Cervical Cancer

Introduction :

Carcinoma of cervix is the most frequent of all the genital tract cancers, and after the breast, the second most common site of malignancy in female body. India has the highest number of cervical cancer in the world according to the international agency of research on cancer (IARC), a part of the world health organisation (WHO), Approximately, cancer cervix accounts 80%, ovary 10% and uterine body 4-5% of genital cancers in India. Every year, around 74,000 patients die in the country out of 1,32,000 women diagnosed with this deadly disease. Across the world, around 2,80,000 women die of this disease every year and 27% of these deaths occur in India only.

What is CERVICAL CANCER?

The cervix is the lower part of the uterus(womb). It is sometimes called the uterine cervix, the body of the uterus is where the baby grows, the cervix connects the body of the uterus to the vegina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix.

The part next to vagina is the ectocervix or exocervix. The 2 main types of the cells covering the cervix are squamous cells (on the ectocervix) and glandular cells (on the endocervix) the place where the two cell types meet is called the transformation zone. Most cervical cancer starts in the transformation zone. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop precancerous changes that turn into cancer.

Type of Cervical Cancer :

Cervical intra epithelial neoplasia (pre cancerous changes)

Squamous cell carcinoma 80% - 90%

Adenocarcinoma – 20%

Risk Factors :

1. HPV – the virus called human papilloma virus which infects mostly women causes the disease the virus get transmitted through sexual contact and even preventive measures like contraceptive cannot prevent it from entering a women’s body from infection, the virus takes 15-20 years to develop and attack as cervical cancer in womens body.
2. High risk HPV types- 16 & 18 cause 2/3rd of cervical cancer.
3. Low risk HPV type – 6 & 11
4. Smoking
5. Immunosuppression – Hiv infection, taking immunosuppressive drugs
6. History of sexually transmitted infection
7. Diet – poor diet can lead to cervical cancer. Also overweight women are more likely to develop adenocarcinoma of the cervix
8. Oral contraceptives (birth control pills) long term use of OC pills increases the risk
9. Multiple sexual partners
10. Multiple full term pregnancies
11. Sexual activity at young age and child bearing at early age (before age 18 years)
12. Low socioeconomics group
13. Mother took DES when pregnant with the patient

Cervical Cancer Screening :

It is recommended that woman undergo periodic cancer screening based on following criteria, Sexually active woman above 18 years. Sexual life more than 10 years.

More than 3 pregnancies and labour.

Screening method used :

1. PAP smears
2. VIA (Visual inspection of cervix with 3% or 5% acetic acid)
3. VILI (Visual inspection of cervix with lugol’s iodine)

How it is diagnosed?

1. Pelvic examination – involves internal examination of the vagina and adjacent organ by the gynaecologist.
2. PAP smear – involves using a small spatula to obtain a sample of the cells from the cervix. The cells are spread into glass slides, the sample is sent to a laboratory to be examined under microscope.
3. Colposcopy – If smear test is abnormal, patient may be referred for a colposcopy in order for a biopsy to be taken. A colposcopee is like a small microscope with a light.