The lower part of the uterus is called the cervix. Cervix cancer is caused due to infection with high risk strains of human papillomavirus in majority of the cases. The mode of transmission is through sexual contact. Body’s immune system wards off the virus but in some people the virus can persist for a longer time period causing cancerous changes in the cervical cells. While there is no definitive treatment for HPV virus infection, timely diagnosis, gynaecologist visits, regular screening and vaccination can help prevent cervix cancer.
Cervix cancer is caused by human papillomavirus infection (HPV). While a normal cell has controlled growth and multiplies at a set rate, the abnormal cancerous cells multiply uncontrollably and accumulate in masses which causes tumour and can also enter into the bloodstream to spread in other parts of the body. The virus causes abnormal changes in the cells of the cervical lining which can become invasive and cause cancerous spread to adjacent tissues.
Based on the affected cell type Cervix cancer are of the following types:
- Squamous cell carcinomas
- Adenosquamous carcinomas
The majority of the cases are squamous cell carcinomas (80-90%) while Adenocarcinomas are present only in 10-20% cases.
Stages of Cervix cancer:
Based on the involvement of adjuvant structures and the spread of cancer, Cervix cancer can be at various stages:
Cancer is limited to the cervix
- Spread of cancer beyond the cervix into pelvic tissues but not upto the pelvic side walls
- Lower part of the vagina affected with spread upto the pelvic wall and lymph nodes
- Cancer spread to other body parts such as bladder and abdomen
The signs & symptoms of cervix cancer may very depending on the stage of cancer. These include:
- Vaginal discharge, watery or bloody with or without foul odour
- Abnormal vaginal bleeding
- Bleeding after sexual intercourse
- Postmenopausal bleeding
In later stages of cancer with spread to nearby tissues, the symptoms include:
- Hematuria – Blood in the urine
- Dysuria - Painful urination
- Loose motions
- Rectal bleeding
- Swelling in the lower extremities
- Unexplained weight loss
- Pelvic pain
- Painful intercourse
Risk factors of
The risk factors for cervix cancer are:
- Multiple sexual partners – It increases the risk of HPV infection·
- Pre-existing sexually transmitted diseases – STIs such as Gonorrhoea, Chlamydia, AIDS, Syphilis increase the susceptibility to HPV infection
- Young age at first coitus
- Multiple pregnancies
- Poor genital hygiene
- Low socio-economic status
- Immunocompromised state – Weak immune system due to preexisting health conditions leads to increased risk of infection
Cervix Cancer Occurrence
- Cervix cancer is the 4th most common cancer in females worldwide and the second most common cancer in Indian women
- Around 99% of Cervix cancer cases are caused due to human papilloma virus (HPV) infection
- 70% are caused by high risk strains HPV type 16 and 18
- The global mortality rate for cervix cancer is 13.3/100,000 women as per 2020 data
Diagnosis and Tests for
Cervix cancer can be diagnosed through pelvic examination and Pap smear test during gynaecological visit followed by biopsy from suspicious area of cervix or visible growth. The doctor may perform the following tests -
- Colposcopy (visual examination of the cervix under magnification) with directed biopsy in the absence of visible growth
- Liver function test, Kidney function test
- Blood and Urine test
- Imaging of the pelvis and upper abdomen.
Pap smears are the most effective way of early detection. Pap Smear detects pre-cancerous changes in the cervix which can be treated on time before the development of cancer. The test is non-invasive and safe. Light spotting can be present after the test. It can also be accompanied by an HPV test. Early detection and intervention are crucial aspects for preventing Cervix cancer.
All females between 21 to 65 years of age should get themselves screened by Pap smear every 3 years. The addition of HPV test to Pap smear (Co-test) increases the screening interval between two successive tests to 5 years. HPV test is not recommended in females less than 30 years as chances of HPV positivity are high in females less than 30 years due to natural infection after sexual activity and it would eventually be cleared by body's immune system in the next two years.
Cervical tissue samples are tested in the laboratory for abnormalities and graded 1 to 3. These changes are also called as dysplasia and are indicative of precancerous conditions. Based on the grade, they help to identify the severity of precancerous conditions.
- Grade 1 – Mild dysplasia
- Grade 2 – Moderate dysplasia
- Grade 3 – Severe dysplasia
While mild cervical cell dysplasia is seen in most of the women and it regresses spontaneously over the next two years of follow-up, only in a few women it has the potential to develop into invasive cancer cells. Advanced diagnostic tests and imaging can be recommended for accurate diagnosis. All cases of moderate and severe dysplasia require treatment. Appropriate diagnosis and treatment of the pre-cancerous condition can prevent cervix cancer.
Treatment modalities for Cervix cancer are: ·
Surgical removal of the uterus, cervix, adjacent tissues and lymph nodes. This is known as Radical hysterectomy and pelvic lymph node dissection. The route of surgery can be MIS (Minimally Invasive Surgery) either Laparoscopic or Robotic approach or conventional open (Laparotomy) route. Surgery is the treatment of choice in young patients in early cases of stage – I Cancer. ·
Use of beamed radiation and radioactive pellets to target cancerous tissue. Radiation therapy can be given in all stages of cancer cervix ·
Use of combinations of Chemotherapy drugs Cervix cancer can be cured if diagnosed in early stages. Patient specific treatment plans and palliative care is needed for recurrences.
Cancer of the cervix is preventable cancer. It can be prevented by regular pap smear screening and timely and appropriate treatment of the pre-cancerous lesions. While most women get infected at an early age, the infection clears itself out eventually. Those females who are unable to clear the infection and have persistent HPV infection for couple of years, develop cancer cervix. This latent period from infection to development of cancer spans somewhere between 10-30 years providing us a long window of opportunity for screening tests, thereby preventing cancer to develop.
Primary prevention of
- HPV vaccine for girls aged 9-14 years
- Health information communication along with sex education
- Promoting use of barrier contraceptive methods
Secondary prevention of
- Regular gynaecological examinations and screening Pap tests for women between 21 to 65 years of age such as Pap
- HPV testing in women above 30 years of age
- In case of immunocompromised patients, annual HPV DNA Testing
- Appropriate treatment of precancerous lesions in cases of positive Pap and HPV test
Regular Pap smears are the most cost-effective preventive test for Cervix cancer. Lifestyle change such as following sexual hygiene and smoking cessation can also decrease the incidence of Cervix cancer. HPV vaccines are more effective prior to infection hence girls aged 9 to 14 years are advised to get vaccinated. Screening Pap tests should still need to be continued post HPV vaccination. Identification and treatment of precancerous lesions can reduce Cervix cancer cases and deaths
Our BLK-Max Medical Experts
If you are facing any similar signs or symptoms please contact the BLK-Max team to schedule an appointment at : +91-11-30403040