Article by Cancer Hospital India
In India more women die because of cancer of cervix than by any other disease. This happens despite the fact it is easily preventable and curable. Out of 500,000 new cases of cancer cervix detected worldwide each year, India contributes 20 percent (100,000) of them. The registered cases in population based Cancer Registry is just the tip of the iceberg. Many more women are dying without being diagnosed and reported, as a result of progressive advanced staged cancer cervix, in remote rural areas. In last few decades, because of Cervical cancer screening programs, in most of the developed countries the incidence of ca cervix has dropped significantly. Because India lacks such a program, the picture have is still gloomy, and most women come to know about their disease, when it is already in advanced stages (Stage III / IV). Overall 5 years survival rates in India 49 percent compared to 72 percent in developed countries. The main reason for poor prognosis in India is that more than 2/3rd of our cases are detected in advanced stages (III or beyond), when overall survival is less than 30 percent. This is a matter of concern to a civilized society where ladies are dying premature by due to a preventable cancer.What is cancer of cervix and how it occurs? Cancer of the cervix, also the mouth of uterus or the lower most part of womb (where baby grows), is easily accessible for examination by the gynecologist per vaginal examination. Cancer of cervix is probably caused by high risk strains of the human papilloma-virus (16, 18, 31, 45 etc), a common sexually transmitted infection. In more than 90 percent of the infections, HPV clears up on its own, but in 10 percent of cases either cancer or genital warts develop. Multiple sex partners increases risk of HPV infection and the more partners the current partner has had, the higher is the risk that he will transmit HPV. Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human immunodeficiency virus (HIV) and other factors like smoking, diet, oral contraceptives are other important high risk cofactors in cervical carcinogenesis. Early age of marriage and early child bearing are contributing factor in our country. The HPV virus causes cervix cancer was established by the research work of Nobel laureate Professor Herald Har Hassen, and this led to development of a vaccine for it. The HPV vaccine can prevent 70 percent of cancer cervix and current guild lines recommend immunization all girls is adolescent age groups i.e. before sexual exposure with 3 doses of HPV vaccine. During cancer development, the HPV viral particles get integrated with DNA of human nucleus resulting in mutation and rapid cancerous proliferation. This process cervical takes a few decades, for precancerous or cancerous changes to occur in cells. What are the aims of cervical cancer screening and the available methods for it?Screening aims are to detect cancer cervix the precancerous or early stages, when it is treatable. The Pap smear is the most widely available and effective method for this. Efforts are going on to develop an alternative cost effective method to suite low resource setting, to cater the vast population of developing poor countries. For this VILI /VIA/Low cost HPV DNA testing are being investigated in various research trials.
What is Pap smear?
For a PAP smear of vaginal secretions and spreading on slide which is then
.. in the pathology laboratory and examined under the microscope by a trained pathologist to detect precancerous changes in the cells. It is well recognized, that widespread use of Pap smear can reduce cancer rate by more than 50 percent sd precancerous lesions are picked up and treated.
What to do, if one a precancerous lesions & role of Colposcopy? : If an abnormality is detected on a Pap smear one should immediately seek expert advice from a Gynecology oncologist. Further evaluation is by colposcopy is required and close follow up must be done, as about 30-50 percent of severe dysphasias may transform into cancer. Colposcopic evaluation visualizes the precancerous lesion in a magnified way, to help the gynecologist in taking a biopsy from the most affected area. After a colposcopy and biopsy reports, a patient may just require close observations with frequent Pap smears or wider local excision of cervix with LEEP (Loop Electric Excision Procedures) or cold knife conization of the lesion. Wherever facilities are available and affordable, triage HPV DNA testing can be done. In a few cases the Pap smear/ Biopsy may reveal cancer.
What are the sign and symptoms of cancer of the cervix?
Persistent white discharge or foul smelling discharge. Bleeding per vagina (Post-coital, Post-menaupausal or irregular menstruation). Vomiting with decreased urination or pain in pelvis or sacral areas. Incontinence of urine or faces may be signs of advances stages of cancer cervix.
Stages of cervical cancer are Precancerous stage CIN(Mild/Moderate/Severe Dysplasia) Stage 0 carcinoma in situ. Stage I disease is localized to cervix Stage II spread to adjacent parts in the pelvic Stage III: spread upto pelvic walls or into lymph glands StageIV: spread to distant organs
Treatment of precancerous and Cancer of Cervix Precancerous dysplasias are treated either with local destructive procedures (cyro or electric cauterization) or local excision (LEEP or cold knife excision). Early cervical cancers are best treated surgically with radical cancer surgeries, while in advanced cases killing the cancer cells with radiation is more suitable. Such radical surgeries are best and safely done by doctors with specialized training in Gynec cancer surgeries.
How to win over cancer cervix & to aim for cancer cervix free India?
It is achievable through regular Paps smears along with immunization (of adolescent uninfected girls). It requires political will power with social commitment. Empowerment of women and to educate them about health needs is other essential aspects, to win over cancer cervix. The non governmental organization can contribute a lot, by organizing screening camps and in facilitation of follow up of suspicious cases for colposcopy at higher centers. Not only that, they can provide immense support at time of need, when a mother of young children is detected with cervix cancer. They can help in clearing many doubts and myths about the disease and treatments. Identification of individual hindrances in receiving unrestricted complete treatments and resolving the issues need special attention in Indian scenario.
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Author on various topics for Cancer, Radiation Oncology ,Allied Services, Healthcare, Hospitals and Health Subjects.For more information please visit Cancer Hospital India
