Cervical Cancer: Prevention and Control
Background: Cervical cancer is the second most common cancer in Indian women. It is a sexually transmitted disease that results from persistence infection with oncogenic types of human papillomavirus (HPV). Oncogenic HPV DNA is found in over 95% of invasive cervical cancers worldwide. Cervical cancer is a leading cause of cancer deaths in developing countries because of high HPV infection rates and lack of comprehensive cervical Pap smear testing of susceptible women. Cervical cancer is a preventable disease as it has a well defined, long pre-malignant phase which can be detected by regular screening tests and follow up. Unfortunately, most women in India are not aware about the screening. Cervical cancer screening has the potential to prevent or reduce incidence and mortality disease.
Human Papillomavirus (HPV) is a common virus that is spread through sexual contact. About 14 million people, including teens, become infected with HPV each year. Most of the time HPV has no symptoms so people do not know they have it. There are approximately 40 types of genital HPV. Some types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. Other types can cause genital warts in both males and females. Four out of five people have at least one type of HPV at some time in their lives. The virus is spread through intimate contact with genital-skin during sexual activity, via tiny breaks in the skin. Usually this happens without anyone ever knowing it or it causing any problems. Genital HPV is a very common sexually transmitted infection which usually causes no symptoms and goes away by itself, but can sometimes cause serious illness due to persistent infection. HPV is responsible for almost all cases of genital warts and cervical cancer, 90% of anal cancers, 65% of vaginal cancers, 50% of vulva cancers,35% of penile cancers and 60% of oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils).
Symptoms:
– Abnormal vaginal bleeding
– Excessive vaginal discharge with foul smell
– Vaginal bleeding after having sexual intercourse
– Pain in the lower abdomen
– Pain during sexual intercourse
Diagnosis:
Pap Test – It’s simply picking up cells from the cervix, i.e. the lower part of the uterus and preparing a slide to be sent to the pathologist for examination. It should be done for all women who are sexually active and between 21 to 65 years of age. In case a woman is sexually active before the age of 21, the test should be done within 3 years of her first sexual intercourse.
According to CDC ( Centers for Disease Control and Prevention) you should not schedule your Pap test for a time when you are having your period. If you are going to have a Pap test in the next two days—
a. You should not douche (rinse the vagina with water or another fluid).
b. You should not use a tampon.
c. You should not have sex.
d. You should not use a birth control foam, cream, or jelly.
e. You should not use a medicine or cream in your vagina.
Colposcopy – A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas.
Biopsy – If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the outpatient department (OPD). A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).
Treatment:
Three types of treatment are used to treat cervical cancer viz. surgery, radiotherapy and chemotherapy depending upon the stage of cervical cancer:
Total hysterectomy with or without bilateral salpingo-oophorectomy.
Modified radical hysterectomy and removal of lymph nodes.
Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus chemotherapy.
Prevention:
Screening tests diagnose few changes in the cervix which are pre-cancerous and could develop into cervical cancer in future. If the abnormal tissue or cells can be removed, then the disease can be prevented from developing and causing problems. Cervical screening is a method to prevent cervical cancer by performing a simple test called Pap smear test (Pap smear is a simple and painless test, Pap test is done in girls or women above 21 years and should be repeated once in every 3 years. If this test is combined with HPV DNA test (for women above 30 years of age), then the duration of screening can be increased to 5 years).
Md. Kausar Neyaz, Ph.D
June 07, 2015
References:
1. American Cancer Society. https://www.cancer.org/latest-news/special-coverage/cervical-health-awareness-month.html
2. Int J Womens Health. 2015 Apr 16;7:405-14. doi: 10.2147/IJWH.S50001. eCollection 2015.
3. Epidemiology of cervical cancer with special focus on India. https://www.ncbi.nlm.nih.gov/pubmed/25931830