Understanding Cervical Cancer

The cervix is the lowest portion of the uterus, which connects it to the vagina.
Cancer of the cervix occurs when there is an abnormal growth of cells in that area. When the cancer is invasive, it affects the deeper tissues of the cervix and spread to other parts of the body like the liver, bladder, vagina, and rectum. That’s when it’s called metastatic cervical cancer. Cervical cancer, unlike other cancers, can be prevented as it progresses very slowly through the precancerous stages.

What Causes Cervical Cancer?

Cancer of the cervix starts with abnormal changes in the cervical tissue. This can be caused due to:
Development of human papillomavirus (HPV), which spreads through sexual contact. This virus can also cause genital warts and other skin problems.
Early sexual contact
Multiple sexual partners
Taking oral contraceptives (birth control pills)
Cigarette smoking too contribute the growth of HPV

What are symptoms of cervical cancer?

Like many other cancers, cervical cancer may show no signs until it has progressed to a dangerous stage. The major symptoms include

Abnormal vaginal bleeding (other than menstruation including post-sex bleeding)
Painful sex
Abnormal vaginal discharge
Pain in the pelvis or lower belly

How is cervical cancer diagnosed?
Cancer in the cervix is diagnosed through a test called PAP smear test (cervical cytology –a part of pelvic examination).

Who should be screened?
Women of all ages should ideally get a PAP smear test done to check for cervical cancer. PAP Smear should be done:

Once in 3 years in women aged 21-29 years (HPV test is not recommended)
Once in 3 years in women aged 30-65 years and HPV test once in 5 years.
Women who have undergone a hysterectomy (removal of uterus and or ovaries)

Those above 65 years of age need not undergo screening, provided they had 3 negative PAP tests or two negative co-test result in the past 10 years, with the recent test having been done in the past 5 years.

How can cervical cancer be prevented?
Primary prevention (preventing diseases before hand) can be ensured through:
Safe and healthy sex
Using condoms every time
Avoiding unprotected sex, especially if the person is infected
Vaccinating against the cancer

Vaccinations

There are three types of vaccines for cervical cancer – 2 types of Gardasil and Cervarix
Gardasil prevents cervical cancer and genital warts.
Gardasil 9 is recommended for age group 9-12 years (can be administered in women up to 26 years)
Cervarix acts ensures protection against cancer of the cervix.
These vaccines can be given along with tdap and Hepatitis B vaccine.
Side effects of this vaccine are headache, pain, light-headedness, redness and itching.
Routine screening for should continue even after administering the vaccination

Secondary prevention (early detection and treatment)
There are different methods to detect and treat cervical cancer including:
Cervical Cytology: Conventional test or PAP smear test
Liquid-based cytology: Samples of cervical cells are examined to detect cancer
Testing for HPV: Sample cells are tested for presence of the most common high-risk variants of HPV.

How is cervical cancer treated?

Depending on the cancer stage, cervical cancer modes include:
Surgery
Chemotherapy
Radiation therapy
Targeted therapy

Patients would need to follow-up regularly and do periodic tests to ensure everything is fine after the surgery/ therapies.

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