About Cervical cancer

 Cervical cancer is the leading cause of cancer-related deaths among women in the
majority of developing countries and the second most common cancer among women
worldwide especially in India.

 Half a million women a year develop cervical cancer worldwide.

 Each year, cervical cancer causes over 250,000 deaths approx worldwide (50% of those
women who develop cervical cancer.

 Women in developing countries account for about 85% of both the annual cases of
cervical cancer and the annual deaths from cervical cancer.

 Incidence and mortality of cervical cancer vary according to age, reaching a peak in
women aged around 40 years.

Deaths from cervical cancer in the India have fallen over the last 8 years to some extent. This
reduction is mainly because of the cervical screening programmes which may detect changes in
the cells of the cervix at a pre-cancerous stage. If abnormal cells are caught early, cancer can be
prevented or treated.

The changes can be detected by a laboratory test on a small sample of cells. The cells are taken
from an area called the transformation zone on the surface of your cervix, and preserved using a
procedure called liquid-based cytology.

Types of cervical cancer: There are two main types of cervical cancer - squamous cell cancer
(the most common) and adenocarcinoma, although they could be mixed. They are named after the
types of cell that become cancerous. Other rarer cancers of the cervix include small cell cancer.

Symptoms of cervical cancer: Abnormal cells found on the cervix during a cervical screening
test are usually at an early pre-cancer stage, and don't cause any symptoms. Treating the
abnormal cells prevents cancer developing.

If abnormal cells do develop into cervical cancer, you may have the following symptoms:

 abnormal vaginal bleeding, for example between periods or after sex

 smelly vaginal discharge
 discomfort during sex
 vaginal bleeding after the menopause

These symptoms aren't always due to cervical cancer, but if you have them, you should visit your
GP.

Causes of cervical cancer: The exact cause of cervical cancer isn't fully understood at present.
But there are a number of factors that make cervical cancer more likely. However, it's important to
note that some women who have cervical cancer don't appear to have any of these risk factors.
Ninety-nine out of 100 cervical cancers are associated with some 'high-risk' types of human
papilloma virus (HPV).

HPV is a common virus that can be passed on through sex. It usually causes no symptoms at all.
In most women, the immune system will get rid of the infection so they might never be aware of it.
Only a small proportion of women with HPV will develop cervical cancer.

HPV is from the same family of virus that causes genital warts. However, having genital warts
doesn't make you more likely to develop cervical cancer as it's caused by a different type of HPV.

You're more likely to develop cervical cancer if you:

 smoke
 start to have sex at an early age
 have many sexual partners, or have a partner who has had many partners
 hygiene and socio-economic status

Diagnosis of cervical cancer: If you have had an abnormal screening result, or have symptoms
of cervical cancer, your GP will recommend a colposcopy. A colposcopy is simply a close
examination of your cervix by a specially trained doctor or nurse using a lighted magnifying
instrument called a colposcope.

A small sample of tissue (a biopsy) may be taken from your cervix and sent to a laboratory for
testing. This will show if abnormal cells have spread from the skin covering your cervix to the
tissue underneath.

If you're found to have cervical cancer you may need to have other tests to find out if the cancer
has spread. These may include a computed tomography (CT) scan, a magnetic resonance
imaging (MRI) scan or an ultrasound scan. Over the next few years positron emission tomography
(PET)-CT scanning will replace these as the best procedure.

Treatment of cervical cancer: Treatment options for cervical cancer include surgery,
radiotherapy and chemotherapy. Sometimes these treatments are used in combination. Your
surgeon or oncologist will advise you which treatment is best for you.

Microinvasive disease

Microinvasive disease means that the cancer hasn't spread outside your cervix and has not
penetrated very far into the cervix. A minor operation to remove the cancer might be all that is
needed.

You may have one of the procedures listed below.

 Laser therapy (also known as laser ablation) uses heat to destroy the abnormal cells.
 Cold coagulation, which, despite the name, also uses heat to destroy abnormal cells.
 LLETZ (large-loop excision of the transformation zone) or loop diathermy, uses a heated
loop of wire to remove the abnormal areas. The cells aren't destroyed so the tissue can be
sent to a laboratory for testing.
If you're older and have completed your family, your surgeon may offer a total hysterectomy
(removal of the cervix and womb).

If you have disease that has penetrated further into the cervix you may have a:

 radical hysterectomy (removal of your cervix and womb, nearby tissue and the top of your
vagina)
 hysterectomy with lymphadenectomy (removal of the lymph nodes in your pelvis)
 hysterectomy with radiotherapy (a treatment to destroy cancer cells with radiation)

Radical trachelectomy may be an option for some early cancers if you still want to have children.
In this procedure your surgeon will remove most of your cervix, but leave enough behind so that it
may still be possible for you to have a baby afterwards. There is a slightly higher risk of treatment
failure when trachelectomy is used in place of radical hysterectomy.

Invasive disease

If your disease is at a later stage, you may need surgery, radiotherapy and/or chemotherapy.

Surgery

A radical hysterectomy may be performed. Your surgeon will also remove your nearby lymph
tissue to see if the cancer has spread.

Radiotherapy

A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. If the cancer has
spread beyond your cervix, it's unlikely that surgery alone will be able to treat it and radiotherapy
with chemotherapy is the usual treatment. Radiotherapy can also be used after surgery to help
reduce the risk of the cancer coming back.

Radiotherapy can be given either from outside the body (external beam radiotherapy) or internally
(brachytherapy). These treatments are usually given in sequence.

Chemotherapy

Chemotherapy is a treatment to destroy cancer cells with medicines. It's usually given as a series
of injections into a vein. Chemotherapy is usually given at the same time as radiotherapy to make
the radiotherapy treatment more effective. This is called concomitant chemo radiotherapy.
Chemotherapy is sometimes used before radiotherapy or surgery to shrink a tumour. It can also
control symptoms if cancer comes back after an initial treatment as mostly combinations of
treatments is used as chemo-radiation.
 Prevention of cervical cancer:

*Using a condom during sex will give you some protection from HPV.

*Two vaccines are now available, primarily for administration to young girls and ideally
before the onset of sexual activity. These vaccines provide protection against the two
HPV types 16 and 18, currently responsible for about 70% of HPV-related cervical
cancer cases.9

 However, vaccination does not replace other prevention strategies, such as cervical
cancer screening, since these vaccines do not protect against all types of HPV infection.
All women who have been vaccinated against HPV therefore still need regular screening
for cervical cancer.

Cervical Cancer Screening / Surveillance

 Conventionally, the Pap smear is the most commonly used procedure for early detection
of abnormal cervical cells, although a single smear remains only moderately accurate. 10

 If a Pap smear reveals the presence of atypical squamous cells of undetermined

significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL), a colposcopy
with tissue biopsy is performed to further investigate the abnormality.

 Today, the field of cervical cancer screening is changing rapidly with the development of
new markers and molecular diagnostic tests for the detection of high-risk HPV types.

 Molecular diagnostic tests are non-invasive and are used to reliably and accurately
screen women with suspected pre-cancerous lesions. They can help determine which
women with ASCUS/LSIL cervical cytology results should be referred for immediate
colposcopy and which can be followed up with cytological screening.11

 The efficacy of cervical cancer surveillance can therefore be increased by combining

molecular testing for high-risk HPV types with a Pap smear.

HPV vaccine

A vaccine to protect against the strains of HPV that are most likely to cause cervical cancer has
been developed. However, it isn't a complete protection against all strains. As it can take 10 to 20
years for cervical cancer to develop after HPV infection, it will take many years for an effect on the
rates of cervical cancer to be seen.

Although the vaccination programme against HPV has started to be implemented, the screening
programme remains a vital process and shouldn't be ignored.
Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of
cancer treatment is having support to deal with the emotional aspects as well as the physical
symptoms. Specialist cancer doctors and nurses are experts in providing the support you need,
and may also visit you at home. If you have more advanced cancer, further support is available to
you in hospices or at home, and this is called palliative care.