Published in City Times
Cervical Cancer, a Silent Killer
Approximately 500,000 cases of cervical cancer are diagnosed worldwide each year and 300,000 deaths result from the disease every year, according to World Health Organization reports. It is more common these days, not only in the middle aged women as was believed to be so earlier, but even in the younger age groups, says Dr.Anitha, Obstetrician and Gynaecologist. From the time women become sexually active, they are at risk of cervical cancer. Hence, as per present recommendations, any female, irrespective of her age, once she becomes sexually active, should undergo the Pap (Papinacalou) Smear test to detect the disease at certain recommended intervals. This is especially important since it is a fully treatable condition if detected early.
What are the causes and risk factors for cervical cancer?
While the exact cause is yet unknown, certain lifestyle factors and health conditions predispose some women to the condition. Women who begin their sexual life early, possibly before the age of 18 years, those who have multiple sexual partners and women who have borne many children are at higher risk of the disease. In addition, women who have been infected with the human papilloma virus have a strong proneness for the disease. Women with a weakened immune system as a result of HIV or other immunodeficiency disorders and women who smoke, are also at increased risk of the disease.
What are the symptoms of the disease and how early do they manifest?
Pre-cancerous changes of the cervix are usually painless and present no symptoms. But when the disease assumes malignancy, there may be abnormal vaginal bleeding, inter-menstrual bleeding, post-coital bleeding, irregular bleeding, foul-smelling discharge, lower abdominal pain. Other symptoms may include fatigue, weight loss and loss of appetite, back pain and leg pain of an unspecified nature, i9nability to control bowel movements or urination.
How is the condition diagnosed?
Whenever women complain of any of these symptoms, it is very important to examine them thoroughly. Even simple gynaecological examination can often pick up many cases of cervical cancer. This includes feeling locally in the region, followed by examination with the speculum. If the cancer is in an advanced condition, even with the naked eye it is possible to see any growth or bleeding point from the cervix. A Pap smear is a must and if this shows positive for cancer, we then need to do a colposcopy which confirms diagnosis of the condition. The more confirmatory diagnosis, however, would be a cervical biopsy which would provide additional information on the extent of the cancer and its spread.
Once diagnosed, what does treatment involve?
There are four stages of cervical cancer. Treatment depends on the stage of the cancer. Most often the treatment involves a combination of radiation and surgery with very limited role for chemotherapy. Where the cancer is in its early stage and has not spread, surgery may involve removal of the cervix alone, especially if the patient is young, unmarried or newly married and desires to have a family. However in more advanced cases, the uterus may have to be removed.
Will removal of the cervix result in any other complication for the women?
Women can get pregnant after removal of the cervix. However, the cervix plays an important role in pregnancy because of its secretions. Hence these women could have problems during pregnancy or labour and go in for preterm labour.
What is the survival rate of cervical cancer patients following treatment?
In the early stages if the uterus has been removed, the survival rate is good, over 95%. In very, very rare cases, we may even say this is 100%. But as the stage of the cancer advances, the survival rate also becomes slimmer. The cancer can also spread upward to the uterine cavity and pelvic region in the advanced cases and in these conditions, the survival rate is very poor. Particularly so if the lymph nodes are involved, the prognosis is very bad. The survival rates with radiotherapy alone is approximately 70%, 60%, 45% and 20%, respectively, for the four stages.
Is it possible to prevent cervical cancer?
Since most cervical cancer begins with the formation of pre-cancerous or abnormal cells in the cervix, by making appropriate lifestyle changes, it is possible to prevent pre-cancers. Further, all women between the ages of 20 to 60 require regular Pap smear tests, or even earlier if they become sexually active. Once a Pap smear is negative, then it is recommended every two or three years for women who are not considered high risk. In the high risk women if the test returns negative, they have to get it done again after 6 months. If once again this is normal, the test can be repeated every two years. Women over 70 years may stop regular screening if they have had three or more consecutive pap smear tests return negative over a ten year period.
How safe is a Pap smear test on pregnant women?
The test is a very simple one which can be done in barely five minutes. Even in pregnancy it is recommended, if need be. Since it is done from outside the cervix and does not involve entering the uterine cavity, it cannot harm the foetus in any way.