Sakaal Times
25 March 2011

Dr Sucheta Parte,Senior Gynaecologist,ONP Tulip Hospital Oyster & Pearl Hospital
Cervix is the part of the woman’s reproductive system. It is the lower narrow part of the uterus which connects the uterus to the vagina. Cervical cancer is malignant neoplasm of the cervix uteri and is the most common cause of cancer deaths in women where PAP tests are not available. It is the easiest gynaecological cancer to prevent through screening and early vaccination.

Every year, 500,000 women worldwide are diagnosed with cervical cancer. Eighty per cent of cervical cancers are found in developing countries. India accounts for 27 per cent of the world’s total cervical cancer cases and deaths every year.

Causes
The exact cause is unknown but infection with high risk strain of Human Papilloma virus (HPV) is the most important risk factor for development of cervical cancer. HPV is transmitted through sexual contact. It affects 80 per cent of all sexually-active people. More than 150 types of HPV are identified of which 15 are classified as high risk types. Types 16 & 18 cause 70 per cent of Ca Cx. Type 6 and 11 are associated with genital warts.

Other risk factors include early age of sexual activity, multiple partners, STDs, smoking, weakened immune system, long-term hormonal pills.

Symptoms
Most commonly, cervical cancer is asymptomatic. However, sometimes it shows symptoms like vaginal bleeding, postcoital bleeding, dysparunia, altered vaginal discharge, post menopausal bleeding. In advanced cases, loss of appetite and weight, fatigue, pelvic pain, leg pain, leaking of urine or faeces from vagina, bone fractures, etc.

Prevention
Practice safe sex, avoid smoking, maintain a healthy diet and lifestyle, go for regular screening (PAP smear, HPV test, liquid cytology) and vaccination.

PAP test is a simple OPD procedure done to detect abnormal cells in the cervix well before cervical cancer develops, and cancer when detected early is easier to treat. In this test, the loose surface cells on the cervix are scraped using specially-shaped spatula and a brush. The cells are smeared on to a slide, stained and examined for abnormal cells. The test needs to be done within 10 days of the end of menstruation.

PAP screening should be started as early as 3 years from first intercourse, to be done yearly until 30 years of age. After 30 years if 3 consecutive PAP & HPV testing show negative results, then screening can be done once in 2-3 yrs. Screening can be stopped at 70 years in well-screened women who have not had an abnormal PAP in last 3 examinations. Depending on PAP result, the person may be advised HPV testing, repeat PAP test, colposcopy, cervical biopsy or endometrial biopsy.

Vaccination is the only true form of prevention. It stops the disease from happening in the first place. There are 2 available vaccines today — Gardasil (Quadrivalent ) & Cervarix (Bivalent). Quadrivalent vaccine protects from 6, 11, 16, 18 HPV types and partial protection from 33, 35, 41. Bivalent vaccine protects from 16 & 18 HPV types and partial protection from 33, 35, & 41. Dosage schedule — 3 doses (0, 2 & 6 Quadrivalent & 0, 1 & 6 months for bivalent) protection starts within one month of last dose. Vaccination is ideal for age groups between 11 and 26 years.

Diagnosis
Diagnosis of cervical cancer is done by clinical examination, PAP, Biopsy, ultrasonography.

Treatment
Treatment modalities depend on the stage at which cervical cancer is detected. They vary from LEEP, laser therapy, cryotherapy, trachelectomy, radical hysterectomy, radiotherapy and chemotherapy.