Cervix is the lower most part of the uterus and is a common site of cancer in women. Unlike most of other cancers, cervical cancer is preventable and can be diagnosed at an early stage and cured.
What causes cervical cancer
Virtually all the cases of cervical cancer are caused by a virus, known as Human Papilloma Virus. Most of the times, body clears the virus. Persistent infection can lead to the development of cervical cancer. Estimated time between infection and occurrence of cancer is between 10-15 years.
Other risk factors are smoking, use of oral contraceptive pills, weak immune system like in patients with HIV infection, or using medicines to treat cancer, or giving birth to too many children.
What are common symptoms of cervical cancer
Early stage disease may be silent, diagnosis at such stage is performed by screening tests.
Patients with advanced stage may present with following symptoms
Vaginal bleed after menopause or in between the periods may be the first symptom of cervical cancer.
Vaginal bleed after intercourse or pain during intercourse may occur in few patients.
Patient may complain of foul smelling discharge from the vagina. Few patients with advanced disease may complaint of difficulty during passing stool or blood in the stool, blood in urine, pain during passing urine, swelling in feet, pain in lower abdomen or backache, and tiredness.
Many of these symptoms may occur to other diseases also, hence a detailed work up is required to confirm the diagnosis.
What are the tests required to confirm the disease
Whenever the cervical cancer is suspected, detailed evaluation of patient is done. Patient should discuss all the symptoms, following which detailed physical examination is performed. In addition, following tests are peformed to reach the diagnosis.
Biopsy is performed to confirm the diagnosis. Biopsy can be done in the OPD mostly, but sometimes needs performed under anesthesia in minor operation theatre. If the tumor is small and is in initial stage, whole tumor be removed during biopsy. Sometimes, a acetic acid or lugol’s iodine solution can be applied to cervix before the biopsy for better localisation.
Fertility sparing surgery can be done in young women with early stage disease who wish to preserve their uterus and ovaries.
How to stage the cervical cancer
Staging is performed before planning the further treatment.
PET CT, MRI, ultrasound, and the blood tests are performed to define the extent and stage of the disease.
What are the stages and treatment of cervical cancer
Stage I – Tumor is confined to the cervix, this stage can be further classified in 1A and 1B.
Stage II – Tumor has involved either the upper part of vagina or tissue surrounding the uterus
Stage III- Tumor has spread to ureter, lower part of vagina, pelvic wall or lymph nodes
Stage IV – Tumor has involved the urinary bladder, rectum, liver or lungs
Stage IA tumor is treated either by local surgery known as conization or by removal of uterus. For IB and higher stages, radiotherapy, chemotherapy and surgery are performed.
What is life expectancy of patients with cervical cancer
Most of the patients with cervical cancer can be cured of the cancer. 70% of patients with cervical cancer can expect to live beyond 5 and more years. In patients with very early disease, 5 year survival is more than 90%. If the tumor is involving the surrounding tissue, 5 year survival is 60%. If the tumor has involved distant organs like liver and lung, 5 year survival is 15-20%.
These figures are rough estimates only, survival in a given patient depend on many other factors also, which can be discusses with treating doctor.
Dr Kanika Batra Modi
Senior consultant, Gynaecologist Surgical Oncologist
Max Super Speciality Hospital
Saket, New Delhi, India