Understanding Cervical Cancer
Cancer of the cervix is a common cancer in women over 30 years of age. It is exclusively seen in sexually active women and the Human Papilloma virus is implicated in causing cancer of cervix.
Worldwide cancer of the cervix is the third most common cause of death in women and this remain an emerging problem in third world countries. In the developed world cancer of cervix has seen a declining trend in the past half a century or so due to widespread screening programs.
Cervical cancer is a result of chronic infection with human papilloma virus, a venereal transmitted virus. In most women the immune system keeps it in check but in some women it causes disease by stimulating the cells of cervix to turn cancerous.
These viruses cause cancerous transformation of normal cells by binding to the genes of cells and causing mutations which activate some proteins while at the same time deactivating some. The initial lesions of cancer cervix are located within the top layer of the covering of cervix (also called Carcinoma in Situ). If detected during this time cancer of cervix can be cured fully.
Cancer of cervix does not cause any symptoms in the initial stages, but when it does cause symptoms the most common complaints are abnormal bleeding between periods or bleeding after sex. Women may also complain of pain while having sex. With local advance of disease women may develop chronic pelvic pain and may also exhibit a pus filled discharge from the vagina due to infection. Cancer of cervix can also spread to distant sites causing symptoms relating to that site.
One of the main reasons for the downward trend in the cases of cancer cervix is the institution of standard screening programmes by pap smears. The American cancer society in its recommendation says that women should have a pap smear immediately after onset of sexual activity or after 20 years whichever earlier. They should have two consecutive yearly pap smears and if both are negative then they should have pap smears every 3 years till 65 years of age.
Recently a quadrivalent vaccine against four common strains of the HPV has been introduced and it has been proven to provide good protection from these four strains of the virus. Since nearly 70% of the cancers of cervix are caused by these four strains nearly 70% of women should be protected with this vaccination. FDA (Federal Drug Administration, USA) has recommended this vaccine in women aged between 9-26 and preferably prior to first sexual activity. This means that it is best to vaccinate your girl as early as possible.
The management of cancer of cervix is based on the stage of the disease. The stage in reference to any cancer refers to the grimness of the cancer. The stage is calculated using many parameters like the size of the tumour, how far it has invaded, are any lymph node involved and are there any distant spread to other organs. The staging of cervical cancer also follows these principles. Once staging is done the appropriate treatment is chosen.
Broadly speaking, cervical cancer with stage 0 or I (locally contained disease) disease is most amenable to treatment with surgery. For disease which has advanced locally or has distant spread (stage II-IV), radiation therapy with platinum based chemotherapy is the preferred treatment.
Cervical cancer underscores need to further bolster our screening programmes and preventive measures. The advent of HPV Vaccine has made a major impact and its use must be popularised to achieve greatest benefits.