT scan are usually done to find the extent of disease and for staging.
What are the treatment options?
Treatment of cervical cancer requires multi-disciplinary approach. Depending on the type and stage of your cancer, you may need more than one type of treatment. For the earliest stages of cervical cancer, either surgery or radiation combined with chemo may be used. For later stages, radiation combined with chemo is usually the main treatment. Chemo (by itself) is often used to treat advanced cervical cancer.
What are the Survival rates?
Cervical cancer is a highly curable disease when detected early with 5 year survival rates as follows:
Very Early stage (Stage 0)- > 90%
Early stage (Stage I and II)- 60 to 90%
Advanced Stage (Stage III and IV)- 15 to 35%
What are the survivorship issues during and after treatment of cervical cancer?
Diagnosis of cancer can be very stressful. Learning more and connecting with people with similar illness can be helpful. Certain issues like infertility may occur as part of treatment (due to surgery, radiation, chemotherapy) and fertility preservation approaches can be explored after discussion with the doctors. Post treatment side-effects like impairment of sexual activity, loss of libido etc may occur, however there are ways to overcome these side-effects and such issues should be discussed openly with the doctors.
Some cancers can come back or recur after treatment. The odds of this happening depend on many factors, including the stage of cancer. Thus regular long-term follow up is necessary following treatment.
What can you do to spread awareness?
As someone who is interested in educating and spreading awareness regarding cervical cancer you can do a lot!
Correct and useful information can be sought at reliable internet sites like nccc-online.org, cdc.gov, cancer.org etc.
By being self-aware you can share and disseminate information. You can encourage family and friends to seek information from various sources. You can also volunteer to be a part of awareness programmes and organisations and do your bit to prevent and spread awareness against cervical cancer!
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