Cervical cancer is curable. Yet, in 2020, globally 342,000 women died from cervical cancer. Twenty-one percent of these deaths, 72,000, were in India where it is the second biggest killer cancer in women. In India, one woman dies every seven minutes from cervical cancer. Most of these deaths can be averted by greater awareness and thereby better prevention and early detection of the cancer.
What is cervical cancer, what are its symptoms, causes, risk factors, treatment, prognosis and how can it be prevented.
Cancer in the cervix is cervical cancer. Cervix is the lower, narrow end of the uterus (womb) which connects the uterus to the vagina (birth canal).
Sometimes abnormal cells appear in cervical tissue. If not removed or destroyed, these can develop into cancer cells which begin to grow and spread in the cervix and the surrounding area. Cervical cancer develops slowly. It takes 15 to 20 years to develop in women with normal immune systems, and 5 to 10 years in women with weakened immune systems.
Cervix has two main parts. Outer cervix and inner cervix. The border where the two parts meet is the transformation zone. Most cervical cancers begin in this zone. Ninety percent of the cancers develop in the cells of the outer cervix. Cancer in the inner cervix is uncommon. Sometimes the cervical cancer has features of both outer and inner cervix cancers.
At early stages, cervical cancer usually does not have any symptoms. Thus, it is difficult to detect. Symptoms usually occur when the cancer has spread.
In some cases, these symptoms of early-stage cancer may appear:
- vaginal bleeding after sex, between periods, after menopause
- heavier or longer than normal periods
- watery vaginal discharge which has a strong odor or contains blood
- pelvicpain or pain during sex
When the cancer has spread to other parts of the body, these other symptoms may also appear:
- difficult or painful urination or blood in the urine
- difficult or painful bowel movements or bleeding from the rectumwhen having a bowel movement
- pain in the abdomen, swelling of the legs, dull backache
- feeling tired
But many conditions other than cervical cancer can also cause these symptoms.
Almost all cervical cancers are caused by high-risk types of human papillomavirus (HPV).
Most of the people who are sexually active get infected with HPV at some point during their life. Body’s immune system overcomes most of the HPV and they go away. But about half of the HPV are high-risk and, if untreated, may persist for years. These may cause cervical and several other types of cancer.
Certain factors increase the risk of cervical cancer. Some risk factors are under your control. Others are outside your control.
Factors under your control
Cervical cancer risk increases with these:
- Sexually active at a young age (especially younger than 18 years old)
- Multiple sexual partners
- Sex with a partner who is high risk (someone with HPV infection or who has many sexual partners)
- Smoking. Women who smoke are about twice as likely to get cervical cancer as those who don’t smoke.
- Weakened immune system. Human immunodeficiency virus (HIV), the virus that causes AIDS, weakens the immune system.
- Past or current chlamydia infection
- Long-term use of oral contraceptives (birth control pills)
- Having multiple full-term pregnancies
- Young age at first full-term pregnancy
- Diet low in fruits and vegetables
Factors outside your control
- Family history of cervical cancer. A woman whose mother or sister had cervical cancer, is at a higher risk of cervical cancer.
- Weakened immune system because of drugs to treat an autoimmune disease or an organ transplant.
- Economic status. Low-income women do not have the means to get screened or treated for cervical pre-cancers.
Factors that lower risk
Cancer, including cervical cancer, cannot be prevented. But its risks can be reduced by doing screening tests to detect pre-cancer before it turns into cancer.
- In the Pap testor smear, cells from the cervix are collected and examined in a lab to find pre-cancer and cancer. Pap test can be done during a pelvic exam.
- Human papillomavirus (HPV) test detects high-risk types of HPV that are more likely to cause pre-cancers and cancers of the cervix.
- Colposcopy is used for a closer look at the cervix to detect changes in cells caused by HPV, and to do biopsy to collect cells for lab examination.
Pap test and colonoscopy should not be done during menstrual period.
Frequency of screening tests
Women aged 21 to 25 should have a Pap test alone every three years. Women aged 25 to 29 may have HPV test alone every three years, but Pap tests are preferred.
Women aged 30 to 65 can have:
- Pap test and HPV test (co-testing) every 5 years, or
- Pap test alone every 3 years, or
- HPV test alone every 5 years
Women should stop having tests at age 65 if they have:
- no history of moderate or severe abnormal cervical cells or cervical cancer, and
- within the past 10 years, three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test.
- Vaccines protect children and young adults against certain HPV infections most linked to cancer. Vaccine protects but does not treat an existing cancer. Therefore, vaccine should be given before a woman is exposed to HPV by sexual activity.
- Vaccine should be given to children ages 9 to 12. And to un-vaccinated adults ages 13 to 26. Vaccination of persons above age 26 is not recommended.
- Vaccine does not give protection against all cancer-causing types of HPV. So routine cervical cancer screening should continue to be done.
- Vaccine’s side effects are usually mild.
Limit exposure to HPV
- HPV is passed by skin-to-skin contact. So, it can spread during sex, or without sex such as through hand-to-genital contact. HPV can spread from one part of the body to another, from the cervix to the vagina and vulva.
- A person with HPV may have no symptoms and thus unknowingly pass HPV to other persons.
- It is difficult to avoid exposure to HPV. But to reduce the risk of HPV, limit multiple sex-partners, and avoid sex with people who have or had multiple sex-partners.
If all the abnormal tissue can be removed by biopsy, no other treatment is needed.
If the cancer has spread, then surgery, chemotherapy and radiation treatment may be required.
Complementary and alternative medicine (CAM) such as meditation, yoga, acupuncture, and supplements like vitamins and herbs, may be used in addition to standard treatments. But CAM is not scientifically tested and may not be safe.
The five year survival rate for cervical cancer is 92% if detected early, 58% if it has spread to nearby tissues, organs, or regional lymph nodes, and 18% if it has spread to a distant part of the body.
Avoid cervical cancer by healthy lifestyle, safe sex, and vaccination. Take screening tests at recommended intervals for early detection and treatment of precancer and cancer. Early detection, cancer is curable. Late detection, cancer is fatal. Choose to live.