Introduction

Cervical cancer is the cancer that develops from the cells of cervix, the lower narrow end of the uterus connecting to vagina.

Epidemiology of Cervical Cancer

According to GLOBOCAN 2022, cervical cancer is the fourth most prevalent cancer worldwide. It affects the low-income and middle income countries where screening and prevention programs are limited. In India, it ranks as the second most common cancer among women, with 127526 new cases reported. According to GLOBOCAN 2020 its incidence rate is 18.3% and the second leading cause of death, with mortality rate of 9.1%. In India, it accounts for 6-29% of all cancers among women. However, Papumpare district in Arunachal Pradesh has the highest incidence of cervical cancer in Asia.

India accounts for 21% of new cases of cervix carcinoma and 23% of deaths due to it in the world. The peak age of incidence is between 50 and 59 years. Compared to 35-44 years in developed countries. In 32.8% of patients disease is localized at the time of diagnosis, while in the remaining 67.2% of patients, it has spread beyond the cervix. The metastasis of the disease makes the treatment costly and the prognosis poor, hence increasing the mortality. Thus, the five year survival rate of the disease is 46% in India and 66% in the US.

Risk Factors

Age- Women between 30-39 years and between 60-69 years are prone to cervical cancer.
Women having multiple sex partners.
Multiparous women( women who gave birth to multiple children)
Weak immune system due to any reason, like patient having HIV/AIDS or on immunosuppressant.
Smoking/Passive Smokers
Exposure to oral contraceptive pills(OCPs)
Obesity
Family history
Low socio-economic status
Exposure to diethylstilbesterol(DES)
Human Papillomavirus (HPV) infection is the most important risk factor. It has more than 150 variants. Some may cause only warts on the skin, genitals, throat, mouth. These are called low-risk types of variants some cause cervical or vaginal or vulval or penile cancer, these are known as high-risk type HPV. HPV types 16, 18, 31 33 are high-risk type of HPV variants. Out of all 16,18 causes 70% of cancer worldwide. And females who become sexually active at young age(<18) or having multiple sexual partners are likely to infect with HPV. In 1996 World health Organization (WHO) declared HPV as the major cause of cervix cancer.

SIGNS/ SYMPTOMS

Generally females remains asymptomatic unless the disease get locally advanced. They are discovered accidently either by screening or at family planning screening.
Irregular menstural bleeding, intermenstural bleeding, postcoital bleeding, postmenopausal bleeding.
Purulent, malodourous vaginal discharge.
Weight loss
loss of appetite
Burning micturition.
low back ache, deep pelvic pain

Diagnosis

Diagnosis of the cervical cancer begins with the screening test, i.e. Pap Smear test or HPV DNA test. If any of these is positive then we go for punch biopsy, colposcopy and other imaging modalities to confirm and know the spread of disease.

Pap Smear test- Also known as Papanicolaou test. The procedure involves collection of cervical cells with a swab and ex

amine them under microscope. If under microscope we find precancerous cells or cancerous cells then the test is said to be positive.

Colposcopy- It is a procedure in which vagina is opened with the help of speculum. And a vinegar solution is applied over the cervix to show the abnormal cells. Now with the help of colposcope these abnormal cells are visualized and biopsy can be taken.

Punch biopsy- With the help of a cutting tool a round top precancerous cells are cut down from the cervix. It is known as punch biopsy.

Cone biopsy- When a cone shaped piece of cervical tissue is cut down then it is known as cone biopsy.

Endocervical curettage- Scrapping the lining of cervix with a curette and send it to examine under microscope.

Loop Electrosurgical Excision Procedure(LEEP): An electrical wire loop is used to remove abnormal cervical tissue.

Once the diagnosis is confirmed further test are done to see the extent and spread of disease like liver function test, kidney function test, Ultrasound abdomen, CT Scan, MRI pelvis, PET Scan, etc.

TREATMENT

Treatment of the cervical cancer depends on the stages of the cancer. Treatment modality involves chemotherapy, radiotherapy and debulking surgery of the tumour, targeted therapy, immunotherapy.

Staging of the cervical cancer

Stage 1- Cancer is around neck of cervix only

Stage 2- Cancer has spread beyond your cervix and uterus but not to pelvic wall or vagina

Stage 3- Cancer has spread to vagina, pelvic walls, ureters, nearby lymph nodes

Stage 4- Cancer has spread to bladder, rectum, or other organs like lungs, bones.

PREVENTION OF CERVICAL CANCER

Cervical cancer is the only preventable cancer. It can be prevented by early screening and vaccination .Being vaccinated at the age of 9-14 years in a effective way can prevent the HPV infection, cervical cancer and HPV related cancers.

Screening from the age of 30 can detect cervical disease early, can be treated in the early stages itself and the the disease can be cured.

Vaccination- Vaccination is recommended at age of 11 or 12 years. A total of two or three doses are recommended depending on the age at initial vaccination. The recommended three dose schedule is 0,1-2,6 months. HPV Vaccination must be avoided in pregnancy.

To conclude, due to screening and new treatment modalities the incidence of cervical cancer have declined over past few decades but it is still a major public health problem.

Cervical cancer