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What is cervical cancer?

Cervical cancer is a malignant tumour of the cervix, which is the lowest part of the uterus.

Cancer of cervix is the second most common life threatening cancer in women worldwide after breast cancer. Developing countries like India accounts for nearly one-third of global cervical cancer burden.

How does it start?

Sexually acquired HUMAN PAPILLOMA VIRUS(HPV) infection is responsible for 70% of cervical cancers & precancerous lesions. More than 100 different strains of HPV are known today.

High risk HPV types 16 & 18 cause cervical cancer & low risk HPV types like 6,11,31,33,45 etc are responsible for benign genital warts.

Precancerous cervical lesions are lesions where the cells have not breached the underlying tissues i.e CIN1, CIN2 & CIN3. 70% of these high grade precancerous lesions progress to invasive carcinoma in 10yrs if not detected and treated.

Risk factors

  • HPV infection
  • Cervical infections like chlamydia, herpes simplex
  • Immunocompromised conditions like HIV infection
  • Cigarette smoking
  • Prolonged usage of oral contraceptive usage (more than 5yrs)
  • Early marriage
  • Early child birth
  • Having more number of children
  • Multiple sexual partners
  • Unprotected intercourse (leads to infections)
  • Hereditary/family history of cancer

Types of cervical cancer

  1. Squamous cell carcinoma: More common (90%). It is the cancer of lining of the cervical canal
  2. Adenocarcinoma: Less common (10%). It is the cancer of mucous producing cells of cervix

Screening for cervical cancer

Though cervical cancer is the second most common cancer in women it can be prevented with appropriate screening tests & vaccinations.

  1. PAP smear test: All women of 30-69 yrs age group should get PAP smear testing for cervical cytology done once in every 3yrs. At Least 3 consecutive PAP smear tests should be negative and then it can be repeated once in every 5yrs.
  2. HPV DNA test: This test is done to detect sexually transmitted Human Papilloma Virus. Co-Testing i.e both PAP smear & HPV test are done together once in every 5yrs.
  3. Colposcopy: is advised in patients who have abnormal PAP smear &/or HPV positive cases.

Prevention:

Cervical cancer is the only preventable cancer!!

Vaccinations are available for Human Papilloma viral infection.

There are Bivalent HPV vaccines - against HPV types 16 & 18 and Quadrivalent HPV vaccines - against HPV types 6,11,16 & 18.

  1. For the adolescent age group: Two doses of HPV vaccine should be given to children (both girls & boys) at ages 11-12yrs, vaccine can be given starting at age 9yrs. Children who start the HPV vaccine series on or after their 15th birthday need 3doses of vaccination given over 6months.*
  2. For adult group: HPV vaccine is recommended for everyone till 25 years of age. However some adults between 26 & 45years who were not already vaccinated may get the vaccine after getting their check up done with a gynaecologist. Vaccination in this age group provides less benefit, as more people might have already been exposed to HPV.*

[* Information according to CDC (Centers for Disease Control and Prevention) www.cdc.gov]

Other cancers that are prevented by HPV vaccine:

The HPV vaccination is used to protect against the following diseases that can be caused by various types of HPV:

  • Cervical cancer
  • Vulvar and vaginal cancers
  • Anal cancer
  • Precancerous cervical, vulvar, vaginal and anal lesions
  • Genital warts

Treatment for cervical cancer:

Radical hysterectomy

Radiotherapy (External radiotherapy and Brachytherapy, that is radiation given within the cervical, uterine and vaginal cavities)

Chemotherapy given along with Radiotherapy to enhance its effect.

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