Cervical Cancer

Cervical Cancer

Overview

  • Cervical cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of cancer death in women. Cervical cancer is the second most common cancer in India.
  • It has been proven that the cervical screening programme is associated with improved rate of detection and cure of cervical cancer.
  • It is one of the vaccine preventable and also screening detectable cancer and thus if detected early can be cured.
  • 80% are squamous carcinomas and 15% adenocarcinoma, both cause pre-invasive and invasive disease.

Risk Factors

HPV infection is the most important factor in developing cervical cancer; HPV is detected in 95% of cervical tumours.

There are around 80 types of HPV that are related to cervical cancer. The high-risk types - HPV 16 and 18 - involved in 70% of cervical cancer.

Other risk factors include:

  • Heterosexual women.
  • Women with multiple sexual partners
  • Smoking.
  • Lower social class.
  • Immunosuppression - eg, HIV and post-transplant.

What are the signs and symptoms?

Many cases are detected by screening. Abnormal vaginal bleeding is the most common symptom of cervical cancer.

Other common symptoms of established cervical cancer are:

  • Vaginal discharge: this varies greatly in amount and can be intermittent or continuous.
  • Bleeding: this can be spontaneous but may occur after sex, micturition or defecation, in the early stages. Occasionally, severe vaginal bleeding may necessitate emergency hospital admission.
  • Heavy bleeding during menstrual periods
  • Pain during / after sexual intercourse
  • Vaginal discomfort/urinary symptoms.

Late symptoms

  • Painless haematuria.
  • Chronic urinary frequency.
  • Painless fresh rectal bleeding.
  • Altered bowel habit.

Screening

Cervical cancer screening recommended for all sexually active women

Screening is done by a Pap smear as an outpatient procedure.

Evaluation

All Patients need to undergo per vaginal evaluation

  • Patient may need Colposcopy - allows examination of the visible cervix and if needed biopsy
  • Basic blood tests
  • CT and/or MRI scanning of the pelvis and abdomen are often used to stage disease, along with relevant biopsies.
  • Positron emission tomography (PET) is also being used increasingly for staging.
  • A CT scan of the chest, abdomen and pelvis with contrast is usually preferred to chest X-ray to assess for metastatic disease.
  • In advanced cases, Examination under anaesthesia is often undertaken with abdominal, vaginal and rectal examination, with or without colposcopy, hysteroscopy, cystoscopy and sigmoidoscopy. Biopsies are taken as necessary.

Treatment options

  • Very early tumours are cured by local excision procedures like conization or trachelectomy or a fertility preserving hysterectomy
  • Early stage tumours are treated with concurrent chemoradiation or with surgery (hysterectomy) with excellent prognosis
  • A few patients in early stage with high risk factors may need a radical hysterectomy surgery and followed by adjuvant therapy with chemotherapy or radiation as necessary
  • Patients with advanced disease may need radical hysterectomy or even pelvic exenteration(anterior/posterior/ total) and pelvic lymphadenectomy followed by adjuvant chemotherapy/ radiotherapy and also targeted therapy if necessary

What we offer in our centre?

All advanced surgeries for carcinoma cervix including

  • Laparoscopic/open radical hysterectomy with bilateral salping0- oophorectomy + Pelvic Lymph node dissection
  • Fertility preserving surgery for young women- Conization or Trachelectomy or Radiotherapy
  • Laparoscopic/open pelvic exenteration in advanced cervical cancers
  • Chemotherapy/ Chemoradiotherapy based on cancer stage
  • Targeted therapy / molecular therapy for advanced cancer
  • Specialised screening for Cervical cancers

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