Dr Rajeev Gupta
Carcinoma of the cervix is the second most common cancer in the women worldwide as well as amongst the Indian women. According to a report by GLOBOCAN 2012 (WHO), about 23 women out of every 100,000 suffer from cervical cancer in India. Almost 123,000 new cases are diagnosed every year and 67,500 patients die every year due to cervical cancer, which amounts to about 8 deaths every hour. India alone is harboring more than 25% of the whole world’s cervical cancer burden. Women in India have a 2.5% lifetime risk to get Cervical Cancer, which is double the risk as compared to the data worldwide (1.3%).
Cancer awareness is the key to prevent cervical cancer. However, it is a tragedy that cervical cancer is widely prevalent in India due to lack of proper knowledge and information. It is also unfortunate that cervical cancer mostly affects the young women. But the important thing to understand is that cervical cancer is completely preventable and, therefore, all you need is awareness to protect yourself from it.
Cervical Cancer is a Sexually Transmitted Disease & also an AIDS Defining illness. It is caused by the infection with Human Papilloma Virus(HPV). HPV prevalence increases with multiple sexual partners and poor genital hygiene. Also, too many children, not enough spacing between children, low nutrition levels and early marriage all contribute to the risk factors for this kind of cancer. The high risk group includes girls who have commenced sexual activity as teenagers, those who have had multiple pregnancies or have multiple sex partners and don’t use contraceptives.
Symptoms of Cervical Cancer
* Abnormal vaginal bleeding.
* Increased vaginal discharge
* Pain in the pelvic area
* Pain during intercourse
* Abnormal vaginal bleeding.
* Increased vaginal discharge
* Pain in the pelvic area
* Pain during sex
The disease remains asymptomatic for a long time till it starts invading neighbouring tissues. Only during the later stages of cancer is when one or more of these symptoms shown in table may be noticeable. However, similar symptoms can also be caused by other infections or other health problems. Hence, it is very important to consult your gynecologist at the earliest
Cervical cancer is a deadly disease once it reaches the invasive stages. But out of all the female genital tract cancers, it is the only preventable cancer, if detected at its early stages. The process of transformation of a precancerous state to cervical cancer takes approximately 10 years or more. During this period, a simple test called Pap smear (Papanicolaou Smear) can detect this precancerous state. Population-based screening with Pap smear is an important secondary preventive measure for cervical cancer that leads to a high-cure rate among cervical cancer patients. As per NCCN Guidelines (USA), Pap smears are recommended for all sexually active women and should begin at 21 years of age or three years after the onset of sexual activity. The test should be repeated every two years till the age of 30 and thereafter, at three yearly intervals if normal and at 5 yearly intervals if both Pap smear and testing for high risk strains of HPV are negative. In a landmark study by Tata Memorial Cancer Hospital, Mumbai, mass screening of women was found to reduce the risk of dying due to cervical cancer by a whopping 30%. It is known that mass screening for cervical cancer even once in 10 years can reduce the incidence of this disease by 60%.
How to Prevent Cervical Cancer?
* Delay the onset of sexual activity
* Limit the number of sexual partners
* Say no to smoking and also avoid second-hand smoke
* Practice barrier method of contraception
* Schedule your Pap tests
* Follow-up on abnormal Pap
* Get yourself vaccinated
* Maintain a healthy diet & lifestyle
Cervical Cancer Vaccination : Vaccination against HPV at an early age is the best way to prevent the disease. In the trials that led to approval of 2 Vaccines (Gardasil and Cervarix ), it was found that they provide nearly 100 percent protection against persistent cervical infections with HPV types 16 and 18 ( Cancer causing serotypes of HPV) and reversal of any cervical cell changes that transform them to invasive cervical cancer. Both vaccines are available presently in the Indian market.
Vaccination Schedule : The HPV vaccines are all designed to be given to people in three doses ( 0, 2nd month & 6th month) over a 6-month period. But recently , the World Health Organization has recommended two doses as the standard delivery for these vaccines, although in the United States three doses are still recommended.
HPV Vaccine Recommendation : As per recommendations of IAP (Indian Academy of Pediatrics), all girls in the age group of 9- 26 years of age , should undergo vaccination, with ideal age of 10-12 years. All females are advised to get themselves vaccinated before the commencement of a sexually active life, since more than 75% of sexually active females have been tested positive for HPV by 22 years of age.
Treatment of Cervival cancer: Once cervical cancer has developed, treatment is planned according to the stage of the cancer
* Precancerous changes in the cervix (Stage 0) can be treated with cryosurgery or laser surgery with aim of preserving the fertility & long term cure (100%)
* Early stage Cancer (Stage I) can be treated with surgery with removal of uterus & both ovaries , with aim of long term cure (5 year survival : 81-96%)
* Locally Advanced Cervical Cancer (Stage II, III ) can be treated with radiation therapy, chemotherapy or a combination of two or more of these methods , with the aim of destroying the cancer & containing the disease, may result in cure (5 year survival : 20-35%)
* Late stage or Metastatic Cervical Cancer (Stage IV) can be treated with chemotherapy , with aim to decrease the tumor load & prolong the life of the patient (5 year survival : <1%)
Author is working as Assistant Professor at Sri Guru RamDass Institute of Medical
Sciences & Research, Amritsar & consultant Medical Oncologist & Hematologist
at Sanjeevani Cancer Clinic, Jammu.
If any query, he can contacted @ email: drrajeevgupta1@gmail.com
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