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CANCER CERVIX



Cervix is the lower narrow part of uterus (womb) that lies between the uterus and vagina (birth canal) accounts for a large burden of cases of cervical cancer diagnosed worldwide. Cancer cervix is the second most common cancer in women in India and the second leading cause of death due to cancer in Indian women. It is usually seen in older women. The peak age group of cervix cancer in women is 55 – 59 years.


RISK FACTORS

The most important risk factor for cervix cancer is Human Papilloma Virus [HPV] infection. It is a sexually transmitted virus. It is a common virus, but not all individuals who get infected with HPV develop cancer of cervix. The other risk factors for cervical cancer are early age at marriage, multiple sexual partners, multiple pregnancies, smoking and poor genital hygiene.



CERVIX CANCER IS PREVENTABLE

Cervix cancer prevention requires behavioural intervention for encouraging safe sexual behaviour as well as vaccination. Behavioural intervention includes educating young women about the risks of cervix cancer and sexually transmitted diseases, avoiding multiple sexual partners and use of condoms. Cervix cancer is preventable by HPV vaccination in adolescent girls. HPV vaccine can be given starting from 9 years till 26 years of age. Two or three doses of HPV Vaccine are given depending on the age of initiation. Individuals over the age of 26 years benefit less with HPV vaccine. They should discuss the benefits and harms of vaccination with their healthcare provider.


CANCER CERVIX CAN BE DETECTED EARLY BY SCREENING

Cancer screening refers to certain tests that can detect a particular cancer even before an individual develops symptoms. This helps to detect cancer in an early stage, when it is curable. Not all cancers are amenable to screening. However cancer cervix is one of the cancers that can be detected by screening. Pap smear test is a simple test and is the most common investigation used to screen for cervix cancer. It can be done in OPD within a few minutes. In Papanicolaou [PAP] smear test, cells are scraped from the cervix and fixed on a glass slide for reading by a trained pathologist. PAP smear test can detect pre-cancerous changes in the cells. Screening by PAP smear should be done every 2-3 years starting from 21 years of age till the age of 65 years. Women over the age of 65 years may stop screening if the tests have been consistently negative for many years. Tests to detect HPV virus infection can also be done alongside PAP smear and this may detect more pre-cancerous lesions than PAP smear alone.


SIGNS AND SYMPTOMS

Most patients of cervical cancer are diagnosed when the cancer is already quite advanced.

The signs and symptoms of cancer cervix are:-

  • Abnormal Vaginal bleeding that occurs:-

    • Between periods

    • After menopause

    • After sexual intercourse

  • Foul smelling or bloody or watery vaginal discharge

  • Pain during sexual intercourse

  • Pain in lower part of abdomen

  • Reduced appetite


DIAGNOSIS

The tests used to diagnose cervix cancer include MRI of pelvis, Chest X Ray, CT scans, PET CT scan and biopsy. Biopsy test means removing a small part of the diseased cervix and subjecting it to microscopic examination to detect cancer cells. Chest X Ray, MRI and PET/CT scans show the extent of spread of cancer.


TREATMENT

Treatment of cervix cancer depends on the stage at which it is detected. Treatment should be planned by a multi-disciplinary team of doctors who specialize in surgery, radiotherapy and chemotherapy. If the cancer is detected at an early stage, it may be treated by surgery or radiotherapy. In some cases, radiotherapy may be given after surgery. Radiotherapy is given to the affected part as well as some surrounding structures. Radiotherapy techniques have evolved with time and now-a-days healthy structures can be spared. Sparing of healthy structures helps to reduce the side effects of radiotherapy. Radiotherapy can be given by External Beam Radiotherapy [EBRT] technique or Brachytherapy or both. Some cases need the simultaneous use of chemotherapy along with radiotherapy. In very advanced cases where the disease has spread to distant organs, treatment is done with chemotherapy with or without biologics. In some cases, immunotherapy is also used based on the results of certain molecular tests performed upon the cancer cells. The survival as well as quality of life of extremely advanced cases of cervix cancer has improved with the availability of modern therapies. Supportive treatment including diet and nutrition, psychological counselling, management of pain, blood products transfusion and treatment of urinary infections plays a vital role in the treatment of cervix cancer patients.


FOLLOW UP

After the completion of treatment of cervix cancer, women need to be in periodic follow up with their doctor for check-up. In these follow up visits, the patient is physically examined and certain tests may be done to make sure that the cancer has not relapsed (come back). After completion of treatment, patients should focus on maintaining healthy lifestyle, diet and exercise, good genital hygiene and quit smoking.


TAKE HOME MESSAGE

  1. Cervix cancer is preventable by adopting safe sexual practices and HPV vaccination.

  2. Cervix cancer is detectable in early stages by the use of screening tests like PAP smear.

  3. Cervix cancer can be treated effectively once diagnosed.

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