A staggering statistic has reflected that India accounts for nearly 1/3rd of the world’s cervical cancer deaths, with women facing a 1.6% cumulative risk of developing cervical cancer and a 1.0% cumulative risk of death from cervical cancer.

How does it occur?

The cervix is the lower, narrow part of a woman’s uterus that opens into the vagina. Cervical Cancers begin in cells on the surface of the cervix. They don’t become cancerous directly, but gradually progress from the precancerous state to Invasive Cancer. Chronic Genital Infections by the high-risk types of the Human Papillomavirus (HPV) are a prerequisite for the causation of this cancer. The other important risk factors are; Sexual activity initiated at a Younger Age, Early Pregnancies, Multiple Pregnancies, Multiple Partners, Immunocompromised Individuals, Lower Socio-Economic Groups with Nutritional Deficiencies, and Poor Genital Hygiene.

Symptoms

The disease starts with subtle changes in the cervical epithelium, and symptoms may not be obvious in the early stages of the disease. It is only as the disease progresses, do women complain of persistent watery discharges, Post-coital bleeding, prolonged and increased bleeding during Menstruation, Episodes of Urinary Tract Infections, etc. The pain usually sets in much later.

Screening

To be able to detect the earlier stages of the disease process, Cervical Cancer screening by way of PAP smears is the best method. This could further be coupled with a test to detect infection by the HPV virus, for more information and risk assessment. Through the vaginal route, the sampling of the cells is done using a wooden spatula and a fine brush to collect the cells over the cervix, which are then either smeared on a slide or collected in a tube, and sent for pathological evaluation.

This cancer occurs in 4 stages, each stage, more severe than the next one.

Treatment

There are various effective methods for the treatment of cervical cancer. It is treatable through

• Surgery
  Surgery aims to remove the cancerous organ and affected tissues to the maximum extent possible. It is the best possible option for a definitive cure when the disease is diagnosed early. Radical Hysterectomy is the most common surgical option and involves the removal of the uterus and the cervix along with a good margin of the surrounding tissues, and dissection of the draining lymph nodes. Conservative surgical options, to retain fertility while treating the disease may be an option available in certain early stages, for those desirous of retaining future fertility.
  In certain situations where the cancer is locally advanced, and has not yet spread outside the pelvis, and the option of radiotherapy has been exhausted, other parts of the pelvis may also have to be removed extensively, followed by reconstructive procedures.
• Radiation Therapy
  This form of therapy involves the application of ionizing doses of radiation to induce cell death of the cancerous cells.
  The calculated radiation dose is delivered to the target organ in fractions, through External Beam Radiation Therapy (EBRT), and Brachytherapy (Internal Radiation), etc.
• Chemotherapy
  Involves the use of antineoplastic drugs to cause the death of the cancer cells. The drugs are generally administered via the intravenous route. In the context of cervical cancer, chemotherapy is most often used either as a concurrent treatment along with the cases selected for Radiotherapy, as a definitive treatment,
  Or
  As a palliative treatment option for the cases not amenable to curative treatments.
  The chemotherapeutic drugs target the cancer cells as well as the cells of normal tissues elsewhere in the body, especially those cells that are generally dividing actively, and this accounts for the toxicities common to chemotherapy and manifests as side effects. Supportive treatments alongside the chemotherapies help the patients cope with the attending side effects.
• Targeted Therapy
  Targeted therapies, utilize certain drugs/ molecules that identify and counteract specific tumor characteristics/biologies, to dampen the proliferation of the cancer cells and to facilitate cell death. The drugs in this therapy attach themselves to the proteins or receptors on cancer cells to exert their effects hence the name targeted, because the normal cells of other organ systems are spared.
  This therapy is also used in addition to chemotherapy and the combinations prove synergistic. Generally used for advanced cancers and for recurrent cancers where other primary treatment options have been exhausted.

Conclusion

With progressive advancements in the treatment modalities, there are better chances of successful cancer treatments and better recoveries. Along with the latest treatments, diagnosis is the most important for early detection and prevention.

We, the Oncologists at MGCHRI, are well-versed in the latest diagnosis & treatments to meet the patient requirements. Connect with us today for compassionate & meticulous cancer treatments.

Written by
Dr. Jyoti Doki,
Gynaec Oncologist
Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam