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March 2011
Protect Yourself From Cervical Cancer
Dr.P.K Das
Cancer of the uterine cervix is the most common cancer in women in developing countries, with an incidence of 19 to 44 per 1,00,000 women in India. The incidence of cervical cancer is the highest in Chennai and Bengaluru. The World Health Organisation estimates that 1.3 lakh Indian women are diagnosed with this type of cancer every year.

Cervical cancer most commonly presents in 50-60 years age group.Patients may have inter-menstrual, post-coital, or post-menopausal bleeding, as also foul vaginal discharge. As the cancer advances, bleeding becomes heavier and more frequent with low backache, low abdominal pain, bleeding in urine or stool or lower limb oedema.

Risk factors
This disease is rarely seen in Catholic nuns - suggesting that the cause of this disease could be a sexually transmittable infection. The Human Papilloma Virus (HPV) -16, 18, etc. are cancer causing viruses detected in most cases of cervical cancer. Risk factors which may lead to cervical cancer are:
  1. Multiple sexual partners.
  2. Partner suffering from a Sexually Transmitted Disease.
  3. Poor genital hygiene.
  4. Early age at sexual exposure.
  5. Multiple child births.
  6. HIV infection.
Screening by clinical examination and pap smear is very useful; it has led to a 50 per cent decrease in mortality rates due to cervical cancer in USA and other Western countries. Annual screening is recommended for every sexually active woman. This should be repeated annually for three to four years, and if reports are normal then it can be reduced to once every 3 years till the age of 65.

Early Detection
Pap smear helps to identify pre-cancerous lesions and early cancer.
  • There are three grades of pre-cancerous lesions: Cervical Intraepithelial Neoplasia (CIN) I, II and III. 
  • 26 per cent of CIN-I lesions progress to CIN-III.
  • 15 per cent of CIN-III progress to form frank cancer.
  • HPV DNA studies are also done for high risk cases.
It is important to stage the disease before starting treatment.Staging involves:
  1. Clinical examination.
  2. Biopsy.
  3. Chest X-ray.
  4. MRI of the pelvis.
  5. Ultrasonography or Contrast Enhanced Computed Tomography (CECT) of the abdomen.
  6. Cystoscopy.
  7. Routine blood investigations.
What Treatment, When
Selection of treatment method depends on the stage of disease.
  • Cervical Cancer treatment involves surgery,radiotherapy and chemotherapy.
  • Loop Electrosurgical Excision Procedure (LEEP) helps in diagnosis and therapy of pre-cancerous CIN lesions.
  • Pre-cancerous and early stage cancer have high cure rates with surgery and radiotherapy. In advanced cases chemotherapy and radiotherapy is advised.
  • Radiotherapy in the form of external radiotherapy and brachytherapy together, is crucial in the treatment of cervical cancer. It takes seven to eight weeks to complete radiotherapy.
  • Palliative treatment is offered for cases with advanced disease, low general condition and deranged kidney function with a short course of radiotherapy.
Vaccinate Yourself
  • There are two cervical cancer vaccines available.
  • Since these vaccines protect against cervical cancer causing viruses HPV-16,18 and others, they are recommended to be given to girls (11 to 12 years) and women (under 26 years) before their first sexual exposure or before they have been infected by the HPV virus.
  • In addition, these vaccines can prevent most vaginal and vulvar cancers caused by HPV.
  • It also prevents genital warts in men and women.
  • One must be aware of possible side effects before taking this treatment. Ask your doctor for them specifically.
  • The role of female circumcision in the prevention of this type of cancer, is debatable though.

Dr. P.K Das Sr. Consultant, Medical Oncology Apollo Cancer Institute, New Delhi

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