Cervical Cancer: Screening and Prevention
One of the deadliest cancers for women, according to WHO, cervical cancer is responsible for over 270,000 deaths a year, with 85% of those deaths occurring in developing countries, where cervical cancer is the second most common cancer for women. About one million women are currently living with cervical cancer although it is easily preventable. Cervical cancer develops on the surface of the cervix, but can grow deeper into the cervix, uterus, vagina, and other parts of the body.
Causes of Cervical Cancer
Human papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. HPV infection is the most important risk factor. Other risk factors include
- Smoking
- HIV infection
- Pregnancy at young age
- Family History of Cervical cancer
Symptoms of Cervical Cancer
Unfortunately, no signs or symptoms of cervical cancer are usually evident until the cancer has become invasive and grown into nearby tissue. At that time, symptoms may include:
- Abnormal vaginal bleeding (after sex, after menopause, between periods)
- Vaginal discharge
A visit to a doctor is advised if any of these symptoms occur.
Diagnosis of Cervical Cancer
Since there are no early signs or symptoms of cervical cancer, the best first warning comes through routine pap exams. The series of tests that may be done include
- Detailed Pelvic exam
- Pap Smear
- Colposcopy – a special magnifying instrument provides a closer look at the cervix.Results from the colposcopy help determine what, if any, further tests need to be done.
- Cervical biopsy
Staging of Cervical Cancer
The diagnostic tests not only help in making the diagnosis but also in determining the stage of cancer (how far the cancer has spread). Cervical cancer staging is done using either FIGO staging system or TNM staging system.
Stage 0: Cancer is only found on the surface of the cervix.
Stage I: Tumor size is smaller than 2 inches or 5 cms. Cancer has grown into the deeper tissue of the cervix and perhaps into the body of the uterus, but not outside the uterus.
Stage II: Tumor size is more than 2 inchers or has grown beyond the cervix and uterus but not to the walls of the pelvis or lower part of the vagina.
Stage III: Cancer has spread to the lower part of the vagina or walls of the pelvis, and may be blocking the ureters.
Stage IV: Cancer has spread to the bladder or rectum, or it is growing outside of the pelvis. Cancer may have spread to distant organs beyond the pelvic area (lymph nodes, lungs, bones, or liver).
Treatment of Cervical Cancer
Specific treatment is based on which stage the cancer is in.
Stage 0: Cryosurgery, laser surgery, LEEP procedure, cold knife conization or cone biopsy, simply hysterectomy.
Stage I: Options depend on whether you wish to maintain fertility.
If you do, then treatment will be a cone biopsy.
If you do not wish to maintain fertility, options include either a simply hysterectomy or a radical hysterectomy with the removal of pelvic lymph nodes.
Stage II: Standard treatment at this stage is usually chemoradiation.
Stage III: Chemoradiation.
Stage IV: Radiation therapy and chemo
The targeted or chemotherapy drugs for cervical cancer include Cisplatin or Carboplatin, Taxol, Gemzar or Topotecan and Avastin
When should Screening for Cervical Cancer be Started?
The two screening tests available include PAP smear and HPV testing. The screening with these tests should be done according to American Cancer Society guidelines. HPV testing alone is not the recommended screening test.
- Start Screening all women at age of 21 years.
- Age 21-29
Pap smear every 3 years. HPV testing is not recommended unless PAP smear is abnormal
- Age 30-65
Pap smear every 3 years OR
Pap smear and HPV testing every 5 years.
- Age more than 65 years
Screening depends on the results of previous PAP smear screening results
Prevention of Cervical Cancer
- The best and easiest way to prevent cervical cancer is to have regular pap tests.
- HPV vaccination guidelines should be followed.
- Vaccinate 9-13years old girls and boys with 2 doses of HPV vaccine
- Vaccine also recommended for females and males 13-26 years of age if not vaccinated before.
- Healthy Lifestyle by avoiding smoking
- Safe sex using condoms.
References:
- www.who.org
- www.cancer.org
- American Joint Committee on Cancer. Cervix Uteri. In: AJCC Cancer Staging Manual. 8th Edition: New York: Springer:2017
