Published in Panorama
Cervical Cancer --- Early diagnosis vital for good prognosis
Cervical Cancer is believed to be the second commonest cancer in women world over and it is a leading cause of cancer-related death, next only to breast cancer in the developing countries of the world. But, it is also one form of cancer that can be detected at a very early stage with a simple Pap Smear Test, thus enabling a good prognosis following treatment, reveals Dr.Anitha Agnel George, Gynaecologist, Al Musalla Medical Centre, Dubai.
Unfortunately, cervical cancer is more common these days, not only in middle aged women as was believed to be so earlier, but even among younger women. Also, the cancer may be diagnosed only when some of these women go in for routine pregnancy checkup, by which time, they may already have had the cancer for some time. Dr.Anitha explains, “From the time women become sexually active, they are at risk of cervical cancer. So as per present recommendations, any woman, irrespective of her age, must undergo a Pap Smear Test, which is a screening test to detect cervical cancer, periodically, once she becomes sexually active. This enables the detection of pre-cancerous cervical cells and rules out the possibility of them developing into cancer in its proper form.”
Who are the women at risk of cervical cancer? The risks of cervical cancer is greater in women who begin their sexual life early, those who have had many children, those having multiple partners and those suffering from sexually transmitted diseases. Also, those women who have had infection from the papilloma virus are at high risk of cervical cancer. According to some studies, women who smoke are believed to be have enhanced risk of developing cervical cancer than non-smoking women in the high risk category.
While the exact cause of cervical cancer is not really known, infection with certain types of human papilloma virus (HPV), which is transmitted sexually, is believed to be linked with cervical cancer. Also, human immunodeficiency virus (HIV) infection, by reducing the body’s ability to fight infection, is believed to increase the likelihood of precancerous cells progressing to cancer.
What are the earliest manifest symptoms of cervical cancer? Abnormal vaginal bleeding, irregular, inter-menstrual or post coital bleeding, foul-smelling discharge and abdominal pain are some of the symptoms of the condition, explains Dr.Anitha. “The disease which develops in the lining of the cervix, the lower part of the uterus, may actually take as long as two to seven years to progress to an advanced stage. In the early stages, the patient may not present with any symptoms at all.”
In fact, cervical cancer may be viewed in two phases – as low or high grade cervical intraepithelial lesion or neoplasia and as cervical cancer proper. Neoplasia are the precursors to full fledged cancer, where the cervical cells are in a pre-malignant stage and the women may present with absolutely no symptoms in this stage! However, once they become malignant, the symptoms begin to appear and they may include low back pain and painful urination. Constipation and blood in the urine may be additional symptoms when the cancer has spread to other organs as well.
Cervical cancer, usually progresses through four stages, involving various regions at each stage. The cervix alone is involved in the early stage from where it may progress to the vagina, uterus and ultimately the surrounding structures including the bladder, rectum and even beyond, in the advanced stage. Once the disease spreads to the lymph nodes, it takes on a vicious and virulent form and beyond a certain stage, women may start haemorrhaging with severe vaginal bleeding.
The positive feature of the disease is that, with regular Pap Smear test, it can be diagnosed even before it reaches the cancerous state and treated with very successful outcomes, emphasizes Dr.Anitha. “The Pap Smear is a simple, five-minute test, by doing which we can detect cervical cancer very early. When diagnosed so early, the disease is 100% treatable with cure, with medication alone or along with surgery. That is why, even in pregnancy, we recommend this test since it is done from outside the cervix and therefore it cannot harm the foetus in any way. Where pregnant woman are diagnosed to have cervical cancer, treatment is given only after delivery. However, the cancer itself, will not harm the foetus or baby, reassures Dr.Anitha.”
The Pap Smear Test is a cytological test for the cervix, which can detect the disease in its earliest manifestation, thus saving patients from its very sinister sequelae. The test involves visualizing the cervix with a speculum and taking samples of the cells from its surface to detect the presence of pre-cancerous cells. If the cells are found to be abnormal, the next step involves a colposcopic examination of the cervix. If abnormal cells are identified with the colposcopy, a biopsy may then be required to confirm diagnosis. Where the case has advanced, even with the naked eye, it is possible to make out the cancerous condition, reveals Dr.Anitha
Of course, in most instances, treatment of cervical cancer may call for surgery but is again is determined by the stage of the cancer, age of the patient and her desire to have a family. If the patient is young, as yet unmarried or newly married, we would not go for a surgical removal of the uterus as a treatment mode. In these cases, only the cervix may be removed and the uterus kept intact. We would then follow up the patient routinely, explains Dr.Anitha.
Dr.Anitha clarifies, “Even after removal of the cervix, there is no problem involved in the women getting pregnant. But the cervix plays an important role in pregnancy because of its secretions and when the cervix is removed, it can cause problems for a pregnant woman during the course of her pregnancy or during labor which could be pre-term.”
The prognosis following diagnosis and treatment, depends on the stage of the disease, says Dr.Anitha. “In the early stages the prognosis or success of treatment is very good. The more advanced the disease, the more advanced the treatment, more complicated the surgery and radiotherapy and poorer the prognosis. If the uterus is removed in the early stages of the cancer, the survival rate is very good, over 95% and in very, very rare instances, we may even say that the survival rate is 100%. But as the disease progresses to spread upward to the uterine cavity and the pelvic region, the survival rate is very poor. If the lymph nodes are involved, the chances of survival is very slim, rather very bad. Radiotherapy can be used in all stages of the disease with success rate progressively coming down from 70%, 60%, 45% and less than 20% for stages I to IV of the disease, respectively.”
The thumb rule in the treatment of cervical cancer, is prevention in the first place, through early screening and diagnosis, emphasizes Dr.Anitha. “Particularly for women in the high risk group, even if the Pap Smear Test is normal or gives negative, it is ideal to do it again after six months. Should the test return a normal or negative once again, then the examination must be done once every two years as a precautionary measure.”