Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of a woman’s uterus to her vagina. Most cervical cancers begin in cells on the surface of the cervix. Cervical cancer was once a leading cause of death among American women.

Cervical cancer is the second most common cancer in Indian women after breast cancer. Every year, 96,922 women are diagnosed with cervical cancer in India, and 60,078 dies from the disease (GLOBOCAN 2018). Here are some facts about this cancer, how you can prevent it, and the treatment modalities.

why cervical awareness month

HPV Vaccines Prevent Cervical Cancer:

• The Message is Clear
• January is Cervical Cancer Awareness Month, a great time to talk about how human papillomavirus (HPV) vaccines can help prevent cancer. Cervical cancer was once the leading cause of cancer death for women

Cervical cancer and fertility

Even if a woman waits to attempt pregnancy, there is a risk of pregnancy complications and/or infertility after cervical cancer treatment. Infertility — There is an increased risk of difficulty in becoming pregnant if the cervix or lower uterus becomes scarred or narrowed as a result of the conization or trachelectomy.

A woman with cervical cancer who wishes to preserve her fertility may feel that she has to choose between doing what seems best for her own life and what might be best for preserving fertility. Every woman’s circumstances are different, and every decision must be individualized based upon the woman’s situation. Advice regarding options for fertility preservation is available from clinicians who are experts in reproductive endocrinology and infertility, in conjunction with a gynecologic oncologist.

CERVICAL CANCER FERTILITY-SPARING TREATMENT OPTIONS

Options for the treatment of early-stage cervical cancer include cone biopsy, hysterectomy, and chemoradiation. Future pregnancies are not possible after hysterectomy or radiation therapy. Some women with early-stage cervical cancer with no spread to other organs or lymph nodes who wish to carry a pregnancy after cervical cancer treatment are eligible for less aggressive forms of treatment. Treatments that allow a woman to carry a pregnancy at a later time include the following:

• Conization – Large biopsy of the cervix
• Simple trachelectomy – More extensive removal of the cervix
• Radical trachelectomy – Removal of the cervix and surrounding tissues, but not the uterus

In addition, removal of the lymph nodes in the pelvis is performed except in women with stage IA1 disease without cancer cells in the lymphatic channels.

Cervical Cancer Facts

Cervical cancer occurs when cells of the cervix (the lower part of the uterus, which connects the body of the uterus to the vagina), grow out of control.

Symptoms include irregular vaginal bleeding, bleeding in between periods or after sexual intercourse, postmenopausal bleeding, and foul-smelling vaginal discharge. Some women may also experience low back pain or lower abdominal pain.

Nearly all cases of cervical cancer can be attributed to persistent Human papillomavirus (HPV) infection. This is an infection that is present in almost all sexually active adults and is generally cleared off by the body. In a few individuals, however, the infection persists, and if not screened, can lead to precancerous and cancerous lesions of the cervix. Other risk factors for cervical cancer include early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, smoking, immunosuppression including HIV infection, and prolonged use of oral contraceptives.

Importance of Cervical Screening

A major cause of the high incidence of cervical cancer in India is the lack of awareness of this disease and the lack of cervical screening. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it has not spread and is amenable to curative treatment. Because of the paucity of screening, many cases of cervical cancer are detected in advanced stages leading to high mortality rates.

How can you protect yourself against cervical cancer?

Consult your gynecologic oncologist or gynecologist, who will do a thorough pelvic examination and tell you about the tests used for cervical screening – Pap test and HPV DNA test. Women aged 21 to 29 years, should have a Pap test every 3 years. From the age of 30, the preferred way to screen is to get tested every 5 years with a Pap test combined with an HPV test (co-testing), OR every 3 years with a Pap test, till the age of 65.

If the Pap and/or HPV tests are abnormal, you may be advised further evaluation, which may include colposcopy (a procedure to examine an illuminated, magnified view of the cervix) along with a biopsy, followed by management according to the results.

Diagnosis and Management

Diagnosis of cervical cancer involves a complete physical examination and a cervical biopsy wherein the doctor takes a small biopsy from the cervical growth to confirm malignancy. In addition, radiological imaging (MRI/CT/PET-CT) is advised to look for the spread of the disease, if any.

The Cancer treatment depends upon the stage of the disease. Patients with early-stage of cancer and in good general condition are advised surgery, in which the uterus and cervix with the neighboring tissues are removed (radical hysterectomy) along with the lymph glands in the pelvis. Patients with advanced stages of cancer are treated with radiotherapy with or without chemotherapy.