Cancer of The Cervix – A Comprehensive Look At Diagnosis And Treatment of Cervical Cancer

Cancer of The Cervix – A Comprehensive Look At Diagnosis And Treatment of Cervical Cancer

Cervical cancer is the fourth most common type of cancer in the world. India, which accounts for one-third of total global cervical cancer deaths, reports 1.32 lakh new diagnosis every year, mostly in the advanced stages. 

What’s more horrifying was the number of annual deaths that was around 74,000. Early detection is the key to counter cervical cancer. Let’s break down the diagnosis and treatment procedure of cervical cancer in this topic.

Diagnosis of cervical cancer

Cervical cancer can be successfully treated if diagnosed early. Most of the guidelines recommend that women should go through screening for precancerous and cervical cancer at the age of 21. Let’s look at various methods and specific tests used in detecting cervical cancer:

Pap Smear test 

This test is the most vital and first line of defense against cervical cancer. Pap smear is actually a routine gynecological check-up that is recommended to all women aged between 21-65 years. The test is routinely conducted every three years until the woman is turned 30 years of age. If the test is negative, you should continue to have Pap smear but with a combination of HPV test every 5 years.

During this procedure, the doctor will scrape and brush off a sample of cells from the cervix. These abnormal cells are then sent for lab examination. Pap smear test is able to detect tumor cells in precancerous or cancerous state. However, abnormal reading does not mean you are at precancerous or cancerous stage. Though Pap Smear is highly effective in preventing cervical cancer, yet the success relies heavily on its accuracy.

HPV DNA test

The test is only recommended to women aged 30 and above. However, if you are below 30 and got abnormal results in Pap smear, your doctor may recommend you to go for HPV DNA test. The test is done similar to the Pap smear. The doctor extracts sample cells from the cervix and check for infection caused by any strain of HPV.

HPV test can also be combined with Pap smear test. If a woman has got abnormal readings in Pap smear, the same sample can be sent for HPV screening. So, no need for additional sample extraction.

Colposcopic examination

If the doctor suspects cancer or if Pap smear reveals some abnormalities, then the doctor may conduct a colposcopy. This procedure allows the doctor to observe the cervix thoroughly with a special magnifying device known as a colposcope. Your doctor might extract sample cervical cells for lab testing. For extracting a sample, he may use following techniques:

  1. Punch biopsy – This method uses a sharp tool similar to a paper punch to quickly extract sample of abnormal cervical tissue.
  2. Endocervical curettage (ECC) – In this procedure, a small brush is used to remove the tissue from the endocervical canal. This is a narrow area between the uterus and the cervix. This procedure can be a little painful but once done, the pain will go away.

Sometimes, for accurate diagnosis, larger biopsies need to be done. If the results from punch biopsy and endocervical curettage are concerning, then the doctor may conduct one of the following procedures:

  1. Electrical wire loop – Also known as Loop Electro Surgical Excision Procedure (LEEP), this method extracts a small tissue sample using a thin, low voltage electrical wire. This is performed under local anesthesia.
  2. Cone biopsy – During this procedure, a cone-shaped piece of the deeper layer of tissue is removed from the cervix and cervical canal. This method evaluates the extent of cervical cancer.

Staging Process

If the cervical cancer is diagnosed, you will need additional tests in order to determine the extent of cancer (staging). The staging of cancer is also a major factor in not only deciding the treatment but the survival rate also depends on it.

Before staging or grading cervical cancer, the doctor will perform tests such as CT scans, X-Rays, positron emission tomography and magnetic resonance imaging (MRI). This will help the doctor find out the extent of cancer beyond the cervix. The doctor may also visually exam the bladder and rectum by using special scopes.

Staging

  1. Stage I – Cancer cells are confined to the cervix and have not traveled anywhere. This stage can be further divided into 2 sub-stages by size.
  2. Stage IA – The area of invasion is not more than 3mm deep and less than 7mm wide and the cancer is not yet visible without a microscope. This stage has maximum 5-year survival rate ranging from 96-99 percent.
  3. Stage IB – Cancer in this stage may or may not visible without a microscope. The tumor in this stage is 4cm or larger in size. The 5-year survival rate for this stage ranges between 80 and 90 percent.
  4. Stage II – Cancer has spread to the upper vaginal portion but not yet invaded the pelvic wall. Five-year survival is between 65 and 69 percent
  5. Stage III – Cancer has invaded the lower 1/3 portion of the vagina but still not spread to the pelvic wall. This stage may also cause changes in the kidneys. The 5-year survival rate in this stage is 40-43 percent.
  6. Stage IV – Cancer has invaded the nearby organs including bladder and rectum or may have reached distant organs such as liver, lungs or bones. The 5-year survival rate is only 15-20 percent at this advanced stage.

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Treatment

Cervical cancer treatment depends on various factors such as general health problems and stage of cancer. But the early the condition is diagnosed, the more the chances of success. Mainly surgery, radiation therapy, and chemotherapy are performed or combination of these, depending on your case.

Surgery

Cervical cancer in the early stages is usually treated with hysterectomy (removal of the uterus). This procedure prevents recurrence of cancer, but after this procedure, you will no longer be able to have children in future. The doctor may suggest:

  1. Minimal invasive surgery - This type of surgery can preserve your ability to become pregnant again if the stage of cancer does not involve lymph nodes.
  2. Simple hysterectomy – This procedure will remove the cervix, uterus as well cancer.
  3. Radical hysterectomy – This method removes cervix, uterus, vaginal portion and the lymph nodes along with the cancer

Radiation Therapy

This treatment involves the usage of high radiation beams to destroy cancer cells. Radiation can be used as a standalone treatment or may be combined with chemotherapy before surgery in order to shrink the tumor or after the surgery to wipe off remaining cancerous cells.

Radiation therapy can be performed externally (external beam radiation therapy), or internally (brachytherapy) by placing a radioactive device inside the vagina. Sometimes, both external and internal procedure can be used. Pre-menopausal women might stop menstruating or begin menopause following this therapy.

Chemotherapy

This therapy typically uses medications, injected intravenously, to eliminate cancer cells. With low doses, chemotherapy is sometimes used in combination with radiation therapy, since former may increase the effect of the radiation. On the other hand, higher doses of chemotherapy are typically used in advanced stages which might not be treatable.

Vaccination

Human papillomavirus (HPV) is the group of virus behind many types of cancer including the cervical. To prevent cervical cancer, HPV vaccine is given three times within six months of time frame to the girls in the age group of 9-13 years. In India, there are only two vaccines available right now Merck’s Gardasil and GlaxoSmithKline’s Cervarix.

Gardasil provides immunity against HPV sub-types 16 and 18. On the other hand, the Cervarix not only protects against HPV sub-types 16 and 18, but also against sub-types 6 and 11 which are responsible for 90 percent of genital warts in both men and women. After receiving vaccination, a girl should undergo Pap Smear test every three years to check for any pre-cancerous or cancerous cells.

Outlook

Early detection of cervical cancer is the key factor behind successful treatment. If you have never gone through Pap smear test, talk to your doctor and go through this simple test, it’s better safe than sorry. Give a little bit change to your lifestyle by avoiding smoking and eating a healthy well-balanced diet.

Cervical cancer can emotionally test you especially when you are worried about your fertility. So ask your doctor for any other opinion if you are still worried. Be smart and your own advocate of health.