cervical cancer

• Cervical cancer is a cancer that develops in the cervix, which is the lowermost part of the uterus that connects the uterus with the vagina.

  Most of the cases of cervical cancer are caused by persistent infection with human papilloma virus (HPV), which is a viral infection, acquired through sexual contact. Presently, vaccination of young boys and girls can prevent against this HPV infection. Also, routine screening of sexually active women can help detect those women with persistent HPV infection and timely treatment can prevent transformation of infected cells to cancerous cells.

Breast is a hormone responsive organ. Most of the causes are related to change in balance of estrogen and progest

Although causes of cervix cancer are not known definitely, it is suggested that infection with HPV, i.e. Human Papillomavirus plays a crucial role and is very common in women who have cervix cancer. The risk factors that are known to be associated with cervix cancer are as follows:

• A high number of sexual partners increase the chances of acquiring HPV infection.
• Sexual activities at an early age increase the chances of contracting the virus.
• Poor genital hygiene
• Exposure to other STDs that is sexually transmitted diseases such as HIV (Human Immunodeficiency Virus), Chlamydia, Gonorrhea, or Syphilis can also increase the risk.
• A weak immune system due to constant exposure to infections or immune suppressants is also a known cause. Autoimmune diseases may also trigger cancer.
• Smoking.

erone hormone levels, of body.

Non modifiable- causes which cannot be changed

Gender females are at higher risk of getting cancer. About 1% of Males also can get breast cancer

Age Chances of getting breast cancer increases with the age,

Family history

Only 5-10% of breast cancer are inherited .These cancers are related to sudden changes (mutation) in genes controlling normal cell functioning of our body. BRCA 1 and BRCA 2 are most common genes associated with breast cancer .There many other genes which responsible for breast cancer but frequency of mutation is very less.

Estrogen exposure

Early menarche (getting first menses at an early age) and delayed menopause (time when menses stops) it exposes a female to estrogen for prolonged time.
Dense breast: Everybody has different breast texture. Having dense breast is considered a high-risk forgetting cancer. Personal history of having breast cancer.
Some pre-cancerous breast diseases like atypical hyperplasia or lobular carcinoma in sit
Radiation exposure -Radiation exposure of breast while taking treatment for certain cancer in young age can cause breast cancer in future. Although with new radiation therapy technologies radiation exposure can be restricted.

Modifiable

• Obesity: excessive weight I carries higher risk of breast cancer. In postmenopausal ladies’ body fat is source of estrogen hormone
• Sedentary life style- in turn can lead to obesity
• Alcohol consumption
• Excess estrogen exposure- hormone replacement therapy, supplements etc

Early-stage cervical cancer generally does not show any signs or symptoms.

Some of the most common symptoms that patient present to the doctor are:

• Vaginal bleeding
• Bleeding between periods or after menopause
• Watery or foul-smelling vaginal discharge
• Pelvic pain or pain during intercourse
•  

After its spread to other parts, the symptoms may include:

• Pain in the pelvic region and lower back
• Difficulty in urination
• Swollen legs
• Kidney failure
• Bone pain
• Weight loss and lack of appetite
• Fatigue
• Blood in urine or stools
• Vomiting

If you experience any of these problems or symptoms mentioned above very frequently, it is recommended that you consult our specialist at the earliest.

There are a number of tests used to diagnose cervix cancer but it is the decision of the treating doctor as to which test a patient should undergo so as to help in further management.

The following tests are used to screen and diagnose cervical cancer:

Per vaginal examination: In this, a speculum is used to examine the vulva, cervix, vagina, uterus, ovaries and other organs. This is a non-invasive and basic examination, which requires only a few minutes and can be easily performed in the outpatient department. And if suspicious the following tests will be done to come to a definitive diagnosis

• PAP smear: This is done when there is suspicion and no obvious lesion. The doctor will gently scrape the outside cells of cervix and vagina, taking a few samples of cells for further testing. The following tests are done post a PAP smear:
  • Thinprep or Surepath test: The liquid-based cytology test transfers a thin layer of cells onto a slide after removing blood or mucus from the sample.
  • Auto Cpap or Focal point: A computer is used to screen the sample for abnormal cells.
• Colposcopy: The doctor uses a special magnifying instrument to check the cervix for abnormal areas. It can also be used to take a cervix biopsy. It magnifies and illuminates the cells of the cervix and vagina
• Biopsy: It is the removal of a small amount of tissue for examination under a microscope, which helps to make a definite diagnosis. A small lesion is removed while taking a biopsy.
• HPV typing: This test is done to detect the presence of Human Papilloma Virus such as HPV 16 and HPV 18, whose infection causes cervix cancer.

CT scan: A Computerised tomography of a patient shows 3D image which gives information of the tumour size, position and spread. Contrast CT is done by injecting a dye which gives a better detail of the tumour.

MRI: Magnetic resonance Imaging. It uses magnetic fields to produce a detailed image of the tumour.

Positron Emission Tomography: This is done by injecting short acting Radioactive glucose into the patient which is “eaten” by the cancer cells. This is detected by sensitive devices to give the exact tumour position, size and spread and are seen to “light up” the region of cancer.

Cervical cancer does not develop in a short period of time. They start as pre-cancerous lesions. Studies have shown that it takes more than a decade for a pre-cancerous lesion to develop into cervical cancer. During this period of development it is easy to identify and these lesions by screening procedures and get treatment early even before the cancer develops.

The treatment of cervical cancer is dependant of the size and spread of tumour, histology, stage of the disease, patient’s general condition and associated diseases. The doctors decide on treatment options according to these factors to be Surgery, chemotherapy or Radiotherapy in different combinations or separately.

Surgery

• In patients with precancerous lesions small surgical procedure like LEEP i.e. Loop Electrosurgical Excision procedure which uses a wire loop heated with the help of electric current to remove the cells from cervical region is performed.
• If the cancer is very small fertility sparring is preferred, surgery like Trachelecomy is performed
• If cancer is small have spread into the uterus as well, a procedure known as Hysterectomy is performed wherein the patient’s uterus is removed along with the adjoining lymph nodes. In elderly patients, who have attained menopause, the ovaries are also removed.

Radiation Therapy

• Cancer that is large in size or has spread beyond the uterus is treated with radiation therapy with or without chemotherapy.
• It makes the use of high energy X-rays to target and destroy the cancer cells or inhibit their growth. Radiation affects only the local site of treatment. Radiation treatment may be external or internal (brachytherapy).
• In External beam radiation, the beams are aimed at the pelvis with the help of a Linear Accelerator. The treatment is done with usage of advanced techniques like 3DCRT, IMRT, IGRT or Rapid-Arc.
• In brachytherapy, the radiation comes from a radioactive seed. The seed is insertedinto the patient’s cervix and uterus by using brachytherapy applicators.
• Radiotherapy is also given as a palliative treatment in very advanced cancers where the disease has spread beyond the pelvic region to other organs like, liver, bone and brain to relieve symptoms like bleeding, bone pain or CNS symptoms.

Chemotherapy

• Chemotherapy makes the use of drugs to kill cancer. It is done in cycles of intensive treatment followed by some amounts of recovery periods in between. In cervical cancer it is usually a weekly cycle.
• In metastatic cancers where the cancer has spread beyond the local region, chemotherapy is also given as a palliative treatment.

The only method to prevent advanced stages of cervical cancer is to detect the changes in your body early by Screening. Regular pelvic exams and pap smears are recommended for the same. Medical professionals suggest that

• Every female should get a pap test done, at least once in three years, once she is 21 years of age or older.
• If a woman is above 35 years of age, a PAP test and HPV test is recommended once every 5 years. If our doctor suggests that you are low risk, these tests can be avoided further.
• Another important preventive measure is to avoid HPV infection. This can be taken care of if one follows these measures carefully:
  
  • Having protected sex.
  • Not having too many sexual partners
  • Getting vaccinated for HPV.
  • Maintaining a healthy lifestyle.
  • HPV vaccination

Human Pappiloma Virus infection plays a major role is the cause of cervical cancer. This can be prevented by the administration of HPV vaccines.

Different types of vaccine are available. They are

• Bivalent that protects against HPV 16 and 18 that are attributed to cause 70% of cervical cancer
• Quadrivalent vaccine which protects against HPV 16, 18, 6 and 11 which also causes genital warts
• Nonavalent vaccines which protect against HPV 16, 18, 6, 11, 31, 33, 45, 52, and 58 which also account for 10-20% of cervical cancers

The HPV vaccines are available from age of 9 to 25 years. The dose given differs according to age. Please consult your doctor.

The vaccines work like other immunizations that guard against viral infections, HPV vaccines stimulate the body to produce antibodies that, in future encounters with HPV, bind to the virus and prevent it from infecting cells.

The vaccines do not prevent other sexually transmitted diseases, nor do they treat existing HPV infections or HPV-caused disease.