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CANCER OF THE CERVIX

Cancer of the cervix, also called cervical cancer, is the leading cause of cancer amongst women in India. There are more than 70,000 cases of cancer of the cervix to be found in the country.

Cancer is an unwanted purposeless and unchecked growth of any body tissue, with a capability of spreading to other areas. Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix.

The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in the lower abdomen. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

Who is at risk in developing cancer of the cervix?

Researchers have identified certain risk factors that increase the chance that cells in the cervix will become abnormal or cancerous. Initiation of sexual intercourse before age 18, many sexual partners, early age of marriage, first pregnancy at an early age, four or more number of pregnancies and women with poor personal hygiene, have an increased risk of cervical cancer.

Women who have had many sexual partners or whose partners have had many sexual partners may have an increased risk of cervical cancer at least in part because they are more likely to get a sexually transmitted virus. Scientist believes that some of these viruses may cause the growth of abnormal cells in the cervix and may play a role in cancer development.

What are the symptoms of cervical cancer?

  • Bleeding after sexual intercourse
  • Bleeding in between menses or post menopausal bleeding
  • Excessive white discharge (leucorrhea)

How can cancer of the cervix be diagnosed?

When we visit a doctor with a problem, the doctor first listens to our complaints in detail and then examines us. In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder and rectum. The doctor feels these organs for any abnormality in their shape or size. An instrument called a speculum is inserted into the vagina. This holds the walls of the vagina apart so that the doctor can see the upper part of the vagina and the cervix. The doctor may then recommend certain tests such as Pap smears, colposcopy, biopsy etc. The pelvic exam and Pap test allow the doctor to detect abnormal changes in the cervix. If these examinations show that an infection is present, the doctor treats the infection and then repeats the Pap test at a later time. If the examinations or Pap test suggests something other than an infection, the doctor may do other tests to find out what the problem is.

Pap Smear

The Pap smear test is an easy way to detect early changes in cells of the cervix, the lower end of the uterus or womb. A Pap smear is taken during an internal examination of the vagina. A speculum is inserted into the vagina and some cells are then taken from the cervix using a small spatula and smeared on a glass slide and sent to a medical laboratory to be checked for abnormality. It is important that all women have a Pap smear test every two years.

Colposcopy is a widely used method to check the cervix for abnormal areas.

These tests may not show for sure whether the abnormal cells are present only on the surface of the cervix. In that case, the doctor will remove a larger, cone-shaped sample of tissue. This procedure, called conization or cone biopsy, allows the pathologist to see whether the abnormal cells have invaded tissue beneath the surface of the cervix. Conization also may be used as treatment for a pre cancerous lesion if the entire abnormal area can be removed.

Early detection

If all women had pelvic exams and pap tests regularly, most pre cancerous conditions would be detected and treated before cancer develops. Abnormal Pap smear test does not necessarily mean patient is suffering from cancer, but may indicate a pre cancerous stage. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer years later. Appropriate treatment at this time can prevent development of cancer. The patient then needs to be closely followed. That’s why it is recommended to have a Pap smear done every two years. That way, most invasive cancers could be prevented. Any invasive cancer that does occur would likely be found at an early, curable stage.

How can cancer of the cervix be treated?

Treatment depends on a number of factors, age, location and size of the tumor, including the stage of the disease and the general health of the patient. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Many different treatments and combination of treatments are used to treat cancer of the cervix. The three common modes of cancer treatment are surgery, radiation therapy and chemotherapy. Radiation therapy is the mainstay in the treatment of the cancer of the cervix.

Radiation therapy involves subjecting the cancer-bearing region to radiation. Ionizing radiation damages or destroys the cancer cells and prevents them from growing and multiplying. Normally the treatment is divided over a period of one month, during which fixed doses of radiation are delivered each day. Radiation affects both normal as well as abnormal tissues while ensuring sustained tumor destruction. Usually most of the radiation treatment is given as an outpatient procedure. Radiotherapy treatment in itself is painless just like an X-ray, and may take anything from a few seconds to several minutes.

The different radiation therapies involve delivering radiation either from close quarters or from a distance. Radiation therapy where the source of radiation is close to the tumor is referred to as ‘Brachytherapy’. Therapy, where the radiation source is located away from the tumor is referred to as ‘Teletherapy’. Brachytherapy is mostly delivered by directly implanting radioactive wires or seeds into the tumor, while Teletherapy is given by using fixed machines.

Surgery is one of the commonly used modes of cancer treatment, wherein the surgeon removes a localized tumor.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing and dividing normal cells in the body. The treatment is given in cyclic form once in 3 to 4 weeks, to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time. Chemotherapy and Radiation therapy may cause side effects, but most side effects of radiotherapy and chemotherapy are reversible after treatment is over.

Follow-up care

Regular follow-up examinations including a pelvic exam, a Pap test, and other laboratory tests are very important for any woman who has been treated for pre cancerous changes or for cancer of the cervix. The doctor will do these tests and exams frequently for several years.

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