Cervical cancer

Cervical cancer symptoms are usually mild in the early stages and can go unnoticed. Symptoms vary according to the stage of cancer and include:

Early or Stage 1 Cervical Cancer

Early-stage cervical cancer may not cause symptoms, but signs of stage 1 may include:

• Watery or bloody vaginal discharge
• Foul odor in the vaginal discharge
• Vaginal bleeding after sexual intercourse
• Vaginal bleeding between menstrual periods
• Longer and heavier menstrual periods
• Bleeding post-menopause
• Discomfort during sexual intercourse

Advanced Cervical Cancer

If there is a spread of cancer (metastasis) to nearby tissues or organs, symptoms may include:

• Blood in urine
• Diarrhea
• Tiredness
• Weight loss
• Loss of appetite
• A general feeling of being ill
• Dull and aching pain in the back
• Swelling in the legs
• Pelvic/abdominal pain
• Difficulty or pain during urination
• Pain or bleeding from the rectum while passing stool

Note: It can take almost 20 years for the initial lesion caused by sexually transmitted HPV to develop into an invasive form of cervical cancer. Learn what the experts have to say about cervical cancer.

Almost all cervical cancers are caused by sexually transmitted human papillomavirus (HPV).

The human papillomavirus (HPV), which also causes genital warts, has over 1,000 strains, with HPV-16 and HPV-18 being the most common causes of cervical cancer.

HPV causes cancer by its proteins E6 and E7 disrupting key tumor suppressor genes like P53 and retinoblastoma and altering DNA.

Most people will get HPV at some point in their lives and may not realize it, as the body often fights against the infection.

However, if the body fails to combat this infection, it can lead to changes in the cells of the cervix, resulting in cancerous cells. HPV can spread through:

• Any direct skin-to-skin contact with the genitals
• Vaginal, anal, or oral sex
• Sharing sex toys

Several risk factors for cervical cancer are linked to exposure to HPV, which include:

• Human immunodeficiency virus (HIV) infections: According to studies, the risk of developing an infection from high-risk HPV types is higher in women with HIV.
• Multiple sexual partners: Many studies have suggested that women with multiple sexual partners are at high risk for HPV acquisition and cervical cancer. Additionally, multiple sexual partners of the spouse can be an extra risk factor.
• Excessive use of oral contraceptives: Oral contraceptive (OC) pills are known to be a risk factor for cervical cancer. A study has reported that the use of OC for 5 years or more can double the risk of cancer.
• Smoking: Smoking increases the chance of developing precancerous lesions of the cervix (called moderate or severe dysplasia) and raises the risk of cervical cancer.
• Hygiene patterns:
  • Not using a sanitary napkin
  • Not maintaining vaginal hygiene
  • Not taking special care in cleaning the genitals when washing
• Weak immune system: Having a weakened immune system caused by immunosuppression increases the risk of HPV infection and cervical cancer.

Early stages of cervical cancer don't usually involve symptoms and are hard to detect. The International Federation of Gynecology and Obstetrics (FIGO) classified cervical cancer stages into the following:

• Stage 0: Also known as carcinoma in situ, it is the presence of abnormal cells in the innermost lining of the cervix.
• Stage I: Invasive form of cancer that is only confined to the cervix.
• Stage Ia: Preclinical invasive carcinoma that can be diagnosed only by means of microscopy.
• Stage Ib: Clinically visible lesion that is confined to the cervix uteri.
  • Stage Ib1: Primary tumor not greater than 4.0 cm in diameter.
  • Stage Ib2: Primary tumor greater than 4.0 cm in diameter.
• Stage II: The locally limited spread of cancer beyond the uterus but not to the pelvic sidewall or the lower third of the vagina.
• Stage IIa: Spread into the upper two-thirds of the vagina without parametrial invasion.
• Stage IIb: Extension into the parametrium but not into the pelvic sidewall.
• Stage III: Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a non-functioning kidney that is incident to invasion of the ureter.
• Stage IIIa: Extension into lower one-third of the vagina, without spread to the pelvic sidewall.
• Stage IIIb: Extension into the pelvic sidewall and/or invasion of the ureter, with the latter resulting in a non-functioning kidney or hydronephrosis.
• Stage IV: Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum.
• Stage IVa: Extension of the tumor into the mucosa of the bladder or rectum.
• Stage IVb: Spread of the tumor beyond the true pelvis and/or by metastasis into distant organs.

Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer. Cervical cancer diagnosis requires the following:

1. A physical exam and complete medical history: Examining the whole body to check general signs of health, including checking for any signs of disease, like lumps or anything unusual. Past medical history, individual health habits, and prior illnesses and treatments will also be taken into account.
2. Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum is performed. A speculum is inserted into the vagina to look for signs of disease.
3. Traditional pap smear: A pap smear, also called a pap test, is a procedure to test for cervical cancer in women. It involves collecting cells from the cervix.
4. Liquid-based cytology (LBC): A new method of preparing cervical samples for cytological examination, involving making a suspension of cells from the sample to produce a thin layer of cells on a slide.
5. Visual Inspection: Visual inspection with acetic acid (VIA) involves visualizing a woman's cervix to detect precursors of cervical cancer after the application of acetic acid on her cervix.
6. HPV testing: The HPV test is a screening test for cervical cancer. It detects the presence of HPV, the virus that causes cervical cancer, in the system.
7. Computerized screening: Computer-assisted image analysis and artificial intelligence have been introduced to improve the sensitivity of the Pap smear. AI has shown promising results in screening and examination based on image pattern recognition.
8. Endocervical curettage: A procedure to collect cells or tissue from the cervical canal using a curette. Tissue samples are taken and checked under a microscope for any signs of cancer.
9. Colposcopy: A procedure in which a colposcope is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken and checked under a microscope for signs of disease.
10. Biopsy: This is done if the pap smear shows any abnormal cells. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer.
11. Imaging: These tests help doctors locate the cancer and determine if it has spread to other parts of the body. They include:
    • Computed tomography (CT) scan: Involves taking pictures of the cervix at specific times after the intravenous injection of contrast medium to find out the tumor's location in relation to nearby organs and blood vessels.
    • Positron emission tomography (PET) scan or PET-CT scan: A PET scan is usually combined with a CT scan or MRI scan to produce images of the inside of the body, providing a more complete picture of the area being evaluated.

Women’s Cancer Awareness Package is a group of tests clubbed together to detect cancer markers in women. Get your lab tests done by our professionals in the comfort and safety of your house.

There are more than 100 kinds of HPV, and about a dozen of them have been shown to lead to cancer. The two most important strategies to prevent cervical cancer are to get the HPV vaccine and to get tested regularly according to American Cancer Society (ACS) guidelines. These include:

1. Undergoing cervical screening

   Early detection of the types of HPV that can cause cancer is key to preventing cervical cancer. A well-proven way to prevent cervical cancer is to have screening tests.

2. Getting the HPV vaccine

   The HPV vaccine can help prevent HPV infection by protecting against HPV. These vaccines help prevent pre-cancers and cancers of the cervix. Some HPV vaccines are also approved to help prevent other types of cancers and anal and genital warts.

3. Limiting exposure to HPV
   • Encouraging partners to talk with a doctor or nurse about the HPV vaccine.
   • Avoiding sexual activity when visible warts are present.
   • Limiting the number of sexual partners.
   • Avoiding sex with individuals who have had many other sexual partners.
4. Not having unprotected sex

   Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of barrier methods of birth control, such as condoms and dental dams during oral, anal, and vaginal sex, can help protect against HPV infection. Using condoms significantly reduces the risk of HPV infections by providing a barrier that minimizes skin-to-skin contact during sexual activity.

   CTA: Prioritize your health—choose condoms for protection and peace of mind.

5. Maintaining a healthy lifestyle

   This may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

Note: India accounts for around 16% of the total deaths caused by cervical cancer worldwide, and it can be prevented with a vaccine. Learn more about the vaccine to prevent cervical cancer: Age, Types, Schedule & More.

Different types of treatment are available for patients with cervical cancer. They include:

1. Surgical procedures
   • Conization: A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix.
   • Hysterectomy: A surgical procedure to remove the womb (uterus). A hysterectomy can be:
     • Simple hysterectomy: Removal of the uterus and cervix.
     • Radical hysterectomy: Removal of the uterus, cervix, upper vagina, and surrounding tissue, including lymph nodes.
   • Loop electrosurgical excision procedure (LEEP): This procedure uses a wire loop heated by an electric current to remove cells and tissue in the cervix and vagina, serving as part of the diagnosis and treatment for abnormal or cancerous conditions.
   • Exenteration: Surgery performed if cancer has recurred within the pelvis, removing the cervix, uterus, and ovaries.
   • Radical trachelectomy: Surgery to remove the cervix, nearby tissue, lymph nodes, and the upper part of the vagina, used to treat early-stage cervical cancer while preserving fertility.
   • Bilateral salpingo-oophorectomy: A surgical procedure to remove both the ovaries and fallopian tubes, performed concurrently with a hysterectomy.
2. Radiation therapy: Uses high-energy X-rays or other particles to destroy cancer cells. Radiation therapy may be administered alone, before surgery, or instead of surgery to shrink the tumor. The types of radiation therapy include:
   • External-beam radiation therapy: The most common type, where radiation is delivered from a machine outside the body.
   • Internal-beam radiation therapy: Also known as brachytherapy, involves applying a radioactive source near the tumor using implants.

   Note: For the early stages of cervical cancer, a combination of radiation therapy and low-dose weekly chemotherapy is often used to enhance the effectiveness of the radiation treatment.

3. Chemotherapy: The use of drugs to destroy cancer cells by inhibiting their growth, division, and reproduction. The chemotherapy drugs most often used include:
   • Cisplatin
   • Carboplatin
   • Paclitaxel (Taxol)
   • Topotecan
4. Targeted therapy: This treatment targets specific genes, proteins, or tissue environments that contribute to cancer growth and survival. It blocks the growth and spread of cancer cells while limiting damage to healthy cells. For recurrent or metastasized cervical cancer, platinum-based chemotherapy combined with targeted therapy is used. Targeted therapy includes:
   • Bevacizumab (Avastin)
   • Bevacizumab-awwb (Mvasi)
   • Bevacizumab-bvzr (Zirabev)
   • Tisotumab vedotin (HuMax-TF)
5. Immunotherapy: This therapy enhances the body's natural defenses to fight cancer by improving the immune system's ability to attack cancer cells. The immune checkpoint inhibitor pembrolizumab (Keytruda) is used to treat cervical cancer that has recurred or metastasized during or after chemotherapy. It may also be used in conjunction with chemotherapy, with or without bevacizumab, for patients with recurrent or metastatic cervical cancer.

Some herbs and spices have shown promising results in cancer management, but it is important to understand they should not replace conventional treatments. Always consult your doctor before starting anything new.

• Basil (Tulsi): Contains compounds that may exhibit anti-cancer properties. Buy premium quality tulsi products.
• Clove (Laung): Contains eugenol, which has been studied for its potential anti-cancer properties.
• Garlic (Adrak): Rich in organosulfur compounds, which have been associated with reduced cancer risk.
• Rosemary (Gulmehendi): Contains antioxidants like carnosic acid and rosmarinic acid, which may have anti-cancer effects.
• Saffron (Kesar): Contains an element called crocin, which has shown potential anti-cancer properties.

Cervical cancer complications are observed in advanced disease stages and associated treatments, similar to other cancers. They may include:

• Kidney failure: Kidney involvement typically occurs in the more advanced stages of cervical cancer. Kidney failure can often be associated with blockage of the ureters.
• Hydronephrosis: This condition involves the swelling of a kidney due to a build-up of urine, indicating advanced disease as it shows involvement of the parametria.
• Pain: Pain is experienced when cancer progresses and spreads to nearby tissues and organs, particularly in the pelvis or during urination.
• Lymphedema: This refers to tissue swelling caused by an accumulation of protein-rich fluid that is usually drained through the body's lymphatic system. It is often a result of treatment involving pelvic radiotherapy or lymph node removal.
• Blood clots: Cervical cancer can increase blood thickness, leading to the formation of blood clots. Large tumors may exert pressure on leg veins, facilitating clot formation.
• Fistulas: A fistula is an abnormal connection between two body parts, such as an organ or blood vessel, and another structure.
• Orbital apex syndrome (OAS) and blindness: OAS is a rare condition linked to malignant mixed Müllerian tumors (less than 5% of uterine cancers) and involves optic nerve damage when cancer spreads to the eye.

Prevention is better than cure! The HPV vaccine can be your shield against cervical cancer. Learn how.

When exploring alternative treatments for cervical cancer, always consult your medical team, as some may conflict with your treatment plan. Common alternatives include:

1. Naturotherapy

   A holistic approach using plant-based nutrients can support cervical cancer treatment. While not a replacement for conventional therapy, it may enhance the effectiveness of chemotherapy and radiotherapy. Helpful herbs include:

   • Curcumin or turmeric (Haldi)
   • Ginger root (Adrak Ki Jadh)
   • Holy basil (Tulsi)
   • Green tea
   • Grapes (Angoor)
   • Broccoli
   • Banana (Kela)
   • Cabbage
2. Homeopathy

   Homeopathy is considered a complementary approach that may help manage symptoms and improve overall well-being in cervical cancer patients. It should always be used alongside conventional treatments under medical guidance.

3. Acupuncture

   One of the most distressing and intractable conditions in patients with cancer is pain. Acupuncture is recommended for patients to control cancer pain. Previous studies have reported that it not only has beneficial efficacy for cancer pain management but also has minimal adverse events for patients with cancer pain. However, more research is required to specifically explore the effectiveness of acupuncture at pain acupoints for cervical cancer pain.

New Research on Cancer Management!

Significant strides in cancer research offer hope, as scientists from Tata Memorial Centre propose a novel nutraceutical to reduce treatment toxicity and lower cancer recurrence rates.

Cancer impacts physical, emotional, social, and financial well-being, making it a challenge for patients and families. For some, cancer may persist, requiring ongoing care. Here are tips to cope:

1. Give importance to palliative care
   Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other non-medical needs. Palliative treatments vary widely and often include:
   • Medication to relieve symptoms
   • Nutritional changes
   • Relaxation techniques
   • Emotional and spiritual support
   • Encouraging the patient to engage in activities they love
2. Follow up regularly
   Most doctors recommend that women treated for cervical cancer continue to have regular Pap tests, regardless of the treatment method (surgery or radiation). Survivors of cervical cancer should remain vigilant for early detection of other cancers, such as breast, lung, and colorectal cancer. Imaging tests may be conducted if signs or symptoms of cancer recur.
3. Manage the physical symptoms of advanced cancer
   Advanced cervical cancer means cancer that has spread to other areas of the body, such as the liver or lungs. Unfortunately, advanced cancer is usually not curable. However, treatment can often control cancer and relieve symptoms. The American Cancer Society recommends brisk walking for at least 150 minutes or engaging in vigorous-intensity activity for 75 minutes each week to maintain health. Walking may improve the quality of life for people with advanced cancer.
4. Focus on emotional and mental well-being
   Fear and anxiety related to cancer or ongoing treatment can be managed by:
   • Discussing advanced cancer
   • Sharing feelings with close family members and friends
   • Gathering all necessary information regarding treatment
   • Understanding physical limitations
   • Managing sexual relationships through open communication with partners
   • Coping with practical issues such as financial expenses, childcare, and work-related concerns
5. Supervise the cost of cancer care
   Cancer treatment can be expensive, and financial strain can become a source of stress and anxiety for patients and their families. In addition to treatment costs, there may be unexpected expenses that can hinder patients from continuing treatment. This can be managed by consulting a social worker about available benefits or grants, who can also assist with the claims process.

Tips for caregivers

• Encourage and provide mental support to the patient
• Understand the course of treatment
• Help the patient manage their symptoms and side effects
• Coordinate medical appointments and ensure timely medication administration
• Assist the patient in maintaining personal care and hygiene
• Communicate with empathy and a positive attitude toward the patient
• Help with household chores
• Manage insurance and billing issues on their behalf