Cervical Cancer; What We Should Know!

Cervical Cancer; What We Should Know!

Cervical cancer is the 3rd most common cancer in India as reported by Globocan 2018. Approximately 97,000 new cases of cervical cancer are diagnosed & 60,000 deaths are reported in India every year. We have more than 2,25,000 patients suffering with this disease in India at any given point of time. Cervical Cancer is mainly caused by Human Papillomavirus (HPV) infection & it is sexually transmitted between partners, most of the times.
HPV or Human papillomavirus is a virus that is spread through sexual contact or skin-to-skin contact. Sexual contact covers different forms of sex including sexual intercourse (vaginal sex), oral sex, anal sex, or any other contact involving the genital area (e.g. hand to genital contact). Use of condoms does not guarantee complete protection from HPV infection, because they do not cover all exposed genital skin.
Approximately 70%-80% of infected individual does not develop signs & symptoms and most cases never develop any problems caused by HPV. In 20% to 30% females, however, HPV infection poses a greater chance of developing pre-cancerous condition of cervix and subsequently the cancer of cervix. On an average, it takes 20 to 25 years for a new HPV infection to cause cervical cancer.
Screening of Cervical Cancer Regular screening tests can help detect cervical cancer in early stages. These tests can help identify pre-cancerous cells that may eventually manifest into cervical cancer. Most guidelines suggest beginning screening for cervical cancer and pre-cancerous changes from the age 21.

Screening tests include:

Pap Smear test- During a Pap test, doctor scrapes and brushes cells from the cervix, which are then examined in a lab for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.
HPV DNA test. The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer.

Diagnosis of Cervical Cancer-

Suspicions of cervical cancer on screening test or otherwise can be confirmed by doctors by doing thorough examination of the cervix region. A special magnifying instrument called Colposcopy is used for checking abnormal cells in this process. For obtaining tissues for confirmation of diagnosis, doctor may do biopsy and the further tests will be performed on the tissue sample to confirm diagnosis.

Treatment of Cervical Cancer:

Treatment of cervical cancer is done primarily in 3 ways i.e. Surgery, Radiation Therapy and Chemotherapy. Advanced medicines like Targeted Therapy and Immunotherapy are also used for the treatment of cervical cancer. Treatment of these cancers is done by expert faculty of each treatment i.e. Surgical Oncologist, Radiation Oncologist and Medical Oncologist. Taking their advice for appropriate treatment in a desired sequence is recommended.

Over 100 different strains of HPV have been identified; more than 40 of these are known to infect the cervix, and approximately 15 are known to cause cervical cancer. Researchers have categorized and labelled the different HPV types / strains as 'high risk' or 'low risk' on the basis of their intensity / potential for causing cervical cancer to the infected women. Presently, two HPV vaccines are available in India. These two vaccines protect against different types of HPV:

HPV Vaccine Timings and Doses:

All of the HPV vaccines are given by injection. Dosing depends upon age and the present state of immunity of an individual.
  • If subject is younger than 15 years of age with normal immune function, she should get two injections at least six months apart.
  • If subject is 15 years of age or older with normal immune function, she should get three injections. The second dose is given one to two months after the first, and the third dose is given six months after the first.
  • If subject have an infection with HIV or she is immunocompromised (e.g, have another health condition that weakens subject's immune system), she should get three injections regardless of the age at which she may start the vaccination series It is best to get all the recommended doses. If one misses a dose, taking advice from the healthcare provider / doctor about the number of doses required is recommended.

Who should be vaccinated?

HPV vaccination should ideally be done for all girls ages 11 to 12 years, and it can be given as early as 9 years of age. "Catch-up" vaccination is recommended for all females up to 26 years of age who have not yet received it. The decision to vaccinate adults in this age group should be individualized, typically in conversation with a healthcare provider, as some people in this age group may still benefit from it.