Cervical cancer is the most common cancer in women in India. Anatomically cervix is the part of female genital system and it is the narrow neck at the lower part of a women’s uterus, just above the vagina. The cervix connects uterus and vagina.
Approximately eight out of ten cervical cancers originate in the surface cells lining the cervix (squamous cell carcinomas). These cancers do not form suddenly. Over time, healthy cervical cells can become abnormal in appearance which is called as dysplasia, although these cells are not cancerous but they can become cancerous. When dysplastic cells become cancerous called as carcinoma in situ (CIS) and this is non invasive cervical cancer. As the cancer cells multiply, some may invade the lining of the cervix, spread to nearby tissues and enter the blood stream or lymphatic system. When this happens it can spread to other parts of body. As it usually takes many years for dysplasia to become carcinoma in situ, it often takes months or years for cervical cancer to become invasive. PAP-test which is highly effective, widely available screening test for cervical cancer and it can be easily diagnosed at precancerous stage.
Risk factors for cervical cancer-
- Poor personal hygiene.
- Onset of sexual activity at early age.
- Many sexual partners.
- Any sexually transmitted diseases such as HIV/AIDS
- Weak immune system
How it presents-
- Abnormal vaginal bleeding usually postcoital.
- Vaginal discomfort
- Malodorous discharge
- Blood in urine
- Passage of stools through vagina
- Leg oedema.
Staging and treatment –
Stage 0 (carcinoma in situ)
Carcinoma in situ (CIS) is the stage in which cancer cells are only in the surface layer of the cervix. Treatment option for CIS includes mainly small less invasive surgeries like laser surgery. For women who wish to have children, treatment with a cone biopsy may be an option. After the woman has finished having children, a hysterectomy is recommended.
Early or locally advanced stage
In this stage can be well treated with external radiotherapy where radiation given along with chemo (concurrent chemoradiation) followed by internal brachytherapy. It can be also treated with surgery but subsequent radiotherapy/chemotherapy can be decided based on biopsy report.
At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy to relieve the symptoms of cancer that has spread to the areas near the cervix or to distant sites (such as the lungs or bone). Chemo is often recommended.
Prevention of cervical cancer:
Cervix carcinoma vaccines are available under many trade names. These vaccines prevent infection by certain types of human papilloma viruses(HPV). Available vaccines protect against either two or four types of HPV strains. All vaccines protect against at least HPV 16, 18 that causes greatest risk of cervical cancer. It is estimated that they may prevent 70% of cervical cancer, they are also effective against some genital warts (HPV4 and 9). The vaccines require two or three doses depending on how old the person is. Vaccinating girls around the age of nine to twenty five is typically recommended and it provides protection for at least eight years. In those already infected, vaccine does not help.