Cervical cancer: A preventable maladyMarch 6, 2020
More than eleven lakh new patients get afflicted with cancer each year in India. This figure is predicted to almost double by 2040 as a result of demographic and epidemiological changes and improved access to diagnostics.
Cervical cancer occurs when the cells of the cervix grow abnormally and attack other tissues and organs of the body. When cervical cancer is invasive, it affects the deeper tissues of the cervix and may spread to other parts of the body (metastasis), most notably the lungs, liver, bladder, vagina, and rectum. Most women might not be diagnosed for cervical cancer as the virus (human papillomavirus (HPV)) often resolves on its own in two years or less without any treatments. However, in few cases, some women may continue to be infected long after exposure.
Typical symptoms of cervical cancer include heavy menstrual bleeding, bleeding after intercourse, foul-smelling discharge, or pain in the legs. What might appear to be routine period problems in a woman may signal cervical cancer, but these symptoms many times tend to be ignored.
A pap smear is the most common cervical cancer screening test which involves collecting cells from the cervix. This is a simple outpatient procedure performed by a doctor. The benefit of this test is that it can detect even minor changes in the cervical cells, that may suggest the possibility of the patient developing cervical cancer in the coming years. Detecting these abnormalities early with a pap smear test means one can halt the onset of cancer.
Screening by cytology
In most cases, cervical cancer is caused by a sexually transmitted infection called human papillomavirus (HPV). Therefore, it is important to undergo cervical cancer screening even if you have been having sexual intercourse with a single partner. Having multiple partners increases the risk of cervical cancer. Thus, during vaginal or anal sex, using condoms can help one to protect against HPV. For oral sex, dental dams are recommended.
Stages of cancer
Stage 1 – The cancer affected area is restricted to a small portion and hasn’t affected other regions of the body.
Stage 2 – In this stage, the cancerous cells have spread to uterus and cervix and lymph nodes in some cases.
Stage 3 – The cancer affects the vagina and the pelvis. In this case, the ureters can be blocked due to which urination is affected.
Stage 4 – The cancer has affected the other body organs – lungs, liver or heart.
The guidelines by US Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) recommend screening by cytology (Pap smear test) every three years. However, a “co-test” is much preferred, which involves Pap test with HPV DNA by PCR every five years for women between 30-65 years. Conducting these two tests every five years results in better compliance, reduces the cost and effort of testing, and ensures low risk of developing cervical cancer.
After undergoing Pap smear test, a woman can go about her daily routine without any restrictions. The samples are transferred to a laboratory where they are examined under a microscope to look for characteristics in the cells that indicate cancer or a precancerous condition. Depending on the type of Pap testing one is undergoing, the doctor transfers the cell sample collected from the cervix into a container holding a special liquid to preserve the sample (liquid-based Pap test) or onto a glass slide (conventional Pap smear).
The country needs a national mission to battle cervical cancer by screening all women from a completely preventable form of cancer. Why should thousands of women die needlessly from cervical cancer when its cause and pathogenesis are well known and actionable with timely intervention.
The author is Senior Vice President with Metropolis Healthcare Ltd.