Cervical Cancer

Overview—Cervical Carcinoma

Cervical cancer is a cancer that occurs in the cervix, which is the lower and outer part of the uterus, commonly called as the “mouth of the uterus”.

INCIDENCE OF CA CERVIX

• 436.76 million women 15  years and older, at risk of developing cervical cancer.
• India accounts for ~ 1/4th of Cervical cases and deaths worldwide.
• 2nd Cause in female cancer deaths. 
• 2nd leading cause of  cancer deaths in women aged 15-44 years.
• 1 Woman dies every 8 minutes to ca cervix.

Different strains of the human papillomavirus (HPV), play a major role in initiating most cervical cancers.
Generally, when exposed to HPV, a woman’s immune system typically prevents the virus from doing any harm. In some women, the virus may survive for years, causing some cells on the surface of the cervix to become cancer cells.
One can reduce the risk of developing cervical cancer by undergoing various available screening tests and receiving a vaccine that protects against these strains of the HPV infection.

What are the signs and symptoms of cervical carcinoma—

In the early-stage, cervical cancer generally produces no signs or symptoms. In more more-advanced cervical cancer signs and symptoms are—

• Vaginal bleeding after intercourse.

• Vaginal bleeding between periods or after menopause.

• Watery, bloody vaginal discharge that may be heavy and have a foul odour.

• Pelvic pain or pain during intercourse.

What are the risk factors for cervical carcinoma?

• Many sexual partners. More the number of the sexual partners a woman or man has, greater are the chances of acquiring HPV and hence cervical cancers.

• Early sexual activity. Having sexual activity at an early age increases the risk.

• Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases the risk of HPV.

• A weak immune system. – Poor general conditions, unhygienic living, long standing ailments.

• Smoking. Smoking is associated with squamous cell cervical cancer.

• Poor Hygiene- Owing to hygiene factors, the incidence of cervical cancer is higher in rural India than it is in urban India.

• Multiple child births

How to prevent cervical carcinoma?

It is the most preventable form of cancer. So, cervical cancer could be prevented by developing immunity for towards the infection. Hence, HPV vaccination is available.

To reduce the risks of cervical cancer:

• Get vaccinated against HPV. Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.

• Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. 

• Practice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce the risk of cervical cancer.

• Don’t smoke.
• Getting vaccinated is not a substitute for screening examinations.

What causes cervical cancer?

Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells.
Healthy cells grow and multiply at a constant rate, and eventually stop growing  and die at a particular time. Cancer cells grow and multiply out of control, and they don’t die.
These accumulating abnormal cells form a mass (tumor), which may be malignant or a cancer. Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.

What is a PAP Test?

Diagnosing cervical cancer usually begins with a Pap test. This test can detect abnormal changes in cervical cells early, even before cancer develops. It is a quick test that is usually done in the doctor’s OPD. The doctor gently inserts a speculum (a plastic or metal tool) into the vagina, then uses a small stick or brush to pick up a sample of cells from the cervix. The cells are smeared on a glass slide or put in a special liquid and sent to a lab to be looked at under a microscope. 

Pap test is generally recommended every 3 years, depending on the screening guidelines and the health history of the woman. 

What is an HPV DNA Test?

This test is done on a sample of cells removed from the woman’s cervix, the same sample used for the Pap test. This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. Certain strains of HPV, such as HPV-16 and HPV-18, are seen more often in women with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” this means the test found the presence of HPV. Many women have HPV but do not have cervical cancer, so HPV testing alone is not an accurate test for cervical cancer.

What are the vaccines available for preventing cervical cancers?

There are Two HPV vaccines (Gardasil and Cervarix) available, to reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93% and 62%, respectively. The vaccines are between 92% and 100% effective against HPV 16 and 18 up to at least 8 years. 

HPV vaccines are given to girls between age 9 and 26, as the vaccine is only effective if given before sexual activity occurs. The vaccines have been shown to be effective for at least four to six  years, and they are believed to be effective for longer. 

Is Cervical Cancer Curable?

Cervix cancer is one of the most preventable and curable of all cancers. They can be treated with Surgery, Radiation Therapy and Chemotherapy, depending on the stage and type of carcinoma and its stage.