Cervical cancer is the fourth most common cancer in women. In 2018, an estimated

 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease.

In India cervical cancer is the second most common malignancy among females.

Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.

Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.

When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer,as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.

With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.

PREVENTION

The Centers for Disease Control and Prevention (CDC) initially recommended the vaccine for all people aged 9–26 years. However, the CDC now advise that the vaccine is also available for all women and men aged 26-45, who did receive the vaccine as a preteen.

Women should have regular cervical smear tests, or Pap test. A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate the possible development of cancer so that action can be taken early.

SYMPTOMS AND EARLY SIGNS

In the early stages of cervical cancer, a person may experience no symptoms at all.

The common symptoms of cervical cancer are:

• bleeding between periods
• bleeding after sexual intercourse
• bleeding in post-menopausal women
• discomfort during sexual intercourse
• vaginal discharge with a strong odor
• vaginal discharge tinged with blood
• pelvic pain

Anyone who experiences any of these symptoms should see a doctor.

STAGING

Staging aims to assess how far the cancer has spread and whether it has reached nearby structures or more distant organs. It helps to decide the most effective type of treatment.

• Stage 0: Precancerous cells are present.
• Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes
• Stage 2: The cancer has now moved beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.
• Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.
• Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.

Undergoing screening and seeking medical attention if any symptoms occur can help a person access early treatment and increase the chances of survival.

RISK FACTORS

• Having many sexual partners or becoming sexually active early, leads to increased risk of HPV infection.
• Smoking
• A weakened immune system
• Long-term use of some common contraceptive pills slightly raises a woman’s risk.
• Other sexually transmitted diseases (STD): Chlamydia, gonorrhea, and syphilis increase the risk of developing cervical cancer.
• Socio-economic status: increased incidence in lower socio-economic group

TREATMENT

Cervical cancer treatment options include surgery, radiotherapy, chemotherapy or combinations of these.

Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as age and overall state of health.

Surgery is a common treatment method for very early stages when the cancer has not spread beyond the cervix.

For locally advanced cases when the cancer has spread beyond the cervix, surgery is not usually an option and typically involve either radiation therapy or a combination of radiation therapy and chemotherapy.

In the later stages of cancer, professionals provide palliative therapy to relieve symptoms and improve quality of life.