What is cancer?
Cancer is defined as a disease in which there is abnormal growth of cells that also have the capability to spread to spread to other parts of the body.
What is cervical cancer?
Having said that, cervical cancer is the cancer of the mouth of the uterus and is the most common cancer of the female genital tract. After breast cancer, cervical cancer is the leading cause of morbidity and mortality.
Incidence
On one hand the incidence of cervical cancer is decreasing in the developed nations owing to the increase in screening methodology, the incidence of cervical cancer is increasing in developing nations and these countries contribute 83% of the cases diagnosed annually world wide.
The age at which cervical cancer develops is earlier as compared to other gynaecologic malignancy. The median age at diagnosis is 40 to 59 years.
Risk factors
Apart from an individual genetic tendency to develop cancers, there are various risk factors that can be attributed to cervical cancer.
- Lower socio economic status and ignorance towards screening of cervical cancer.
- Cigarette smoking
- Multiple Sexual partners
- Multiple child births
- Human papilloma virus
Human Papilloma virus(HPV)
It is now a well accepted fact that HPV is closely related to cervical cancer. HPV is the primary infectious etiologic agent linked to cervical cancer. There are various types of HPV that are linked to cervical cancer of which HPV 16, 18, 31 and 33 are the most common. Having multiple sexual partners exposes a female to an increased risk of exposure to this virus and hence increases the risk of development of cervical cancer.
Pathogenesis of cervical cancer
Human papilloma virus plays an important role in the development of cervical cancer. There are various types of this virus and some of them have a capability to merge with the human genome, changing it and causing the cells to start proliferating/ dividing without control. There is a cascade of mechanism and it usually takes several years for the cells to become malignant. Screening thus plays a very important role in picking up the disease at an early stage and thus preventing the cancer from occuring.
Following cancer formation, if the growth occurs from the mouth of the cervix the growth will be ectophytic and if it involves the cervical canal it would be endophytic. These cancer cells can be very well be picked up by screening tools such as a PAP smear test and thus enabling the cancer to be picked up at an early stage.
Cervical cancer screening
What is cervical cancer screening
Screening is a procedure in which a basic simple test is done in a large population to pick up a disease. Screening tests usually involves simple cost effective OPD procedures having a capacity to pick up a disease. As cervical cancer takes years to develop, screening tests have proven to be extremely beneficial in detecting the disease even before the symptoms appear. One of the tests involved in cervical cancer screening is PAP smear test. PAP smear test along with HPV DNA testing is considered the best.
What is PAP smear test
PAP smear tset is an OPD based test in which cells from the cervix are taken on a wooden spatula also known as the Ayre’s spatula which is specially designed for the cervix. The spatula is simply rotated at the mouth of the cervix. It is an OPD procedure which is painless and doesn’t take more than five minutes. These cells can also be tested for HPV DNA which further adds to the screening of cervical cancer.
How frequently should I get the test done?
The federation of obstetrics and gynaecology of India recommends that women aged 25-65 years should undergo cervical screening every five years preferably with HPV DNA testing. If HPV DNA tests are not available then PAP smear testing alone should be done every three years.
Screening should be continued till 65 years of age group.
What are the red flag signs and when should I report to the doctor ???
- Foul smelling vaginal discharge
- Bleeding or spotting in between periods
- Bleeding or spotting after or during intercourse
- History of weight loss in the recent past
- Pain lower abdomen: persistent lower abdominal pain of varying degrees.
- Bladder symptoms: frequent urination, painful urination or blood in urine
- Rectal symptoms: diarrhoea, rectal pain and sometimes blood in stools.
Treatment of cervical cancer
Once there is suspicion of cervical cancer, after thorough examination a cervical biopsy is taken from the affected area to confirm the presence of cancer and to see the type of cellular transformation.
Clinically the patient is examined to know the stage of the disease. With the advancement of technology, various imaging modalities help in assigning the stage of the disease.
Based on the stage of the disease, either a surgical treatment followed by chemotherapy and radiotherapy or straight chemoradiation is given to the patient.
Follow up
Once the treatment of cervical cancer is over, it is very important for the patient to follow up with the Doctor. Follow up visits are more frequent in the beginning after the treatment is over.
Follow up visits are usually done by the treating cancer surgeon along with imaging modalities like chest X ray or ultrasound or PET CT/ MRI.
