Cervical Cancer Treatment in Mumbai, India

Cervical cancer refers to the abnormal growth of cells in a woman's cervix (an organ that connects the vagina to the uterus). The disease can spread to other body parts like the vagina, liver, lungs and bladder.

Associated Anatomy

Cervix, uterus, and vagina

Cervical Cancer Symptoms

• Abnormal vaginal bleeding after sexual intercourse, menopause or after pelvic examination
• Heavy periods or bleeding in between periods
• Watery vaginal discharge with a heavy odour
• Discomfort during urination or bowel movement
• Pain during or after sexual intercourse
• Pelvic pain
• Pain in the lower back or stomach region
• Loss in appetite, weight and unusual tiredness
• Swelling of legs

Cervical Cancer Causes

In most cases, cervical cancer is caused due to the following reasons:

• Human Papillomavirus (HPV) Infection: Prolonged infection from the human papillomavirus is the main cause of cervical cancer in women. HPV is a sexually transmitted infection affecting more than half of the world’s population.
• Genetic Factors and Metastasis: Although the exact mechanism is unknown, genetic factors also may play a role in causing cervical cancer. Cancer cells from other organs (vagina, kidney, or bladder) can metastasise to the cervix.
• Immunosuppressants: Individuals who are immunocompromised (having a weakened immune system) or are on immunity-suppressing medicines (immunosuppressants) may pose an increased risk of developing cervical cancer.

Cervical Cancer Stages

Based on the extent of spread, cervical cancer is classified into five stages as follows:

• Stage 0: This is the early stage of cervical cancer, when cancer is found only on the surface of the cervix (inner lining of the cervical wall).
• Stage I: Cancer may have penetrated deeper but is restricted to the cervix. It has not started to spread (metastasise).
• Stage II: The cervical cancer cells may spread outside the cervix and uterus. Metastasis may start at this stage.
• Stage III: Cancerous cells spread to the sidewalls of the pelvis, which in turn may cause edema (swelling) of the kidney and neighbouring organs. Cancer may spread further from the lymph nodes.
• Stage IV: This is the advanced and last stage of cancer, where the cancerous cells spread from the cervix to distant body parts like the lungs, bladder and kidney.

Cervical Cancer Treatments

After examining the patient, the doctor can opt for any of the following Cervical Cancer treatments:

• Surgery: If the cancer is diagnosed in the early stage, surgery can be considered. The process involves removing the cervix, or part of the cervix, uterus, ovaries or fallopian tubes, depending on the size of cancer. Surgery is also done if cancer has reoccurred and other Cervical Cancer treatment options are not feasible. Removal of lymph nodes prevents the progression of the cancerous cells.
• Radiation: Radiation therapy uses radiation, which aims at killing or shrinking the cancerous cells in the cervical region. This Cervical Cancer treatment option is used when the cancer is widely spread or along with medicines (chemotherapy) after surgery. Radiation can be given both internally and externally.
• Chemotherapy: Chemotherapy medications such as cisplatin, carboplatin, and paclitaxel are often used to kill or slow down the growth of the cancerous cell or help relieve symptoms of the disease. It is given along with radiotherapy as chemoradiotherapy before the surgery to reduce cancer or after the surgery to prevent cancer from coming back.
• Targeted Therapy or Immunotherapy: Targeted medicines like bevacizumab prevent cancer from growing further and are used in advanced stages of cancer. Immunotherapy is done when no other Cervical Cancer treatments are working. In this method, the immune system is boosted using pembrolizumab, which detects cancer cells and fights them.

Cervical Cancer Prevention

Primary Prevention

• A PAP test every three years to help detect early signs and reduces the risk of cancer progression
• Getting an HPV vaccine against human papillomavirus infection, a major cause of cervical cancer
• Avoiding unwanted use of oral contractive pills or medications
• Limiting the sexual partners or delaying first intercourse
• Practising safe sex, using condoms or dental dams
• Avoid giving birth to many children
• Introducing dietary changes, healthy lifestyle modifications and quitting smoking

Secondary Prevention

• Radiation therapy at the site of recurrence can kill cancerous cells after the surgery.
• Chemotherapy can prevent or hinder the growth of cancerous cells.
• Having regular follow-up pelvic exams and screening tests can detect signs of recurrence of cancer.
• Maintaining a healthy lifestyle can prevent a recurrence.

Cervical Cancer Risk Factors

The factors that increase the risk of cervical cancer are:

• Sexual contact (oral, anal, or vaginal) with someone with human papillomavirus (HPV)
• Sexual intercourse within one year of onset of periods
• Multiple sexual partners
• Giving birth to three or more children or giving birth at a younger age
• Individuals with weakened immune systems or with comorbidities
• Having HIV/AIDS or any other sexually transmitted disease
• Long term use of contraceptive pills (birth control), leading to changes in cervical cells
• An unhealthy diet, lack of physical activity, smoking, sex at a young age
• Previous history of cancer in organs like the vagina, vulva or bladder
• Chances of cervical cancer increase if the patient’s mother was on diethylstilbestrol, a medicine used to prevent miscarriage while pregnant.

Cervical cancer is common in women under 45 years, and chances are high in the younger population.

Cervical Cancer Complications

The possible complications of cervical cancer, even after treatment, include kidney failure, blood clots, fistula (abnormal connection of two vessels or organs), and radiating pain in nerve endings, bones, and muscles if cancer progresses to the advanced stage. Early menopause, emotional stress, mood changes, and urinary dysfunction are other side effects of the treatment.

There are no chances of getting pregnant if the uterus is removed during surgery or the eggs are destroyed from radiation therapy.

Typical Test Required For Cervical Cancer

The doctors diagnose cervical cancer by enquiring about the patient’s medical history, signs, symptoms, and physical examination, followed by diagnostic imaging tests and tissue biopsy.

Oncologist suggest that diagnosis of cervical cancer should start early, at the age of 21 years.

A PAP (Papanicolaou test) smear test of cervix cells helps detect the presence of potentially precancerous or cancerous cells in the cervix. A sample of cells is scraped from the cervical wall and is tested for any abnormality. The test is recommended at a frequency of every three years and can be done during a regular pelvic examination.

Other diagnosis tests for cervical cancer include HPV DNA tests and colonoscopy. The human papillomavirus (HPV) DNA test detects the presence of HPV-DNA in the cervical samples, an indirect indicator to assess the risk of cervical cancer. Colonoscopy is done to obtain an enlarged view of the various parts of the cervix to identify and treat the affected area.

Epidemiology

• Cervical cancer is the fourth leading cause of cancer death worldwide in women.
• It also accounts for the second most common cancer in women aged 35–44 years.
• The average age of diagnosis of cervical cancer is 50 years.

Prognosis

Expected Prognosis

Recent advancements in diagnostic procedures and frequent screenings (PAP tests) have resulted in the earlier detection of cervical cancer. HPV vaccination and advanced treatment options have increased the survival rate of people suffering from the disease.

Natural Progression

Cervical cancer spreads to surrounding organs such as the uterus, vagina and bladder. If left untreated, the cancerous cells can also metastasise to distant body parts such as the kidney, lungs and so on. This progression may cause life-threatening health conditions and can even lead to death.

Pathophysiology

Cervical cancer is characterised by the abnormal growth of cells in the cervix. Human Papillomavirus is the main causative agent of cervical cancer and HPV 16 and HPV 18 account for more than 75 per cent of cases worldwide. Smoking and the use of oral contraceptives increase the risk of cancer.

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