What is Cervical Cancer?
Oncologist/Cancer Surgeon, Jaslok Hospital, 28 years of experience
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What is Cervical Cancer?
Cervical cancer is a type of cancer that occurs in the cells at the junction of the vagina and the cervix. The cervix is the lower part of the uterus that connects the vagina to the main body of the uterus. Certain strains or types of human papillomavirus (HPV), which are mainly transmitted through sexual contact, play a role in causing cervical cancer.
Cervical cancer is a leading cause of cancer and cancer-related deaths in women worldwide. In India, it is a major public health problem but this is expected to improve with organized screening programs.
Let us tell you in detail about cervical cancer in this article.
- Causes of Cervical Cancer
- Symptoms of Cervical Cancer
- Diagnosis of Cervical Cancer
- Treatments for Cervical Cancer
- Risks and Side Effects of Treatment
- Post Operative Care
- Prevention of Cervical Cancer
- What is the Cost of Cervical Cancer in India?
Causes of Cervical Cancer
Cervical cancer begins when healthy cells at the junction of the cervix and the vagina, known as the transformation zone, develop mutations. Mutations alter the cell’s normal cell cycle and cause them to grow and multiply out of control. With time, an out-of-control mutated cell forms replicas of itself and so a cluster of these mutated cells is created. This cluster of abnormal cells forms a mass called a tumor. Cancer cells can invade the surrounding tissue and can break away from the tumor to spread anywhere in the body, causing the fatal complications of cervical cancer.
There is a multitude of risk factors that lead to cervical cancer which are mentioned in detail below:
- Human Papillomavirus (HPV):
The most common cause of cervical cancer is infection by the human papillomavirus. There are more than 150 different types of HPV which are divided into 2 categories:
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- Low risk of causing cancer, known as Low-risk HPV
- High risk of causing cancer known as High-risk HPV
Over 99.7% of all cervical cancer patients are positive for high-risk HPV. People infected by HPV may develop warts on their genitals or some may even show no symptoms. In 90% of immunocompetent women, the infection resolves by itself within 2 years. But the real threat is the persistence of infection which occurs in 10% of immunocompetent women infected by high-risk type HPV. These numbers are even greater in women who are immunocompromised.
Other risk factors of Cervical Cancer are:
- Early age of sexual intercourse, i.e., less than 17 years
- Multiple sexual partners
- Other sexually transmitted infections like HIV, Herpes, Chlamydia ( Know more about: What are sexually transmitted diseases?)
- Too many births, greater than 3 children
- Immunosuppressed individuals (HIV or Steroids)
- Poor genital hygiene
- Risk increases with increasing age, i.e., greater than 30 years
- Use of oral contraceptive pills (birth control pills) for more than 5 years ( Know more about- What is an I-pill? )
- Smoking
Symptoms of Cervical Cancer
There are usually no or very few symptoms in the early stages of cervical cancer. Most of the symptoms are seen only in the later stages.
Symptoms in the early stages are:
- Irregular menstrual cycle
- Bleeding on contact (like during sexual intercourse)
- Bleeding on straining (during defecation)
- Excessive white discharge which may be foul-smelling
Symptoms in the later stages are:
- Pelvic pain which may be accompanied by back pain
- Swelling in the legs
- Bladder symptoms: Frequent urination, blood in urine, inability to control urine.
- Rectal pain or bleeding
- Frequent urinary tract infections(UTI)
- Unexplained weight loss
Apart from cervical cancer, blood in urine can also be caused due to bladder cancer and other kidney-related problems. In advanced cases of kidney failure, patients are advised to get a Kidney transplant done.
Diagnosis of Cervical Cancer
Early diagnosis of cervical cancer is crucial as in the initial stages it is easily treatable. In the later stages, it is difficult to treat and thus the woman’s life expectancy reduces to about 5 years.
The only way to diagnose cervical cancer is by regular gynecological check-ups including the following:
- Papanicolaou smear, commonly known as Pap smear, is currently the best diagnostic method available. The doctor inserts a brush into the vagina to pick up cells from the cervix for diagnosis. ( Know more about- What is Pap smear? )
- HPV-DNA testing. It helps detect HPV infection and tells if it is high or low risk. It is also used to detect the persistence of infection.
- Visual inspection of the cervix
- Colposcopy. It is the visual inspection of the cervical cells using a microscope.
- Biopsy. In this, a piece of tissue is taken from the cervix for microscopic examination.
It is important for women above the age of 21 to do their Pap smear every 3 years. Women above the age of 30 must also do an HPV-DNA test along with their Pap smear.
Treatments for Cervical Cancer
The treatment of cervical cancer becomes easy if it is detected early. The main treatments of cervical cancer includes:
- Observation– Women with a positive Pap smear or HPV-DNA test must follow up and repeat these tests every 6 months.
- Cryotherapy– Carbon dioxide or Nitrogen at the temperature of -90 degrees Celsius is applied. This kills the abnormal cells and can destroy small tumors. Depending on the size and location of the tumor it may take a few minutes to a few hours.
- Laser Therapy– Also known as laser ablation, is the use of a high-power laser to destroy abnormal cervical cells and is done under local anesthesia. It is an outpatient procedure and usually, only one session is required.
- Excision– The entire cervix is removed by a method known as Loop Electrosurgical Excision Procedure (LEEP). A low volt current is passed through a thin stainless steel wire loop which is used to cut and remove the tissue. It is done under local anesthesia.
- Hysterectomy– It is the removal of the entire uterus and is performed in women who have completed their family or in women who have no further plans of bearing a child. The ovaries and the fallopian tubes are left in place unless there are indications to remove them as well. It is done under lower spinal or general anesthesia.
- Radiation therapy- Used in early stages of cancer, in this procedure, high-dose X-rays or protons are used to destroy cancer cells. It can be used after surgery if there is an increased risk of recurrence of cancer.
- Chemotherapy- It is a drug treatment that uses chemicals to destroy rapidly growing cancer cells. ( Know more about- What is Chemotherapy)
- Chemoradiation- It is a combination of chemotherapy and radiation therapy.
Risks and Side Effects of Treatment
Cryotherapy, Laser therapy, and small excision procedures, like LEEP, do not have any major risks. Their side effects are limited to pain, cramps, bleeding and excessive discharge which usually clear up within a week.
- Hysterectomy:
Since the uterus of the woman is removed, there is infertility and a stoppage of menses (amenorrhea). If the ovaries are not removed she can still have children via other assisted reproductive techniques (ART) and a surrogate. Complications are very rare and are usually limited to bleeding, infection, and damage to the surrounding structures like the urinary tract, bladder and gastrointestinal system.
- Radiation Therapy:
The side effects of radiation vary from person to person and also depend on the location and dose of radiation given. The most common side effects are:
- Skin rashes in the area irradiated
- Vomiting, loss of appetite, and weight loss
- Diarrhea, loose stools, bleeding from the rectum
- Irritation in the bladder and inability to control urination
- Menstrual changes and irregularity
- Menopausal symptoms like itching, burning or dryness of the vagina
These side effects can be treated by supportive medication.
- Chemotherapy:
Chemotherapy has a multitude of side effects that vary depending on the drugs administered and the dose provided. A few of the common side effects are:
- Fatigue, muscular pain, headaches
- Stomach pain with diarrhea or constipation
- Nausea and Vomiting.
- Loss of appetite, weight loss, loss of muscle mass and strength
- Infertility
- Hair loss
Some of these effects can be controlled with medication.
Post Operative Care
Except for hysterectomy, all the other procedures are one-day procedures and the patients can usually return home the same day itself after a few hours under observation. If they do experience any discomfort after reaching home they are advised to contact their doctor immediately.
Depending on the type of hysterectomy performed one may be admitted in the hospital for 2-5 days and complete recovery takes 4-6 weeks. Until complete recovery the patient is advised to:
- Maintain proper hygiene
- Refrain from vigorous exercise or lifting heavy items
- Refrain from having sexual intercourse
- Drink plenty of fluids to avoid constipation
If the patient gets fever, pain, bleeding, or any abnormal discharge they must report back to their doctor immediately.
Prevention of Cervical Cancer
To prevent cervical cancer these points must be followed:
- HPV vaccination: A HPV vaccine is available which protects from all common types of HPV. It is recommended that all adolescent girls, ages 9-15, must take this vaccine. The complete course of the vaccine involves 3 doses. This vaccine reduces the chances of getting cervical cancer by 96%. The HPV vaccine can also be taken by women above the age of 15 years. ( Know more about- What is HPV Vaccination and how does it prevent cervical cancer? )
- Regular gynecological check-up: This helps in the early detection and treatment of cervical cancer.
- Delay sexual intercourse till 18 years of age
- Limit number of sexual partners
- Use condoms during sexual intercourse
- Limit number of children
- Maintain genital hygiene
- Quit smoking
What is the Cost of Cervical Cancer in India?
The total cost of cervical cancer surgery in India can range from INR 1,80,000 to INR 2,30,000. But the cost of cervical cancer surgery may vary across different hospitals and also depends upon the number of stents and the type of stents being used.
If you are coming from abroad, in addition to the cost of cervical cancer surgery, there will be an additional cost of accommodation and food, the cost of local travel, etc. So the total cost of cervical cancer surgery can range around INR 4,00,000.
We hope that we could answer your questions regarding cervical cancer through this article.
If you want more information and treatment for cervical cancer, you can contact an Oncosurgeon.
We only aim to give you information through this article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.
