Understanding Cervical Cancer: A Gynaecologist’s Perspective for Public Awareness

Cervical cancer is a prevalent, but highly preventable and treatable form of cancer that affects women worldwide. Understanding Cervical Cancer – It originates in the cervix, which is the lowest part of the uterus. In many cases, it is caused by persistent infection with high risk types of Human Papillomavirus (HPV). HPV is a common […]

Cervical cancer is a prevalent, but highly preventable and treatable form of cancer that affects women worldwide.

Understanding Cervical Cancer – It originates in the cervix, which is the lowest part of the uterus. In many cases, it is caused by persistent infection with high risk types of Human Papillomavirus (HPV). HPV is a common sexually transmitted infection. While most infections resolve on their own, persistent infections can lead to cervical cancer. Cervical cancer is cancer that starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (womb). The cervix connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

Working out the stage of a cancer is important, as it helps a person decide the most effective type of treatment. Staging aims to assess how far the cancer has spread and whether it has reached nearby structures or more distant organs.

• Stage 0: Precancerous cells are present.
• Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes
• Stage 2: The cancer has now moved beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.
• Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.
• Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.

Cervical cancer may not cause any signs or symptoms in its early stages. Symptoms often appear once the tumour grows into surrounding tissues and organs. Other health conditions can cause the same symptoms as cervical cancer.
The signs or symptoms of cervical cancer include:
• abnormal vaginal bleeding including between periods, after menopause and after sexual intercourse
• abnormal or increased amount of vaginal discharge
• foul-smelling vaginal discharge
• unusually long or heavy periods
• pain during sexual intercourse
• difficulty urinating
• difficulty having a bowel movement
• leaking of urine or feces from the vagina
• pain in the pelvic area or lower back that may go down one or both legs
• leg swelling, often in one leg
• loss of appetite
• weight loss
• shortness of breath
• coughing up blood
• chest or bone pain
• fatigue
However, it’s important to understand that either of these symptoms does not indicate cancer. One should see a doctor if any symptom persists.

Screening is used to detect precancerous changes or early cancers before signs or symptoms of cancer occur. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The aim of cancer screening is to:
• Reduce the number of people who die from the cancer, or completely eliminate deaths from the cancer
• Reduce the number of people who develop the cancer

1. HPV test. This test is done on a sample of cells removed from the cervix, the same sample used for the Pap test. This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. This test may also be done on a sample of cells collected from the vagina, which a person can collect on their own.
2.Pap test. The PAP TEST has been the most common test for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. A Pap test involves gathering a sample of cells from the cervix. It is often done at the same time as a bimanual pelvic exam as part of a gynecologic checkup. A Pap test may be combined with an HPV test.
3.Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with a few tools and the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.
Screening for cervical cancer can be done during an appointment with a primary care doctor or a gynecologic specialist. In some areas, free or low-cost screening may be available.

One of the most effective preventive measures is the HPV vaccine. Administered to adolescents (can be given as early as 9 years of age), this vaccine protects against the most common high risk HPV types. The vaccine can be given between the ages of 9 and 45.
Vaccines are available that can help protect children and young adults against certain HPV infections. These vaccines protect against infection with the HPV types most commonly linked to cancer, as well as some types that can cause anal and genital warts.
These vaccines only work to prevent HPV infection − they will not treat an infection that is already there. That is why, to be most effective, the HPV vaccines should be given before a person becomes exposed to HPV (such as through sexual activity).
These vaccines help prevent pre-cancers and cancers of the cervix. Some HPV vaccines are also approved to help prevent other types of cancers and anal and genital warts.
The vaccines require a series of injections (shots). Side effects are usually mild. The most common ones are short-term redness, swelling, and soreness at the injection site. Pap smears to be done regularly (every 3 years) between the ages of 21 and 65 is recommended.

Limit exposure to HPV
HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. So a person should not have multiple partners. Also, HPV infection seems to be able to spread from one part of the body to another. This means that an infection may start in the cervix and then spread to the vagina and vulva.
It can be very hard not to be exposed to HPV. It may be possible to prevent HPV infection by not allowing others to have contact with your anal or genital area, but even then there might be other ways to become infected that aren’t yet clear.
Limiting the number of sex partners and avoiding sex with people who have had many other sex partners may lower your risk of exposure to HPV. But again, HPV is very common, so having sexual activity with even one other person can put you at risk. There can be a possibility that someone can have HPV for years and still have no symptoms. So it’s possible someone can have the virus and pass it on without knowing it.
Quit Smoking – smoking Increases the risk of cervical cancer, as well as other types of cancers.
So maintaining a healthy life style, regular exercises, socializing, and keeping oneself productive and happy can cure any problem. But if there is slightest possibility of such exposure then one should visit a doctor and take regular tests and medication for a good and healthy life. So we all should keep in mind that Prevention is better than cure.

Dr Amrita Sethi is Consultant Gynaecologist and Obstetrician, Sethi Hospital