Cervical cancer, or cancer of the cervix, begins on the surface of your cervix. It happens when the cells on your cervix begin to change to precancerous cells. Not all precancerous cells will turn to cancer, but finding these problematic cells and treating them before they can change is critical to preventing cervical cancer.The cervix is the lowest part of your uterus. It connects your uterus to the opening of your vagina.
It is most commonly seen between the ages of 35 and 44yrs. The average age at diagnosis is 50. This rate is on the decline due to screenings and the vaccination.It is the 3rd most common cancer with the incidence rate of 18.3%. Cervical cancer accounts for 6-29% of all cancers among women in India.
Majority of cervical cancer is caused by a virus called human papilloma virus. It spreads through sexual contact with a person who already poses it.Not all HPV causes cervical cancer. Some of them causes genital warts.Most people will get HPV at some point in their lives and not realize it because their bodies fight the infection. However, if your body doesn’t fight the infection, it can cause the cells of your cervix to change to cancerous cells.
Some risk factors can be avoided, while others cannot. Some risk factors within your control are:
- Screening history: Those who haven’t had Pap tests at regular intervals are at increased risk of cervical cancer.
- Infections: Certain types of HPV infections are linked to cervical cancer. Lowering your risk for HPV can also lower your risk for cervical cancer.
- Sexual history: Having sexual intercourse before the age of 18 and having many sexual partners puts you at higher risk of HPV infection and chlamydia. Preventing these diseases reduces your risk of cervical cancer.
- Cigarette smoking is associated with an increased risk of cervical cancer.
- HIV infection: Those who’ve been infected with HIV have a higher-than-average risk of developing cervical cancer.
- Birth control pills: There is evidence that long-term use of oral contraceptives can increase your risk of cervical cancer.
- Multiple children: Having three or more full-term pregnancies may increase your risk for developing cancer of the cervix.
- Having a weakened immune system: Having a weak immune system makes your body unable to fight infections.
Some risk factors you can’t change are:
- DES (diethylstilbestrol): DES is a hormonal drug that was given to people between 1938 and 1971 to prevent miscarriage. If your mother took DES, you may be more likely to get cervical cancer.
- Family history: Cervical cancer may have a genetic component.
SIGNS AND SYMPTOMS:
Women with early cervical cancers and precancerous usually have no symptoms. Symptoms often do not begin until the cancer becomes larger and grow into nearby tissue. Signs and symptoms of stage 1 cervical cancer can include:
- Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
- Vaginal bleeding after intercourse, between menstrual periods or after menopause.
- Menstrual periods may be heavier and last longer than normal.
If cancer has spread to nearby tissues or organs, symptoms may include:
- Difficult or painful urination, sometimes with blood in urine.
- Diarrhea, or pain or bleeding from your rectum when pooping.
- Fatigue, loss of weight and appetite.
- A general feeling of illness.
- Dull backache or swelling in your legs.
- Pelvic/abdominal pain.
The tests used to detect cervical cancer are the Pap test and the HPV test. These cervical cancer screenings can find irregular or problematic cells in their earliest form before they have a chance to turn into cancer. When these cells are found early, cervical cancer is highly treatable and less likely to become serious.Your healthcare provider performs Pap tests and HPV tests by using a brush to swab or scrape your cervix to collect cells.
Most people should have regular cervical cancer screenings.Screenings include Pap tests, testing for HPV or a combination of both tests.
- Cervical cancer screening should begin at age 21 years, regardless of sexual history. Some healthcare providers are willing to delay this until age 25.
- For those 21 to 29 years of age, screening is recommended every three years with only a Pap test (no HPV test).
- For people 30 years and older, co-testing with Pap and HPV should be done every five years, or Pap test alone every three years.
- Routine Pap testing should be discontinued (stopped) in those who have had a total hysterectomy for benign conditions.
- Cervical cancer screening can be discontinued at age 65 in those who have two consecutive normal co-test results or three consecutive normal Pap test results in the past 10 years, with the most recent normal test performed in the past five years.
- People who have been adequately treated for CIN grade 2 or higher will need to continue screening for 20 years, even if it takes them past the age of 65.
Those with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
- Those who have had a total hysterectomy (removal of the uterus and cervix) should also stop having cervical cancer screening unless they have a history of cervical cancer or precancer. People who have had a hysterectomy without removal of their cervix should continue to follow the guidelines above.Those with certain risk factors such as DES exposure before birth, HIV infection or a weakened immune system will follow a different schedule.
Includes surgery, radiotherapy and chemotherapy.Various with stage of the cancer at the time of detection.
Comprehensive cervical cancer control includes primary prevention – vaccination against HPV,Use of barrier method of contraception, avoid smoking and using tobacco products, avoiding multiple sexual partners, secondary prevention – screening and treatment of precancerous lesion,Tertiary prevention – diagnosis and treatment of invasive cervical cancer and palliative care.
HPV vaccination is approved to use between 9 to 45yrs of age and protects against cervical cancer development. It is always best o get vaccination done before the start of sexual activity. It reduces the risk of cervical cancer by 90%
Earliest stage of diagnosis, five year relative survival rate is over 90%. Advanced stage of diagnosis where cancer has spread to other tissues or organs, five year relative suri I always rate is around 52-56%
Cancer of cervix is the most preventable cancer which is well controlled in developed nations. In India also there are many screening programs which help in early detection and treatment. It is advisable that all adolescent girls should get HPV vaccination done and HPV screening should start post sexual debut. All women should be aware of this and approach healthcare provider accordingly.