Choose regular screening, healthy lifestyle to fight cervical cancer

Bengaluru: The second most common cancer affecting women in India is cervical cancer, which is most prevalent in those who are between the ages of 15 and 44. Current estimates show that 1,23,907 women are diagnosed with cervical cancer each year and 77,348 lose their lives to the disease in India, which has 483.5 million women who are 15 years of age or older and are at risk of developing the disease. It is important to discuss why more young women are affected by cervical cancer and what can be done to avoid it during this Cervical Cancer Awareness Month, which is marked in January.

According to Dr. Niti Raizada, senior director of medical oncology and haemato-oncology at the Fortis Group of Hospitals, India has the highest rate of cervical cancer deaths and accounts for nearly one-fourth of all cervical cancer cases worldwide.

"One in every 53 women in India develops Cervix Cancer (Cervix being the lower part of the uterus at its junction with the Vagina). But we take heart with the declining trend of this cancer noted especially in urban population. Poor personal hygiene, multiple sexual partners are some of its causative factors. However public awareness by various bodies / NGOs, including even movies made on menstrual hygiene have impacted positively," she said.

Cervical cancer is, of course, a preventable and treatable condition. "We have vaccination against the chief causative factor - the Human Papilloma Virus. A one time HPV Vaccination (Cervix Cancer Vaccine) of about 90% of all girls by the age of 15 years remains a WHO Goal. HPV (Human Papilloma Virus) Vaccine is also advocated in men to prevent genital warts and other cancers including penile, anal," she added.

The most commonly cited reason is a persistent HPV infection. At least half of sexually promiscuous individuals are thought to contract HPV at some time in their lives since it is sexually transmitted. Fortunately, even though HPV infection is so common, only a small percentage of those infected end up developing cervical cancer.

According to experts, early-stage cervical cancer typically has no symptoms or indicators. "However, women frequently approach with observable cancer symptoms. These include inter-menstrual bleed, post-menopausal bleed, post coital- bleed, foul smelling discharge or occasionally back pain & pelvic pain," Dr. Raizada continued.

Depending on the age, symptoms, and results of previous tests, different tests may be used to determine the presence of cervical cancer. "Screening of women remains a Gold standard to identify pre-cancerous states. Cervical Smears also known as PAP smear screening is a simple test for early detection of Cervical Cancer in women with almost 94% specificity. Other tests include visual inspection by Lugol Iodine, Acetic Acid, colposcopy, MRI, PET scan, biopsy, and bimanual pelvic examination," she explained.

"PAP smears are advocated once in every 3-5 years with or without HPV testing between ages 20-65 years & a few things to remember to follow 2 days prior to your PAP smear testing: Not to douche or use any foam or cream or lubricants or vaginal medicines, not to use a tampon & abstinence. PAP smear can be done even during pregnancy and post delivery after 6-8 weeks," she added.

Depending on the stage, treatment for cervix cancer is determined. "MRI Pelvis is for local staging and PET CT scan to look for distant spread. If the lesion is in an early stage, then the focus is on local therapies. A very small tumor without lymph node involvement can be treated with surgery based on size and extent. Surgery planned can be Radical trachelectomy (where only the cervix of the uterus is removed) or Radical Hysterectomy (where the entire Uterus is removed)," she stated.

"Often stage 2 to 4a requires External Beam Radiotherapy(RT) and later Brachytherapy. This involves giving radiation to the part affected by cancer and some surrounding structures. When Cervical cancer has metastasised to non-regional lymph nodes, lungs, liver etc then we will administer chemotherapy and biologics to reduce the tumor burden & improve the quality of life and survivorship," she added.

Dr. Raizada told The Hans India that certain fertility sparing surgeries, including the Fertility-Sparing Trachelectomy, can be used for a young lady with very early-stage cervical cancer who is keen on retaining her fertility.

"After completion of treatment, all women are advised surveillance which means regular follow up check-ups to make sure that disease is under control. Along with follow-up, healthy lifestyle, exercise and diet advice is an integral part of management . Often a counsellor is involved in the entire course of treatment. So remember the best protection is prevention & early detection. Choose a healthy lifestyle and regular screening," she concluded.