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All About Cervical Cancer - It’s Symptoms & Treatment

The cervix (uterine) is located at the end or lowermost part of the uterus. It is a cylindrical shaped canal made up almost entirely of fibromuscular tissue. The functions of the cervix include allowing the flow of menstrual blood into the vagina from the uterus and administers sperm flow into the uterus from the vagina. The inception of cervical cancer takes place in the cervix. Cervical Cancer is the second most common cancer among Indian women. The leading cause of cervical cancer across the world is Human Papillomavirus (HPV) which is also the most widespread viral infection of the reproductive tract. Even though HPV is sexually transmitted; penetrative intercourse is not necessary as genital skin to skin contact is an equally effective transmitter. Almost all cases of cervical cancer can be attributed to an HPV. HPV-16 and HPV-18 are the two most common cancer-causing strains of HPV. HPVs can potentially cause throat, penile, vaginal, vulvar and anal cancers. The majority of HPV infections clears on their own within a reasonable one to two years depending on the immunity of patient. Persistence of HPV infection leads to cervical cancer. HPV infection causes pre-cancer and cancerous lesion of cervix. There is a ten to 15-year gestation period for the development of cervical cancer in women with a healthy immune system whereas the same could be around five to ten years for women with a weaker immune system. Women who have HIV naturally face the higher risk of developing cervical cancer. Even smoking tobacco can contribute to the growth of this cancer. Women exposed to the medicine diethylstilboestrol (DES) during prenatal stages are also at risk of cervical cancer. This was used earlier to prevent miscarriages but in fact it causes abnormalities in cervical cells; it has been discontinued since many decades now. Other contributors to the growth of cervical cancer include birth control pills, early marriage, early onset of sexual activity or having multiple sexual partners.

Symptoms of Cervical Cancer

There are a number of cervical cancer symptoms which are experienced by the patient. Again, these are not defining symptoms and can very well be attributed to regular infections that do not lead up to the occurrence of cervical cancer.

These include:

  • Uncommon and atypical bleeding, randomly in between menstruation, post intercourse, or post menopause.
  • Vaginal discharge
  • Pelvic pains.
  • Increase frequency of micturition
  • Pain felt during urination.
  • Difficulty in defaecation.

These symptoms should not be ignored and a doctor must be consulted at once.

A simple yet effective test called the “Pap Test” is used to screen for the presence of the cervical cancer. A device (akin to a cotton swab) is used to swab the cervix and is sent to a laboratory for evaluation. Doctors recommend Pap Tests according to the age of women. For example, the test should be conducted at the age of 21 years or 3 years after the onset of sexual activity whichever occurs earlier. There is also an HPV test which can help in detection of cervical cancer. Positive report on PAP smear is confirmed by a tissue biopsy. Women should sign up for regular cervical screening tests irrespective of the occurrence of symptoms as it is very helpful in detecting HPV infection which can lead to cervical cancer and other premalignant lesions.

There are 4 stages of Cervical Cancer:
 

Stage 1 is when the cancer is limited to cervix

Stage 2 Carcinoma involving cervix and vagina or parametrium

Stage 3 Cancer has spread to the lower part of the vagina or to the pelvic wall but is still away from other parts of body.

Stage 4 Cancer has grown and spread beyond the true pelvis or into the rectum or bladder.

Treatment of Cervical Cancer

Cervical cancer treatment depends on the stage at presentation and usually involves surgery, Radiotherapy and chemotherapy either alone or a combination of two or more.

Surgery is the foremost treatment in early stage cervical cancer and entails removal of uterus, upper vagina and regional lymph nodes, is potentially curative and offers long term survival.

Radiation therapy either alone or in combination with chemotherapy is performed in locally advanced cancer.

Chemotherapy is prescription of anti cancer drugs and is recommended in cases where cancer has spread to other parts of body.

Cervical cancer can also arise during pregnancy but is usually detected at an early stage through regular testing. Doctors usually recommend delivery as soon as the baby is able to survive outside the womb. Cervical cancer is a preventable cancer and requires just a little effort and awareness. Screening for cervical cancer should be part of periodic health check-ups. Small details matter.

Dr. Arun Kumar Giri
Director
Surgical Oncology

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