Key Takeaways
- Cervical cancer progresses gradually from precancerous alterations in the cervix.
- Nearly all cases are caused by persistent high-risk HPV infection.
- Types 16 and 18 of HPV are responsible for the majority of cervical cancer cases.
- The five-year survival rate for early-stage cervical cancer exceeds 90%.
- It is highly advisable to undergo screening every 5 years from ages 30 to 65.
- The HPV vaccination administered between the ages of 9 and 14 offers significant preventive benefits.
- The majority of deaths caused by cervical cancer can be avoided through early detection methods.
- Women living with HIV need to undergo screening at an earlier stage and with greater frequency.
What is Cervical Cancer
Cervical cancer ranks among the most prevalent cancers impacting women in India. Most instances are attributed to ongoing infection with high-risk Human Papillomavirus (HPV).
- The disease progresses gradually over an extended period, allowing effective prevention through vaccination and consistent screening.
- Early detection leads to a five-year survival rate that surpasses 90%.
- Cervical cancer is a type of cancer that occurs in the cells of the cervix, which is the lower part of the uterus that connects to the vagina.
- It is often caused by persistent infection with certain strains of human papillomavirus (HPV). Early detection through screening can lead to effective treatment and improved outcomes.
- Cervical cancer originates in the cervix, which is the lower section of the uterus that links to the vagina. The process typically begins with precancerous cellular alterations known as dysplasia.
- The progression of these abnormal cells to invasive cancer can take 10 to 15 years.
The majority of cervical cancers develop in the transformation zone, the region where squamous and glandular cells meet. This region exhibits a biological susceptibility to HPV infection.
Cervical cancer, in contrast to numerous other cancers, exhibits a consistent progression pattern. The gradual progression allows for detection and treatment before reaching a life-threatening stage.
What Causes Cervical Cancer?
The leading cause is a persistent infection with high-risk Human Papillomavirus (HPV). Types 16 and 18 of HPV account for the majority of cases globally.
HPV is transmitted via intimate skin-to-skin contact. Many infections resolve on their own without intervention. Cancer arises when the virus persists in the body, causing prolonged genetic damage to cervical cells.
Further Considerations Regarding Risks in India
Multiple factors can elevate the likelihood of developing cervical cancer:
HIV infection
Smoking refers to the act of inhaling and exhaling the smoke produced by burning tobacco or other substances. It is a common practice that has been part of various cultures for centuries, often associated with social rituals and personal habits.
However, smoking is also linked to numerous health risks and concerns, making it a significant topic of discussion in public health. Understanding the implications of smoking can help individuals make informed choices regarding their health and lifestyle.
- Engaging in sexual activity at a young age
- Pregnancies involving more than one fetus
- Prolonged use of oral contraceptives
- Additional sexually transmitted infections
Women living with HIV need to undergo screening at earlier stages and with greater frequency.
Different Forms of Cervical Cancer
Cervical cancer is categorised by the specific type of cells affected.
1. Squamous Cell Carcinoma
Represents a significant majority of cases, accounting for 85–90%.Arises from the flat squamous cells that form the lining of the outer cervix.
2. Adenocarcinoma
It starts in the mucus-producing glandular cells located within the inner cervical canal.
3. Adenosquamous Carcinoma
A unique subtype that includes both squamous and glandular elements.
Initial Signs of Cervical Cancer
In the early stages, cervical cancer may not cause noticeable symptoms. Screening remains a crucial process.
As the disease progresses, the following symptoms may manifest:
Bleeding that occurs between menstrual periods
- Experiencing bleeding after intercourse
- Bleeding after menopause
- Continuous discharge that is either watery or has an unpleasant odour
- Discomfort in the pelvic region or lower back
- Discomfort experienced during sexual activity
It is essential to seek medical evaluation for any instance of abnormal vaginal bleeding.
Cervical cancer screening in India
Screening identifies precancerous changes before cancer develops.
Identifies viral strains that pose a high risk directly.
Analyses cervical cells to identify any irregularities.
- Co-Testing refers to the practice of conducting multiple tests simultaneously to gather comprehensive data and insights. This approach can enhance the efficiency and effectiveness of the testing process.
- Integrates HPV testing with cytology to enhance accuracy.
How Can Cervical Cancer Be Prevented?
Cervical
cancer is largely preventable through vaccination, screening, and lifestyle measures.
1. HPV Vaccination (Primary Prevention)
- Recommended for girls and boys aged 9–14 years
- Catch-up vaccination up to 26 years
- Select adults up to 45 years after a medical consultation.
- Safe for immunocompromised individuals
- Stronger immune response at younger ages
- Does not replace screening
2. Regular Screening (Secondary Prevention)
- Women aged 30–65 years: Screen every 5 years
- Women with HIV: Start earlier and screen more frequently
Methods include:
- HPV DNA test
- Pap smear
- Co-testing
- VIA (in public health settings)
- Early detection prevents invasive cancer.
3. Safe Sexual Practices
- Limit the number of sexual partners.
- Use barrier protection
- Encourage vaccination for both partners.
- Delay early sexual exposure.
4. Avoid TobaccoTobacco
- Smoking increases the risk of persistent HPV infection.
- Quitting improves immune clearance.
5. Strengthen Immune Health
- Manage HIV effectively
- Treat other STIs promptly.
- Maintain balanced nutrition
- Regular medical check-ups
6. Treat Precancerous Lesions Early
- Cryotherapy
- LEEP procedure
- Thermal ablation
- Prevents progression to invasive cancer
Recommendations for Screening by the WHO
- Women aged 30 and older are recommended to undergo screening every 5 to 10 years.
- It is recommended that women with HIV start screening at the age of 25.
- Individuals should undergo at least 2 lifetime screenings by the ages of 35 and 45.
- The recommendations are integral to the global strategy aimed at eliminating cervical cancer.
Access to Screening in India
In India, VIA (Visual Inspection with Acetic Acid) is utilised extensively.
- It is advisable to conduct this every 5 years.
- The intended age range is between 30 and 65 years.
- Accessible at government health facilities
- The low screening rate leads to diagnoses at later stages.
Understanding Diagnosis and FIGO Staging
When screening results indicate abnormalities, additional testing is necessary.
Colposcopy is a medical procedure used to closely examine the cervix, vagina, and vulva for signs of disease.
It involves the use of a colposcope, a specialised magnifying instrument that allows healthcare providers to see these areas more clearly. This procedure is often performed when abnormal results are found on a Pap smear or when other concerns arise regarding cervical health.
An enlarged analysis of the cervix. A biopsy is a medical procedure that involves removing tissue or cells from the body for examination. This process is often used to diagnose diseases, including
cancer, by analysing the sampled material under a microscope.
The results can provide crucial information regarding the presence and type of disease, guiding further treatment options. A tissue sample is extracted and analysed using a microscope.
Cancer is staged using the FIGO system once it has been confirmed.
- Stage I: Limited to the cervix
- Stage II: Involvement of the upper vagina
- Stage III: This Stage is characterised by locally advanced conditions.
- Stage IV: Metastasis
The Stage of a condition plays a crucial role in determining the appropriate treatment approach.
Survival Rates
- The Stage at which a diagnosis is made plays a crucial role in determining survival outcomes.
- Localised disease has a five-year survival rate of approximately 90%.
- Regional distribution: approximately 55–65%
- Distant metastasis occurs in approximately 15-20% of cases.
- Identifying issues early greatly increases the likelihood of positive outcomes.
Options for Treating Cervical Cancer
The approach to treatment is influenced by the Stage of the condition, tumour size, and factors related to fertility.
Initial Phase of Illness
- Cone biopsy is a medical procedure used to remove a cone-shaped section of tissue from the cervix for examination. It is often performed to diagnose or treat cervical conditions.
- Radical hysterectomy is a surgical procedure that involves the removal of the uterus, cervix, and surrounding tissues. It is typically performed to treat certain types of cancer or other severe conditions affecting the reproductive system.
- Surgery aimed at preserving fertility in specific situations. Surgery frequently serves as a curative option for Stage I disease.
Locally Advanced Disease
The standard treatment consists of:
- Cisplatin chemotherapy is administered every week
- External beam radiation therapy is a treatment method that directs radiation from outside the body to target cancer cells. This approach is commonly used in various types of cancer treatment plans.
- Brachytherapy refers to a form of radiation therapy where a radioactive source is placed inside or very close to the area requiring treatment. This method allows for a high dose of radiation to target the tumour while minimising exposure to surrounding healthy tissue.
- Chemoradiation is considered the standard treatment for Stage IIB–III disease.
Advanced or metastatic disease refers to the Stage of cancer where the disease has spread beyond its original site to other parts of the body. This Stage often presents unique challenges in terms of treatment and management.
The available treatment options are as follows:
Systemic chemotherapy is a treatment that uses medication to target cancer cells throughout the body. This approach is often employed to manage various types of cancer and can be administered in different forms, including intravenous or oral medications.
Targeted therapy is a type of treatment that targets specific molecular pathways associated with cancer. This approach is designed to interfere with the growth and spread of cancer cells while minimising damage to normal cells.
By focusing on specific pathways and mechanisms, targeted therapies can provide more effective treatment options for patients.
Immunotherapy refers to a treatment approach that utilises the body's immune system to fight diseases, particularly
cancer.
This method can enhance the immune response against tumours and has gained significant attention in recent years for its potential effectiveness and innovative techniques.
Molecular testing facilitates the development of tailored therapy strategies.
The impact of cervical cancer in India
- Cervical cancer continues to be an essential issue for public health in India.
- India reports more than 120,000 new cases annually.
- This cancer ranks as the second most prevalent type among women in India. A significant number of patients receive their diagnosis at more advanced stages of their condition.
- Cervical cancer is responsible for hundreds of thousands of deaths worldwide each year, with the majority of these fatalities occurring in low- and middle-income countries.
When is it advisable to seek the expertise of a specialist?
If you encounter any of the following symptoms, it is advisable to consult a medical professional:
Bleeding following intercourse
- Ongoing discharge
- Discomfort in the pelvic region
- Menstrual bleeding that occurs in an irregular pattern
It is recommended that
women over 30 undergo screening, regardless of whether they are experiencing symptoms.
Medical Disclaimer
This content is provided for educational and informational purposes only. It does not substitute professional medical advice, diagnosis, or treatment. Individual risk factors vary based on medical history, immune status, lifestyle, and reproductive health. Always consult a qualified gynaecologist or oncologist for personalised screening schedules, vaccination guidance, and treatment decisions. In case of urgent symptoms, seek immediate medical attention.
