CANCER OF THE CERVIX

Cervix is the lowermost part of the uterus located in the pelvis (lower part of the abdomen) in women. Technically, it is a part of the uterus but the type of cancer occurring in this part of the uterus, its spread and treatment is quite different from cancer occurring in the remainder of the uterus. So, cancer of the cervix (which means ‘neck’ of the uterus) is treated as a separate entity.
Cervical cancer is the commonest cancer amongst women in rural India and is the second common cancer in urban women (after breast cancer). Cervical cancer is making a comeback in the cities especially in the Human Immunodeficiency Virus (HIV) infected women.
Infection by the Human Papilloma Virus (HPV) notably strains 16 and 18-is a common cause of cervical cancer. This infection is acquired by sexual contact and most women clear the infection. However, a dormant infection in some women may trigger development of cervical cancer. This infection is usually asymptomatic and needs to be diagnosed by special tests.
Multiparity (> 3 full term pregnancies) has also been shown to be a risk factor for cervical cancer. Women with a suppressed immune function (HIV infected or on immunosuppressants) also have a higher risk of developing cervical cancer.
Abnormal vaginal bleeding is the commonest symptom of cervical cancer. It often manifests as bleeding just after sexual contact or bleeding in between menstrual periods. In some women it may present as sustained vaginal bleeding with a white discharge. Some women may complain of backache or bleeding through the urine or faeces; these are usually ominous signs of an advanced cervical cancer. It is not unusual to find women presenting with large cancerous growths protruding through the vaginal opening. Cervical cancer is common in women of child-bearing age and hence the symptoms (especially abnormal vaginal bleeding) are often mistaken for variations in the menstrual cycle. This results in delay in seeking medical attention.
A vaginal examination is usually sufficient to suspect cervical cancer. Biopsy (removal of a small piece by a minor surgery) or a surface scraping of the cervix using a wooden/plastic spatula (Papanicoloau or simply Pap smear) confirms the diagnosis. Additional studies for Human Papilloma virus can be done but the benefit of treating the virus in established cancer is minimal.
Stages of cervical cancer are assessed clinically by per vaginal examination. If the cancerous growth is limited to the cervix, it is an early stage disease (stage I), but if it has involved the surrounding areas, it is likely to be stage II or II disease. A spread to other pelvic organs (urinary bladder/rectum) or out of the pelvis indicates a stage IV disease.
Treatment of cervical cancer depends upon its stage at presentation. In stage I disease, a radical surgery removing the cervix, uterus and the surrounding tissues and lymph nodes is a curative treatment. However, based on the pathology report, some patients with stage I disease may require additional radiotherapy. For patients with stage II-III, radiotherapy with chemotherapy is a standard treatment and is preferred over surgery. Radiotherapy is given continuously over 6-7 weeks and chemotherapy is usually delivered weekly. The purpose of chemotherapy is to enhance the benefit of radiotherapy. For patients with advanced stage (IV), chemotherapy is the only feasible treatment. Patients who show an excellent response to chemotherapy may be considered for radiotherapy later such a possibility occurs only in a fraction of patients.
Cervical cancer is a leading cause of morbidity and mortality in Indian women and is a major burden on health resources in India. The notable fact about cervical cancer is it can be detected at a very early stage by simple screening methods. An effective way of screening for cervical cancer is by using Acetic acid (vinegar) and examining the cervix under a colposcope (vaginal endoscope). The suspicious areas can be biopsied and an early diagnosis can be made. This test is cost-effective, does not need a lot of equipment and can be done in small centres too. It has been validated by a large study conducted at the Tata Memorial Hospital, Mumbai and has been found to be useful in reducing the mortality from cervical cancer.
Vaccination against cervical cancer is a novel concept which came to fore in the last few years. The causative role of HPV in cervical cancer is well documented. A vaccine against the 4 common strains of HPV has been developed and is recommended for girls over the age of 12 years. This vaccine is effective in preventing cervical cancer in 60-70% of women. However, women who have received vaccination must undergo regular screening for cervical cancer.

- Oncologist in Pune | Cancer Specialist | Dr. Chetan Deshmukh