Cervical cancer is one of the commonest malignancies in Indian women, approximately one lakh new cases being diagnosed every year in our country. Before cervical cancer appears, the cells of the cervix go through precancerous changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. An annual Pap test looks for changes in cervical cells that can lead to cervical cancer. Through increased use of the Pap test, the cervical cancer death rate has greatly declined.
Cervical Cancer Symptoms
In its earliest stages, cervical cancer usually does not display any symptoms, which is why regular Pap tests are so important, particularly for sexually active women. Inform your doctor immediately if you experience any of the following symptoms:
- Vaginal discharge tinged with blood
- Bleeding after sexual intercourse
- Abnormal bleeding: after menopause, between menstrual periods or excessively heavy periods
- Increased urinary frequency
- Swollen leg (seen in more advanced cases)
Risk Factors for Cervical Cancer
Cancer of the cervix is highly preventable. Regular Pap smears not only detect cancerous cells, but also abnormal changes in the cervix that can eventually progress to cancer over a period of 10 to 15 years. A sexually transmitted virus called the human papilloma virus (HPV) causes almost all cases of cervical cancer. HPV usually goes away by itself, and most people with HPV never even know they have it. And while experts point out that most women infected with HPV will not develop cervical cancer, doctors urge women to be aware of that risk, and to get Pap smears regularly.
Other Risk Factors Include:
The risk of cervical cancer increases with age and most often is diagnosed in women over the age of 40. However, younger women are often diagnosed with precancerous lesions that require treatment to prevent cancer.
Cigarette smoke contains chemicals that damage the body’s cells. It increases the risk of precancerous changes in the cervix, especially in women with HPV.
Certain types of sexual activity may increase a risk of getting HPV infection such as multiple sexual partners, or high-risk male partners, first intercourse at an early age and using non-barrier birth control methods.
Lack of regular Pap tests
Cervical cancer is more common among women who have no prior Pap smear screening. The Pap test helps doctors find precancerous cells.
Sexually transmitted diseases
Women with an STD have a higher risk of cervical cancer.
Diethylstilbestrol (DES) exposure before birth
Weakened immune system
Women who have undergone an organ transplant or take steroids for other reasons have a higher than average risk of developing cervical cancer.
Cervical Cancer Prevention
- HPV vaccines have the potential for preventing cervical cancer. Routine vaccination is recommended for females ages 11 to 26. The vaccine is most effective when given to girls between the ages of 11 to 12. Three doses of the vaccine are given by injection during a six-month period.
- A Pap test, often called a Pap smear, is a screening procedure used to detect abnormal cells in and around the cervix. In this test, the doctor uses a stick or brush to take a few cells from the cervix. An abnormal result could mean inflammation of the cervix, trichomonas or yeast infection, or other causes. In postmenopausal women, the Pap test could detect abnormal glandular cells that could indicate endometrial cancer. Women should have a Pap test beginning three years after starting vaginal intercourse and no later than age 21. At age 30, women with three or more consecutive exams with normal results may have a Pap smear performed less frequently. This is dependent on risk factors and should be discussed with the doctor. Women who have been treated for cervical dysplasia (a precancerous lesion) or cancer may need to have a Pap smear more frequently if recommended by the doctor.
Cervical Cancer Detection
Because cervical cancer is highly treatable when detected in an early stage, many studies are looking at developing better ways to detect cervical cancer, such as fluorescent spectroscopy. This method uses fluorescent light to detect changes in precancerous cells in the cervix.
Tests & Procedures
If you have symptoms or Pap test results that suggest precancerous cells or cancer of the cervix, your doctor will suggest other procedures to make a diagnosis. The first step is usually colposcopy, in which the doctor examines the cells of the cervix more closely. Another common test to more closely examine the cells is a biopsy, in which a sample of cervical cells is taken for examination.
Colposcopy is a diagnostic test used to evaluate an area of abnormal tissue on the cervix, vagina, or vulva using an instrument called a colposcope. It magnifies tissue so a healthcare practitioner can see abnormalities that cannot be seen with the naked eye.
In a biopsy, your doctor removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells. Most women have the biopsy in the doctor’s office, and no anesthesia is needed.
Cystoscopy and Proctoscopy
If advanced cancer is diagnosed and your doctor suspects the cancer may have spread beyond the cervix, a cytoscopy or proctoscopy may be done using a lighted tube to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).
To learn more about the extent of disease and suggest a course of treatment, the doctor may order some of the following imaging tests: Chest X-ray:
This is a picture of the chest that shows your heart, lungs, airway, blood vessels and lymph nodes. A chest X-ray can often show whether cancer has spread to the lungs.
Computed Tomography (CT) scan
This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease outside the cervix or abnormal organ structure. CT scans also can be used to guide a needle into a mass if a biopsy is needed.
Magnetic resonance imaging (MRI)
This diagnostic test uses magnetic fields and radio waves to create computerized pictures of the pelvis and abdomen. You may have to be placed in a tube, which can feel confining to people who have a fear of enclosed spaces. Treatment of cervical cancer will depend on a number of factors, including:
- The stage of the cancer
- The size of the tumor
- The patient’s desire to have children
- The patient’s age and overall health
Small Precancerous Lesions
Cryotherapy, Laser Surgery, Cone or Simple Hysterectomy may be used for precancerous lesions or for cancerous tissue that has not spread beyond the cervix.
Large Cervical Cancer Lesions
The following surgical procedures may be used for larger cervical cancer lesions (usually up to four to five centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.
This procedure removes the cervix and surrounding tissue but not the uterus. It is used for women who have a larger cancerous area but wish to preserve the ability to have children. The procedure may include removal of lymph nodes. Typically patients considered for this procedure have to have tumors less than two centimeters in size.
The surgeon removes the cervix, uterus, part of the vagina and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes. Depending on a woman’s age and the size of the tumor, she may also have a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes).
Radiation therapy is used for cancers that have spread beyond the cervix (II, III or IV) or very large lesions (larger than four centimeters). Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Radiation therapy is used instead of surgery in most cases. However, it is sometimes necessary after surgery if it is discovered that the cancer has spread outside the cervix, or to reduce the risk that a cancer will come back after surgery. There are two types of radiation therapy:
External radiation therapy
uses a machine outside the body to send radiation toward the cervical cancer. With the availability of advanced, sophisticated techniques like Intensity Modulated Radiotherapy (IMRT), High Definition Rapid Arc (VMAT), the probability and incidence of acute and late radiation related sequelae has reduced considerably, thereby improving patient’s compliance and cure rates.
Internal radiation therapy (Brachytherapy)
Internal radiation therapy uses a small amount of radioactive material that is delivered directly to the tumor using pellets or implants. Radioactive source is inserted through the vagina into the cervix, where they are placed next to the tumor while the patient is under anesthesia.
Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit using systemic chemotherapy. The drugs enter the bloodstream and can reach cancer cells throughout the body. Almost all cervical cancer patients in good medical condition who are receiving radiation for stage IIA or higher, will be offered chemotherapy in addition to radiation therapy.