Overview

Cervical Cancer arises from the cells lining the cervix, which is an opening between the vagina and the womb. Cervical cancer is the second most common cancer and accounts for 22.86% of the total cancer burden among Indian women. It is most commonly seen among women who are in their 30s and 40s.

Cervical Cancer arises from the cells lining the cervix, which is an opening between the vagina and the womb. Cervical cancer is the second most common cancer and accounts for 22.86% of the total cancer burden among Indian women. It is most commonly seen among women who are in their 30s and 40s.

Of all, HPV-16 and HPV-18 types are observed to cause 70% of cervical cancer cases and precancerous lesions.

Types

Based on the type of cell that it originates from, cervical cancer is categorised into two types:

1. Squamous cell carcinoma: This is the most common type of cervical cancer. This arises from the skin-like cells (squamous) that line the cervix.

2. Adenocarcinoma: This is a rare form of cervical cancer that forms in the glandular cells (cells producing mucus) within the cervical canal.

Symptoms

Cervical cancer is a slow-growing cancer, which is reported to take 10-20 years to develop. In the early stages, it may not have any symptoms. As the disease progresses, the symptoms become apparent. Of all, vaginal bleeding is the first symptom to appear. Other symptoms of cervical cancer include:

• Intermenstrual bleeding (bleeding between normal periods)
• Bleeding after sexual intercourse (post-coital bleeding)
• Vaginal discharge with an unpleasant odour
• Discomfort or pain during sex

The above symptoms are associated with other common and less severe conditions too. Therefore, if any of these symptoms are seen, women must immediately see their doctor for appropriate intervention.

Causes

In most cases, cervical cancers are caused due to Human papillomavirus or HPV infection, which is a common infection of the reproductive tract in women. HPV infection is largely transmitted through sexual contact. Most of these infections and the precancerous lesions that are caused due to the infection clear up spontaneously through the body’s natural defence mechanism. In a few cases, however, HPV infections become chronic and cause precancerous lesions, which eventually become cervical cancer. Following are other risk factors that are associated with cervical cancer:

• Weaker Immune System: Women with the weaker immune system are more susceptible to cervical cancer. Having HIV or other immunocompromised conditions may be associated with increased cervical cancer risk.
• Smoking: The risk of cervical cancer is reported to be two times higher among women who smoke. Smoking also leads to compromised immunity, which is also a risk factor.
• AGE: The risk of developing cervical cancer increases with age. It is mostly diagnosed among women aged between 35 and 44. Around 20% of the cases are seen among women aged over 65.

Poor hygiene, a history of chlamydia infection or herpes, family history of cervical cancer, socioeconomic factors, excessive usage of oral contraceptives and a diet low in fruits and vegetables are other risk factors that are associated with cervical cancer.

Diagnosis

There are various methods to detect and diagnose cervical cancer:

a. Physical Examination: To start off, the doctor may recommend a vaginal examination to check for the signs of cervical cancer. If an abnormal growth is suspected, additional tests may be recommended.

b. Colposcopy:This procedure assists a more detailed examination of the cervix. A special tool called a speculum is inserted into the vagina to get a magnified view of the cervical wall. If precancerous lesions are observed during this procedure, a sample for biopsy may also be collected.

c. Biopsy: Biopsy may help in arriving at a definitive diagnosis. The sample collected is examined under the microscope to check if the cells are cancerous.

Treatment

Different treatment options available for cervical cancer management include surgery, radiation therapy and systemic therapies, such as chemotherapy, immunotherapy and targeted therapy. The treatment plan is made based on the stage and nature of the disease and the overall condition of the patient.

a. Surgery: Surgery is the main line of treatment for cervical cancers.

• Removing the tumour only: In the early stages of cervical cancer, the disease can be successfully managed by operating the tumour along with a small portion of healthy tissues surrounding it. This treatment option preserves fertility.
• Trachelectomy (removal of the cervix): A few early-stage cervical cancers are treated through trachelectomy or the removal of the entire cervix with some surrounding tissue. However, the uterus remains intact, and women may have no problems getting pregnant after this procedure.
• Hysterectomy (removal of cervix and uterus): This procedure removes the cervix, uterus, part of the vagina and nearby lymph nodes. This procedure reduces the risk of recurrence.
• Palliative surgery: This surgery is recommended in advanced stages in order to ease the pain and other symptoms caused by the disease. The main goal of this surgery is to improve the quality of life for patients.

b. Radiation Therapy: Systemic therapies are administered to find and attack tumours throughout the body including the ones that are too small to detect. These are usually recommended in advanced stages.

c. Systemic Therapy:Radiation therapy kills cancer cells by using intense energy beams, such as X-rays and protons. For better results, radiation therapy is used in conjunction with chemotherapy or surgery.

• Chemotherapy uses anti-cancer drugs which destroy the tumour cells by stopping their growth and multiplication. Lately, concomitant chemoradiotherapy is being widely preferred for cervical cancer management.
• Immunotherapy uses the body’s own immune cells to launch an attack against cancer cells. During this procedure, the immune cells are extracted and modified to identify the cancer cells and attack them.

Frequently Asked Questions

1. Is bladder cancer treatable? ?

Yes, bladder cancer is one of the few cancers that can be detected in the early stages when it is more easily treatable. There are multiple treatment approaches to treat and manage early to advanced-stage bladder cancers with positive clinical outcomes.

2. Can I live a normal life after bladder cancer?

It is not uncommon for survivors to worry about not being able to return to their normal life after their bladder cancer treatment.

Bladder cancers can be challenging, yet, returning to routine activities and continuing to have a normal life is possible. However, the survivors need to keep up their follow-up appointments with their doctors and follow their expert team’s recommendations.

3. Does quitting smoking reduce bladder cancer risk?

Smoking is one of the biggest risk factors for bladder cancer, and it increases one’s risk of getting bladder cancer risk by three times.

Therefore yes, quitting smoking can reduce one’s bladder cancer risk.

4. If I am diagnosed with bladder cancer, will the doctor remove my bladder?

No, removing the bladder is not the only treatment option for bladder cancer. Treatment planning is made based on multiple factors such as the stage and grade of the tumour, its size, exact location and the patient’s overall condition.

In the early stages, only the tumour and a small portion of the healthy tissues surrounding it are removed. The surgery may be followed by chemotherapy to reduce the risk of recurrence.

In advanced stages, bladder removal may be recommended in order to improve the survival rates for the patients. The removal may be followed by neobladder reconstruction, wherein a part of the patient’s intestine is excised to build a reservoir and it is attached to the urethra. Neobladder functions in a similar way to your original bladder.