Anticipate the danger that looms

Dr Shruti Bhatia

Every year in India, approximately 1,23,000 new cases of cervical cancer are diagnosed and 68,000 women die from this deadly disease. Maximum numbers of cases occur in rural areas as compared to urban areas because of lack of awareness, knowledge and facilities to diagnose. Fortunately, the incidence is decreasing, but unfortunately it is still one of the most common cancer afflicting Indian women, along with breast cancer.

Cervical cancer is cancer of the lower narrow part of the uterus, which is the entrance to the womb. Its common symptoms are abnormal bleeding, which may be inter-menstrual or post-coital or post-menopausal. Seldom, it causes any significant symptoms.

The cells lining the cervix undergo certain changes, which may or may not take the form of cancer. There is a strong correlation between HPV infection (human papilloma virus infection) and cancer of cervix. Almost all cases of cancer cervix are associated with prior HPV infection. The age group most prone is 35-55. It is rarely seen below 20 years. Although 20 per cent cases are above 65 years of age.

HPV infections are of two types — low risk and high risk. There are nearly about 120 types of HPV of which many are low-risk types. Low-risk infections usually do not lead to cancer. These can, however, cause genital warts or very minor cell changes in the cervix. There are more than a dozen types of high-risk HPV that can cause abnormal cells to form on the cervix. Types 16 and 18 are the most dangerous, since these cause about 80-90 per cent of cervical cancers of the total number. In one study, the National Cancer Institute found that about 10 per cent of women with HPV type 16 or 18 developed advanced, pre-cancerous cervical disease within three years, and 20 per cent did so in 10 years.

High-risk infections can be detected on routine screening like PAP smear, HPV DNA testing and by colposcopy. These often present as lesions on the cervix like cervical erosions which can be treated by cryocautery, electrocautery or LEEP. For prevention of HPV infection, two vaccines are available — injection Gardasil and injection Cervarix. Both vaccines target HPV 16 and 18 which are the high-risk HPV strains. Women between the age 13 to 45 are advised to meet their gynecologist and go in for the vaccination.

Lower age of sexual exposure and multiple sexual partners are definitely responsible for HPV infections and progression to cervical cancer. Lower age at first pregnancy and long-term use of oral contraceptives also contribute to risk factors. Low socio-economic status, lack of education, smoking, exposure to DES in the mother’s womb are also linked to cancer of cervix as well. A person affected with HIV infection is fivefold more at risk of cancer cervix.

Detection of cancer cells can be done by conventional PAPs screening, liquid cytology + HPV testing. This is usually done by an experienced gynecologist. Once the cancer cells are detected the next step is the staging of cancer. This depends on the size of tumour, depth of spread and spread to lymph nodes. Also spread to distant and neighboring organs is looked into. Treatments offered are surgery, radiotherapy and chemotherapy. In advanced cases, targeted therapy is offered to improve the patient’s quality of life.

The writer is a senior consultant, gynae oncology, Action Cancer Hospital, New Delhi