Dr Prashant Kumar Dash, Medical Director, vHealth by Aetna elaborates on various aspects related to the diagnoses of cervical cancer
In India, cervical cancer has become one of the most common fatal diseases, killing nearly 200 women every day. With the inclusion of preventive vaccines for cervical cancer in the National Immunisation Programme, it is crucial for women to be well aware and informed about the causes, symptoms and effects of cervical cancer. According to a WHO report, cervical cancer is the fourth most frequent cancer amongst women worldwide with an estimated one million-plus women currently living with this condition. This disease is a consequence of a long-term infection with human papillomavirus (HPV), the most common viral infection of the reproductive tract.
Causes of cervical cancer
Human Papillomavirus infection (HPV) is sexually transmitted, but penetrative sex is not necessary for transmission. Skin-to-skin genital contact is a well-recognised mode of transmission. Nearly all cases of cervical cancer can be attributable to HPV infection. Although more than 100 types of HPV known, infection with only 10 per cent of high-risk strains is responsible for cervical cancer. Peak infection incidence is in the late teens and early 20s, but in 80 per cent of patients, the infection resolves within a year. Once the infection is resolved, the risk of cervical cancer returns to baseline.
Risk factors for cervical cancer
Strong:
1. History of HPV infection
2. Age group- highest risk in women between 40 to 55 years of age
3. Early onset of sexual activity (younger than 18)
4. Multiple sexual partners
5. Cigarette smoking (both active & passive)
6. Suppressed immune system
7. HIV infection
Weak:
1. Oral contraceptive pills
2. Uncircumcised male partner
3. Other sexually transmitted diseases
4. Multiple pregnancies
Symptoms of cervical cancer and when to test for cervical cancer?
Early stage disease is frequently asymptomatic. Pre-cancerous lesions are often detected only after a cervical cancer screening test like Pap smear. With disease progression, various symptoms may become apparent.
1. Presence of risk factors- Age between 40 to 55 years, history of HPV infection, multiple sexual partners, early age of sexual activity and suppressed immune system
2. Abnormal vaginal bleeding- Irregular or inter-menstrual (between periods) bleeding
3. Bleeding after sexual intercourse
4. Painful coitus
5. Cervical mass or cervical bleeding on physical examination
6. More severe symptoms may arise at a later stage of cancer like foul smelling purulent vaginal discharge and bladder/bowel obstruction
Types of cervical cancer
Based on the cellular composition, cervical cancer is of 2 types:
1. Squamous cell cervical cancer- Majority (90 per cent) of cases are squamous cell cancers which have a relatively better outcome
2. Adenocarcinoma- 10 per cent of cervical cancer cases are adenocarcinoma which has a relatively worse outcome.
3. Mixed cancer- Sometimes, the cervical cancer is composed of both types of cells.
Natural history of the disease
Pre-invasive lesions may spontaneously regress, but untreated cancer of the cervix is uniformly fatal. The treatment of invasive cervical cancer is based on stage. Treatment plans are based on clinical practice guidelines, local expertise and available resources, and individualised discussion between the patient and physician. In specific circumstances, it may be appropriate to adjust treatment plans if there is a desire to preserve childbearing potential.
Some measures to reduce the chances of developing cervical cancer:
• Human papillomavirus (HPV) vaccine
• Safe sex. Using a condom during sex helps protect from HPV infection
• Regular cervical screening
• Have fewer sexual partners
• Delaying first sexual intercourse
• Stop smoking
One in five women who develop cervical cancer die within the first year of diagnosis and fewer than 50 per cent of patients survive beyond 5 years of being diagnosed with cervical cancer. The length of survival is dependent on the stage of cancer at the time of diagnosis. The survival chance of a person becomes better if the cervical cancer is diagnosed and treated at earlier stages. Therefore it is important to avail of cervical cancer screening. Current national guidelines recommend cervical screening for all ever sexually active women between the ages of 30 to 59 years. Regular cervical screening can save thousands of lives every year. After reading all the facts mentioned above, together let’s spread this message about this deadly condition and save the lives of women all around us.