Cervical Cancer: Don’t You Worry

Cervical cancer arises from the cells of the cervix which further develops into a malignant tumour

Cancer is a disease where body cells grow abnormally in number and character, spreading themselves across boundaries to other tissues and organs of the body.

Cervical cancer arises from the cells of the cervix which further develops into a malignant tumour. The cervix uteri refer to the lower part of the female reproductive organ (uterus) which protrudes and opens into the vaginal canal. The cervical opening hosts two types of epithelial cells- the inner columnar epithelium and the outer squamous epithelium forming the squamo-columnar junction (SCJ) which is the most vulnerable site for cervical cancer as it is prone to repeated rounds of cell injury and repair. 

As the cancer forms, the cells in the cervix undergo dysplasia where abnormal growth of cells affects the deeper layers of the cervix. When the abnormal growth isn’t treated during the earlier stages, cancer invades locally to adjacent tissues, and through blood, and lymph to major organs, resulting in the death of the patient. 

Causes of cervical cancer 

Cervical cancer is categorised into Cervical Intraepithelial Neoplasia (CIN), and Invasive Cervical cancer (ICC) which can be classified into early, advanced, and metastatic cervical cancer, depending on its invasion into adjacent tissues or organs. 

The causes of cervical cancer can be partly infectious, and partly genetic. Around ninety percent of cervical cancers occur due to infection with Human Papilloma Virus (HPV), which is transmitted through sexual contact. 

Are you at risk? 

The risk of developing cervical cancer depends on various biological, behavioural, cultural, and social factors. Early marriage, multiple pregnancies, poor genital hygiene, use of oral contraceptive pills, and unsafe sexual practices could lead to cervical cancer. Other factors like the use of smoking or smokeless tobacco, excessive use of alcohol, physical inactivity, and unhealthy diet also contribute to the development and progression of this cancer by lowering immunity. 

How to help yourself against cervical cancer? 

Cervical cancer is one of the preventable cancers and can even be cured if detected early. The earliest stages of cervical cancer can be detected using various screening tests such as;

Cytology/Pap Smear Test: The Papanicolaou test or Pap Smear test is a cervical screening method to detect potentially precancerous and cancerous cells in the cervix- the lower, narrow end of the uterus. Here, the health practitioner makes a smear of cells from the SCJ and observes under the microscope for any abnormal characteristics. Detecting these abnormal cells during the early stages with a Pap smear can prevent cervical cancer from getting worse through proper treatment and follow-ups.

Visual inspection methods: These tests are called VIA/ VILI (Visual Inspection with Acetic acid/ Visual Inspection with Lugol’s Iodine). The test can be administered in any health facility, where the practitioner uses a mild acidic solution to look for an increased uptake in cancerous cells. 

HPV DNA tests: These are advanced and WHO-recommended tests, wherein the cells at SCJ are grown in a liquid media and tested for the presence of genetic material (DNA) of HPV. This helps in determining the presence of precursors to cervical cancer, viz., persistent HPV infection, and averts the development of CIN or ICC. 

National guidelines recommend all females in the reproductive age group (above 30 years) undergo a screening test for cervical cancer once in a period of 5 years. This helps in the early detection and treatment of low-grade lesions. Cancer screening has been included under national health programmes to provide these tests free of charge and thus bridge the rich-poor gap in cervical cancer prevention.                                                                    

Are there vaccines for cervical cancer?

Vaccines against HPV infection (HPV vaccines) can reduce the incidence of cervical cancer and other cancers caused by HPV, worldwide. In kids, HPV vaccines can be given to girls and boys between ages 9 to 14 years. However, a catch-up vaccination can be taken after 15 years of age. In any case, you can go for a screening test as early as 25 years to ensure if you have human papillomavirus (HPV) infection or any cancerous lesions or not.

When to seek help? 

The major disadvantage in the diagnosis of cervical cancer is that it does not produce any symptoms in the woman until the lesion reaches an advanced stage. An affected woman at  early stage of this cancer might have vague complaints such as backache, generalised abdominal pain, or lower abdominal pain. In later stages, the woman might experience irregular menstrual cycles, bleeding in between menstrual cycles, pain or bleeding during sexual intercourse, excessive or foul-smelling vaginal discharge, reduced appetite, and loss of weight. 

Major red flag signs for cervical cancer include persistent foul-smelling vaginal discharge, blood-stained discharge, pain or bleeding during sexual intercourse, intermenstrual bleeding, and chronic backache or lower abdominal pain. Women with these symptoms should consult a healthcare specialist at the earliest and get themselves evaluated for cervical cancer. 

Can it be cured? 

The treatment and cure of cervical cancer solely depend on the stage of cancer at the time of its diagnosis. The diagnosis and staging of cervical cancer are done using advanced tests such as colposcopy and biopsy, histopathological examination, and MRI.