It is sad to see a woman suffer from cervical cancer and it is unfortunate if she dies of it. This is so very true when know we can prevent it or screen detect early pre-cancers and treat them there and then. So, before I proceed there are a few facts that one should know to understand things better.
Cervix is the lower end of the uterus (organ where a fetus grows) and leads to the vagina (birth canal). It remains the second most common cancer that affects females in the developing countries. Before cancer develops there are certain changes called as “dysplasia” which can be screen detected and treated to avoid future chance of getting this cancer. The causative agent for almost all cervical cancer is infection with human papilloma virus (HPV), transmitted through sexual intercourse, which now can be prevented with a vaccine, widely available.
- Multiparity – giving birth to many children.
- Having many sexual partners.
- Young age at first intercourse.
- Smoking cigarettes.
- Using oral contraceptives pill.
- Weakened immune system, such as HIV infection, organ transplant.
Screening for cervical cancer aims to detect early pre cancer lesions by means of a Pap test or by checking presence of HPV infection (HPV test). It is recommended to start Pap test from age of 21 years (for sexually active females) once every 3 years and HPV test from age of 31 years every 5 years. Screening should continue up to 65 years. There are standard reporting guidelines for abnormal test, which may then warrant a colposcopic examination (a lighted, magnifying instrument to visually inspect abnormal areas in cervix) and/or biopsy.
In Pap test. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.
- Vaginal bleeding esp post-coital bleeding
- Unusual vaginaldischarge.
- Pain during intercourse
- Avoiding high risk sexual behavior and smoking
- Using barrier protection as done for preventing sexually transmitted diseases (STDs)
- Getting an HPV Vaccine: Two HPV vaccines have been approved by the S. Food and Drug Administration (FDA). The HPV vaccines have been shown to prevent infection with the two subtypes of HPV that cause most cervical cancers. The vaccines protect against infection with these types of HPV for up to 8 years. It is not known if the protection lasts longer, as the vaccines were introduced about that much time back. The vaccines do not protect women who are already infected with HPV. Therefore recommended age for vaccination is 11-13 years, however catch up vaccination up to 25 to 45 years is allowed but, the level of protection decreases.
DIAGNOSIS AND STAGING
Biopsy is imperative for diagnosis. Once diagnosis is established a good pelvic examination can give a fair idea of the stage. Sometimes a CT scan or MRI scan is done to fine stage the extent of disease. A PET CT whole body is done to see for spread to distant areas. Simply put,
Stage 1 – Microscopic disease detected only on biopsy
Stage 2 – Gross disease amenable to visual inspection or any extension into vagina.
Stage 3 – Gross disease laterally spreading to surrounding tissues of cervix including pelvic walls.
Stage 4 – Spread to other parts such as surrounding bladder, rectum, liver, lung, bones etc.
Stage 1 and early stage 2– encompasses localized disease amenable to surgical ablation and cure from the disease. Surgeon will remove the cervix along with the uterus and along with it also the surrounding lymph nodes. For those who get up-staged after surgery may require radiotherapy post surgery. Those who do not wish to undergo surgery or are poor surgical candidates can be offered curative radiotherapy. Success rate is 70-90%.
For Late Stage 2 and 3 and Early 4 – Treatment of choice is internal and external radiation therapy combined with chemotherapy. Internal radiotherapy (brachytherapy) is achieved by keeping radiation source inside the vagina to achieve higher dose to kill cancer cells and minimize toxicity to adjoining pelvic structures. With latest techniques of external radiotherapy such as IGRT (image guidance) offer superior results with minimal side effects. Success rate at these stages is 30-60%.
For Late Stage 4 – Chemotherapy is the mainstay of the treatment. Some time radiotherapy or surgery is used to allay symptoms. There are hardly any cures. Unfortunately, despite extensive research no breakthrough has happened in the last decade to improve survivals in late stages.
Should that bother us, if we were to follow the entitled – “cervical cancer is all about prevention and screening”?
Look for specialist Cervical Cancer Doctor.