Cervical cancer usually develops in the cervix, which the narrow entrance of the womb. The cervix is a part of the lower uterus.

The American Cancer Society predicted that doctors are likely to make 13,170 new cervical cancer diagnoses by the end of 2019 in the USA. They further also added that over 4,200 women in the US are estimated to die from cervical cancer in 2019.

Human papillomavirus (HPV) is the most common identifiable cause in the majority of cervical cancer cases. The HPV vaccine is effective in preventing Human papillomavirus, but not all types of HPV.

The CDC (Centers for Disease Control and Prevention) has recommended people from 9-26 years of age to get this vaccine. However, now CDC has advised vaccine for even men and women aged 26-45 years who didn’t take the vaccine during their preteens.

This article is drafted to spread awareness about cervical cancer, as not much females seem to know about it, in comparison to other forms of cancer. To spread more light on the topic, we sat with Dr Kapil Kumar the Director and HOD of the surgical oncology department at Fortis Hospital, Shalimar Bagh in New Delhi.

Early Signs & Symptoms of Cervical Cancer

Most patients are likely to experience no symptoms in the early stages, so it is recommended that women get regular Pap tests or cervical smear test.

A Pap test is a form of preventive measure. It helps indicate and identify the changes in the cervix cells that can possibly be concerning.

If patients do experience some signs, they might include:

• Constant pelvic pain (usually pelvic pain is an alarming sign for cervical cancer or any other condition)
• Bleeding between periods
• Discomfort or pain during sexual intercourse
• Bleeding after coitus
• Post-menopausal bleeding in women
• A strong odor of vaginal discharge
• Blood tinged vaginal discharge
• These symptoms can be caused due to other infections. People experiencing these symptoms should consult a doctor.

Stages

Cancer staging is an important part of treatment as it helps in selecting the most effective technique for treating it.

Staging aims to evaluate where cancer has spread and if it is affecting the distant organs or nearby structures.

The adversity of cervical cancer is categorized through a 0-4 stage system:

Stage 0: Precancerous cells are present in the body.

Stage 1: Cancer cells are growing from the surface and invading cervix’s deeper tissues, possibly getting into the uterus or nearby lymph nodes

Stage 2: Carcinoma cells have moved outside the cervix and uterus, but haven’t affected the pelvis walls or vagina’s lower regions. In this stage, it might or might not have affected the nearby lymph nodes.

Stage 3: Cancer cells have reached to the vagina’s lower region and the pelvis walls, and it might have started blocking the ureters and the tubes connected to the bladder that carry the urine. It might or might not have affected the nearby lymph nodes.

Stage 4:Cancer has attacked the rectum or the bladder and is spreading out from the pelvis. It might or might have attacked the nearby lymph nodes. Over time in stage 4, cancer will spread in distant organs, including the bones, lungs, lymph nodes and liver.

Undergoing screening and receiving proper medical attention in early stages can help in increasing a patient’s chances of survival.

Causes

Cancer is caused because of uncontrolled growth and division of abnormal cells in the body. The cells have a set lifespan; the body automatically produces new cells for replacing old cells when they die.

Abnormal cells have two characteristics that make them interfere with the body’s healthy functionality:

Unlike healthy cells they don’t die

And they keep multiplying

This eventually leads to the excessive buildup of abnormal cells, that result in the development of a tumor or lump. Despite years of research, scientists are still unable to find the exact reason why these cells become cancerous, but fortunately, they are able to find effective treatments to control and cure cancer.

Few risk factors may increase a person’s risk of getting cervical cancer, which might include:

HPV: aka human papillomavirus is a type of sexually transmitted virus. There are over 100 types of identified HPV that affect humans, and at least 13 types amongst them can cause cervical cancer.

Indulging in sexual intercourse at a young age or having multiple sex partners: Cancer-causing human papillomavirus' are mostly transmitted through sexual contact with a person who has HPV. Women with multiple sex partners have a higher risk of getting an HPV infection, which eventually increases the risk of cervical cancer in them.

Smoking: can make people more prone to different types of cancers including cervical cancer.

Aweak immune system: HIV patients are prone to have cancer, due to the low quantity of immune cells in their body. The risk of cervical cancer is also higher in patients who have undergone organ transplantation, as they take high doses of immunosuppressive medications that prevent the immune system from reacting to the new organ negatively, by suppressing the immune system.

Birth control pills: Use of contraceptive pills for long-term can slightly increase a woman's risk to develop the disease.

Other STD(s) (sexually transmitted diseases): might include Chlamydia, syphilis and gonorrhea that can also increase the danger of cervical cancer.

Socio-economic status: Cervical cancer cases are more common in areas with lower income rates.

Age: Women above the age of 45 have a higher risk of developing cervical cancer.

Treatment

Treatment options for cervical cancer  might include chemotherapy, radiotherapy, and surgery, or a combination of these.

The selection of the treatment is decided by the doctors after consulting a team of specialists from different departments analyzing several factors like the age, current health, medical history and stage of cancer among others.

Good success rates can be achieved through treatment if the cancer is diagnosed at an early stage when it is limited to the cervix than at a later stage when it has spread in other organs.

Treatment Options for Early-stage

Surgery is an effective method for treating cancer if the cells are limited to the cervix. Radiation or chemotherapy may be used post-surgery if doctors believe the ubiquity of cancer cells in the cervix.

Adjuvant therapy reduces the risk of recurrence, maximizing treatment’s effectiveness. In some cases, surgeons also use chemotherapy post-surgery for shrinking the size of the tumor although it is rarely used.

Treatment for advanced cervical cancer

Surgery is rarely an option if the cancer cells have spread outside the cervix.

The advanced stage of cancer is also referred to as invasive cancer, as it has invaded other organs of the body. Advanced stages require more extensive treatment approaches that usually involve one or a combination of chemotherapy and radiotherapy.

For the later stages, cancer specialists provide palliative therapy for relieving cancer symptoms and improving patient’s quality of life.

Radiation therapy (XRT or Radiation Oncology)

Radiation therapy usesx-ray beams that are delivered on the target through a machine. These high energy beams attack the cancer cells. This technique is used for treating more advanced forms of the disease.

When treating cervix cancer, the oncologist will aim the radiation machine at the patient’s pelvic area. The beams can also cause side effects, that may or may not emerge during or after the treatment.

Side-Effects

• Diarrhea
• Upset stomach
• Bladder irritation
• Nausea
• Vaginal narrowing
• Early menopause
• Interrupted menstrual cycle

Chemotherapy

Chemotherapy utilizes chemicals (medication) for treating the disease, by preventing their growth and destroying them in the process. Chemotherapy is used by oncologists for targeting cells that were not removed via surgery or for helping patients with the symptoms of advanced cancer.

Side-Effects

The side effects experience because of the use of chemotherapy are subject to vary depending on the drug used by the patient. But some of them might include:

• Nausea
• Diarrhea
• Hair loss
• Fatigue
• Infertility
• Early menopause

Cervical cancer clinical trials

Some people might end-up finding the best treatment for themselves by participating in a government authorized clinical trials.

Clinical trials help the research process. Researchers use new approaches on cancer patients for determining the effectiveness and safety of new treatments and if they work better compared to the existing ones. By participating in clinical trials, patients contribute to innovation in cancer research, while increasing their chances of getting a cure.

Prevention

Following preventive measures are useful for reducing the risk of cervix cancer:

HPV (Human Papillomavirus) Vaccine

Research shows an apparent link between some forms of Human Papillomavirus and cervical cancer development. If females keep up with the present HPV vaccination programs, they can easily reduce the frequency of risk of cervical cancer.

Safe sex

The HPV vaccine is only effective in protecting people against two types of HPV strains. Other strains may also cause cervical cancer. Indulging in sexual intercourse using protection can help prevent HPV infection.

Cervical screening

Regular cervical screening is helpful in identifying cancer at an early stage, allowing patients to receive treatment almost immediately, before the cancer cells spread further in the body.

Note: Screening indicates the changes in the cervix cells; it cannot detect cancer.

Having limited sexual partners

Multiple sexual partners can increase a woman's risk of getting transmitted with the HPV virus that causes cervical cancer.

Avoiding having first sexual intercourse at an early age

Engaging in sexual intercourse from an early age can significantly increase a woman’s risk of HPV infection. Delaying sexual intercourse can help lower this risk.

Quit smoking

Female smokers are more likely to develop HPV and cervical cancer in comparison to the ones who don’t.

Diagnosis

Pap Smear Test

A Pap smear test helps in identifying the early symptoms of cervical cancer. Early diagnosis helps in improving the success rate achieved after treatment.

Women above the age of 30 years and over should regularly get a cervical smear test or Pap test for detecting the early symptoms of uterus or cervix cancer. Usually the medical professional will perform HPV test at the same time as the Pap test.

Cervical smear test

This screening does not identify cancer but is instead used for detecting abnormal changes in the cervix cells. Without proper care and treatment, some of these abnormal cells can become cancerous.

HPV DNA testing

HPV DNA test determines if the patient has a type of HPV that is likely to result in the development of cervical cancer. It is performed by collecting cervix cells for lab testing.

The test detects strains of high-risk HPV in the DNA cells before any anomalies become evident in the cervical cells.

Additional Tests

Additional tests are recommended if the patient has signs of cervical cancer or their Pap test results reveal the growth of abnormal cells in their cervix.

Some of them might include:

Colposcopy: involves visual vaginal examination through a speculum and, a light magnifying instrument, called colposcope.

EUA (Examination under anesthesia): involves a thorough examination of the cervix and vagina by the doctor.

Cone biopsy: involves extraction of a tiny, cone-shaped section from the abnormal tissues of the cervix for the examination.

Biopsy: involves dissection of a small tissue of the cervix or vagina under general anesthesia.

LLETZ: involve diathermy connected to a wire loop that passes electric current which helps in removing the abnormal tissue and collecting it. Later, the removed tissues are sent to the lab for further analysis.

Blood tests: are performed for counting the blood cells for identifying kidney and liver problems.

CT scan: involves the use of barium liquid by the medical professional for highlighting the cellular abnormalities.

MRI: certain types of MRI might help in identifying early stages of cervical cancer.

Pelvic ultrasound: uses high-frequency sound waves for creating an image of the targeted area on a hospital monitor.

Outlook

The stage at which the patient gets diagnosed can indicate their chances of survival for a duration of at least 5 years.

Stage 1: Receiving treatment at early stage 1, can increase survival chances of at least 5 years by 93 percent. In late stage 1 diagnosis, they become 80 percent.

Stage 2: During early stage 2, the chances are 63 percent, that falls down to 58 percent if the patient is diagnosed and treated at the end of stage 2.

Stage 3: During this stage, patients chances of survival fall down from 35 percent to less than 32 percent.

Stage 4: Patients with stage-4 of cervical cancer have only 15 to 16 percent chance of surviving for another 5 years.

Note: These average survival rates have been listed based on studies and do not necessarily apply to everyone, as each case is unique. In some cases, patients are able to survive even after stage 4 cancer.

Cervical Cancer Treatment

“We provide organ based cancer treatment at Fortis Hospital, which can include Head and Neck, Esophagus, Gyneincluding cervix cancer and ovarian cancer etc. Thankfully the number of cervical cancer patients in India is decreasing, but a significant female population in the western world is still afflicted with the disease, which is why so many patients from abroad are coming to India for treatment” (said Dr Kapil Kumar) ,about the cancer treatment option available at the Hospital.

“Mostly cervical cancer is treated using chemotherapy, and for ovarian cancer, a combination of surgery and chemotherapy is used as a treatment” the doctor added.