What is cervical cancer?

Cervical cancer is the cancer which starts in the cells lining the neck of the womb (cervix). The cervix connects the body of the womb (uterus) to the birth canal (vagina). These cells do not suddenly change into cancer. Instead, the normal cells gradually develop into pre-cancerous abnormal cells which then become cancerous over a period of time.

Hence, the need for Pap smear test to detect these abnormal cells early before they turn into cancer.

What are the risk factors?

The risk factors which may increase the chances of developing cervical cancer are the following:

HPV (Human Papilloma Virus) infection– This virus has been found to cause almost 99% of cervical cancers. Only a few of the many species of HPV are capable to causing cancer. HPV can be spread from one person to another during skin-to-skin contact. One way HPV is spread is through sex, including vaginal, anal, and even oral sex. However, contact with any area of skin affected by HPV can spread the virus. Most of the women have the immunity to fight against the HPV infection. However in some situations; the infection persists and may lead on to cancer. Some factors which may increase the risk of progression of this infection to cancer are:

What are the symptoms?

Unfortunately, cervical cancer does not present with any symptoms in the early stages. However history of bleeding after sex, bleeding in between cycles and any chronic altered discharge should be reported and a thorough examination would be necessary. Due to absence of symptoms in early stages or pre-cancer stage, Pap smear screening at regular intervals (usually once in 3 years) is important.

How can it be detected?

A well-proven way to prevent cervix cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap smear test and HPV detection kit are used for this.

Pap smear test is a simple OPD procedure done by the gynaecologist wherein a gentle internal examination is done and a sample of the cells is taken for microscopic examination in the lab.

Depending on the degree of abnormality found, either repeat testing or treatment is advised. Treatment involves excising or trimming away the area of abnormality so that it does not progress to cancer.

An HPV test can be done on the same sample of cells collected from the Pap test.

The HPV DNA test detects the viral DNA and helps us to understand whether to treat or to follow up. Also another test called colposcopy would be recommended if the Pap smear is abnormal or HPV types 16 or 18 are detected as they are more carcinogenic.

Can cervical cancer be prevented?

Other than the detection methods above, there are a few things that can be done to prevent pre-cancers and progression to cancer. Using condoms during intercourse, avoiding having many sex partners and delaying sex until one is older certainly help in preventing HPV infection.

What about the vaccination?

HPV vaccines are available in India and have been used in various other countries for many years. They protect against infection with HPV subtypes which cause cancer and genital warts. They are most effective if given before the first sexual exposure. The recommendation is to administer it to girls of age 11-12 to 26 years of age. The vaccines are given in 3 doses (0, 1 month and 6 months). The side effects are mild, most commonly redness, swelling and soreness. Although vaccines provide protection of up to 70%, Pap smear screening must continue every 3 years.

As there is no National cancer screening programme in India, it is important for all of us to be aware and spread this awareness to all those concerned so that cervical cancer can be prevented.

Dr. Aruna Muralidhar,