Cervical Cancer Treatment in Delhi, India

Cervical cancer refers to the abnormal growth of cells in a woman’s cervix, an organ that connects the vagina (birth canal) to the uterus (womb). If not treated on time, these clumps of uncontrolled cells in the cervix cause severe symptoms and may even spread (metastasize) to surrounding organs such as the bladder, rectum or distant organs like the liver, lung, and bone.

Types of Cervix Cancer

Based on the affected cell type Cervix cancer are of the following types:

• Squamous cell carcinomas
• Adenocarcinomas
• Adenosquamous carcinomas

The majority of the cases are squamous cell carcinomas (80-90%) while Adenocarcinomas are present only in 10-20% cases.

Cervical Cancer Causes

More than 99% of cases of cervical cancer are caused by Human papillomavirus (HPV) infection. HPV is a sexually transmitted infection (STI). There are more than 100 strains of HPV out of which the high-risk strains particularly HPV 16 & HPV 18 are responsible for causing around 70% of cervical cancer cases.

Cervical Cancer Symptoms

Early-stage cervical cancer rarely causes any symptoms. In most cases, symptoms may occur as cancer becomes invasive. Some common symptoms of cervical cancer include:

• Watery vaginal discharge with an offensive odour
• Irregular vaginal bleeding
• Intermenstrual bleeding (Bleeding between two periods)
• Vaginal bleeding after sexual intercourse
• Bleeding after menopause
• Pelvic pain or low backache
• Swelling of legs
• Discomfort during urination, blood in the urine
• Rectal Bleeding or loose motions
• Unexplained weight loss

Cervical Cancer Diagnosis

Cervical cancer can be diagnosed by taking a biopsy of the growth visible over the cervix. When no growth is visible by colposcopy but the symptoms are suspicious of cancer then the doctor will examine the cervix via colposcopy and will take a directed biopsy from a suspicious-looking area of the cervix.

Cervical Cancer Stages

Based on the extent of spread, cervical cancer is classified as follows:

• Stage 0: Carcinoma in situ. It's not cancer but a precancer.
• Stage I: Cancer is limited to the cervix.
• Stage II: The cancer cells spread beyond the cervix to the neighbouring tissues but not to the pelvic side wall or the lower third of the vagina.
• Stage III: Cancerous cells spread to the sidewalls of the pelvis and/or to the lower third of the vagina, which in turn may cause edema (swelling) of the kidney and ureter. There is no distant spread.
• Stage IV: The last stage of cancer, in which the cancerous cells spread from the cervix to other organs like the bladder, rectum, liver, lung, bone etc.

Cervical Cancer Treatment

Treatment for cervical cancer usually depends on the stage, age & overall health of the patient. With treatment, most early stage cervical cancer cases are curable. The common treatment options include.

Surgery for Cervical Cancer

It is the treatment of choice in the early stage of cancer in which not just the uterus and cervix are removed but the adjacent tissues called parametria and lymph nodes are also removed.

Radiation

• After surgery, the patient may or may not require radiation depending on the final biopsy report.
• This radiation therapy procedure aims at killing or shrinking the growth of cancerous cells in the cervical region. Radiation therapy can be offered in all stages of cervical cancer.

Chemotherapy

• Chemotherapy medications such as Cisplatin, carboplatin, and paclitaxel are often used to slow the growth of the cancerous cell or help relieve symptoms.
• Chemotherapy is also used in some cases along with radiation therapy to increase the effect of radiation treatment.

Cervical Cancer Prevention

• Regular screening with the PAP test helps to detect the presence of precancerous lesions in the cervix.
• Getting an HPV vaccine prevents Human papillomavirus infection, one of the leading causative factors for cervical cancer.
• Practice safe sex, and use condoms or dental dams.

Measures to prevent the recurrence of Cervical Cancer after treatment:

• In select cases, surgery is followed by adjuvant radiation to prevent a recurrence.
• Regular follow-up pelvic examination and imaging tests can help to detect the recurrence earlier.

Risk Factors for Cervical Cancer

The factors that increase your risk of developing cervical cancer include,

• Multiple sexual partners: It increases the risk of HPV infection
• Pre-existing sexually transmitted diseases: STIs such as Gonorrhoea, Chlamydia, AIDS, and Syphilis increase the susceptibility to HPV infection
• Young age at first coitus
• Multiple pregnancies
• Immunosuppression: Individuals with weakened immune systems are more prone to developing cancer
• Long Term use of contraceptive (birth control) pills, as females on pills, are less likely to use barrier contraception
• Smoking
• Poor genital hygiene
• Low socio-economic status

Possible Complications of Cervical Cancer

The possible complications of advanced cervical cancer are as follows:

• Pain
• Vaginal haemorrhage
• Kidney failure leading to uremia
• Blood clots
• Fistulas
• Radiating pain in nerve endings, bones, and muscles
• Depression & Despair

Epidemiology of Cervical Cancer

The estimated incidence of cervical cancer is high occurring at 13·1 per 100 000 women globally and it is the fourth leading cause of cervix cancer death worldwide. It also accounts for the second most common cancer in middle-aged women (age 14-49).

Cervical Cancer Prognosis

Fortunately, recent advances in diagnostic procedures, treatment options and medications have drastically reduced the number of new cases of cervical cancer and its associated death.

Natural Progression of Cervical Cancer

Like other cancer types, if left untreated, cervical cancer spreads to surrounding organs such as the bladder, rectum, kidney, and so on. This progression may cause life-threatening health conditions and can even lead to death.

Pathophysiology of Cervical Cancer

Cervical cancer is characterized by the abnormal growth of cells in the cervix. It is most commonly caused by sexually transmitted human papillomavirus infection.

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