CervicalCancer

What is Cervical Cancer?

When cancer develops in the cervix of a female, it is termed as Cervical Cancer (CC). CC usually develops slowly over time with initial appearance of abnormal cells in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Risk factors of Cervical Cancer

What are its causes or risk factors?

  • Human Papilloma Virus (HPV) infection
  • Early Marriage
  • Sexually active at younger age
  • Having multiple sexual partners
  • Poor genital hygiene
  • Smoking
  • Multiple pregnancies
  • Weakened immune system
  • Malnutrition
  • Prolonged use of Oral Contraceptive Pills (OCPs)
Anatomy of Female Reproductive System

Anatomy of Female Reproductive System

The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus is hollow, pear-shaped organ where a foetus grows. The cervix is the lower, narrow end of the uterus connecting the body of the uterus to the vagina (birth canal).

The lower part of the cervix (ectocervix) lies within the vagina and the upper two-thirds of the cervix (endocervix) lies above the vagina. Most cervical cancers originate in the area where the endocervix and ectocervix join.

What are the signs & symptoms?

Women with pre-cancers and early cervical cancers usually have no signs and symptoms. Signs & symptoms of CC appear only after the cancer has reached an advanced stage. More severe symptoms may develop at advanced stages of CC.

  • Irregular, inter-menstrual (between periods) bleeding.
  • Abnormal vaginal bleeding after sexual intercourse and a pelvic examination or bleeding after menopause.
  • Vaginal discomfort or odorous discharge from vagina, the discharge may contain some blood and may occur between periods or after menopause.
  • Pain during sex
  • Back, leg or pelvic pain.
  • Fatigue, weight loss, loss of appetite.
  • Swelling in one leg.

What are the prevention methods ?

Primary prevention
  • HPV vaccination: HPV vaccines cannot treat HPV infection or CC, but they prevent HPV infection & reduce the risk of CC in girls before the onset of sexual activity.
  • Follow safer sexual practices by using condoms.
  • Stop smoking.
  • Limit number of sexual partners.
  • Delaying first sexual intercourse until the late teens or older.
  • Avoiding sexual intercourse with people who are infected with genital warts or who show other symptoms
  • Timely treatment of reproductive tract infections.
  • Poor menstrual hygiene practices may lead to recurrent STI/ RTIs which may increase the risk of cervical cancer. Good menstrual hygiene practices like using sanitary napkins, their proper disposal, personal hygiene and cleanliness may reduce the risk of cervical cancer.
Secondary prevention
  • CC screening and treating pre-cancerous lesions.
Tertiary prevention - Treatment of invasive CC
  • The goal of tertiary prevention is to decrease the number of deaths. Women suspected of having invasive CC should be referred to facilities that offer cancer diagnosis and treatment. In advanced stages of CC, treatment and palliative care can improve quality of life, control symptoms and minimize pain.

Screening for Cervical Cancer (CC)

Screening

Early detection, by screening all women in the target age group (30-49 years) followed by treatment of detected pre-cancerous lesions can prevent the majority of CCs. It detects pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. Important aspect of screening is that both precancerous lesions and early cervical cancers can be treated very successfully at this stage.

Cervical cancer screening: Visual Inspection with Acetic acid (VIA)

  • It is a simple test for the early detection of cervical pre-cancerous lesions and early invasive cancer. It can be performed by trained ANM & staff nurses.
  • The results of VIA are immediately available and do not require any laboratory or specialist support.
  • 3-5% acetic acid is applied on the mouth of the cervix area and presence of any white lesions are noted after one minute of application.
  • Under normal conditions, you may observe vaginal canal as red or pink due to reflection of light.
  • You may observe dense white patch on the mouth of cervix in conditions like inflammation, benign and malignant growth. This is considered as VIA positive test.
  • VIA positive woman should be managed as per algorithm for CC screening and management under NPCDCs.

Inclusion criteria

Any woman aged 30 years and above and not meeting any of the exclusion criteria should be screened at all government screening centres.

Exclusion criteria

  • Menstruation
  • Pregnancy
  • Within 12 weeks of delivery / abortion
  • Previous history of treatment for CC

If any woman who does not fall under inclusion criteria but having any symptoms, should also be immediately referred to MO In-charge of PHC/CHC/RH/DH for further evaluation.

Cervical cancer screening by Papanicolaou (Pap) Test

Commonly used to screen for CC.

Pap test / Smear Procedure

A procedure that uses a small brush to collect cells from the surface of the cervix and the area around it. The cells are viewed under a microscope to find out if they are abnormal.

Screening

Cervical cancer screening by HPV-DNA Test

This test detects the pieces of DNA of high-risk HPV types in cervical cells. The procedure is same as Pap smear test. WHO recommends HPV DNA based test as compared to cytology based tests like pap smears or VIA tests. It is proved to be more effective in preventing cervical cancer as it is objective diagnostic, leaving no space for interpretation of results.

For the general population of women, HPV-DNA detection is recommended as the primary screening method; starting at the age of 30 years, with regular testing every 5–10 years. For women living with HIV, HPV-DNA detection is recommended; starting at the age of 25 years, with regular screening every 3–5 years.

Key Messages

CC is a disease that can be prevented by avoiding risk factors & HPV vaccination.

Early detection followed by treatment of pre-cancerous lesions can prevent the majority of cervical cancer.

All women aged 30 years and more should be screened for CC at least once.