Watch out for these symptoms and get screened to reduce your risk for cervical cancer

Cervical cancer is probably the most common cancer of the female reproductive tract in India, Asia and in fact the whole world. 99% of cervical cancer cases happen due to persistent infection with human papilloma virus (HPV), a sexually transmitted disease. Most sexually active women get infected with HPV at some point during their lifetime. In most cases, the infection clears out on its own and, in very few cases, the infection persists and progresses to precancerous stage and if untreated subsequently to cervical cancer over a period of time.

If a woman, above the age of 30 years, is having irregular bleeding after menstrual cycle or excessive vaginal discharge which is foul smelling, or has unexplained pain in the back, legs or pelvic region, it is time to get examined by a doctor. These could be possible symptoms of a lurking cervical cancer.

Additionally, pain and bleeding during intercourse, irregular bleeding after menopause and sudden loss of weight and appetite, over a period of time, are also generalized symptoms of cervical cancer and should be addressed.

Lifestyle factors like unsafe sex practices (having more than one partner), smoking etc. increase the risk of developing cervical cancer. A young woman who has had more than three children in quick succession is at higher risk of developing cervical cancer. At the same time, a woman who has consumed oral contraceptive pills for over five years is also at risk. Low immunity and bad hygiene add to this risk.

However, in most cases, cervical cancer, has a long gestational period. With regular screening it is possible to diagnose it early in a non-invasive precancerous stage before it develops into an invasive cancer.

What must be done?

All sexually active women should get themselves screened regularly. Screening helps to detect the precancerous disease. Screening tests includes cervical cytology (Pap smear test), VIA (Visual inspection with acetic acid) or HPV testing. Screening should begin at the age of 30 and should be done every 5 years till the age of 65. Women, who have received abnormal results for screening, should get themselves assessed every 6 months to one year as per their doctor's advice.

Pre-cancerous lesions can be easily treated completely by using freezing (cryotherapy) or burning (laser ablation) or Loop Electrosurgical Excision Procedure (LEEP) as per availability.

What if the screening is not done?

If screening is not followed as advised, women may develop advanced cervical cancer. In such cases, doctors do physical examination and diagnostic tests to find out stage of the cancer. In those cases, often a cervical biopsy is needed initially. Biopsy means removing a small sample of tissue from the cervix and getting it examined by pathologist. The pathologist examines the tissue for abnormal areas including pre cancer or cancer and type of cancer. Then imaging is needed, which helps to determine the size, extent and spread of the cancer to guide further treatment. Based on these findings, doctors determine what is called "clinical stage of the cancer" which describes the extent of the cancer spread.

The FIGO (International Federation of Gynecology and Obstetrics) staging system is used most often for cancers of the female reproductive organs, including cervical cancer. Cervical cancer stage ranges from stages I (1) through IV (4). The lower stage number means less spread of cancer. A higher stage number, such as stage IV, means a more advanced cancer. Each stage has many subdivisions.

For simplicity staging is as follows: Stage I- Cancer cells have grown from the surface of the cervix into deeper tissues of cervix only; Stage II – Cancer has spread beyond the cervix and uterus into the upper part of the vagina or into the tissues on the both sides of the uterus; Stage III – Cancer has spread into the lower part of the vagina or the walls of the pelvis and block the ureters (tubes which carry urine from kidneys to bladder) or the lymph nodes; Stage IV – Cancer has grown into the urinary bladder or rectum or far away organs like lungs or bones.

The treatment options available for cervical cancer include surgery, radiation therapy and systemic therapy. The modality of treatment is determined by different factors, like age and clinical condition of the patient, type and stage of cancer etc.

In early stages, when there is no spread to surrounding tissues or beyond, surgery and/or radiotherapy offers similar cure rates. In advanced stages, often combined treatment of radiotherapy and chemotherapy (chemoradiation) or sometimes chemotherapy alone is required to adequately control the disease in a hope to achieve cure. The type of surgery depends on the stage of presentation. Radiation therapy uses high energy x-rays to destroy cancer cells. It can be given alone, instead of surgery or in combination with chemotherapy.

Systemic therapy is use of intravenous or oral medications to destroy cancer cells. This includes chemotherapy, immunotherapy and targeted therapy. Often they are used in combination with other modalities of treatment viz. radiotherapy or surgery as a part of treatment plan.

So the final take home message which we have to understand is, if caught in pre-cancerous to early stages, the cervical cancer can be treated easily and a life can be saved.

Most importantly, cervical cancer is one of the few cancers which can be prevented and completely treated.