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Cervical cancer is a major issue among women globally, especially in developing countries. India accounts for 1/5th of the world's cervical cancer cases. Cervical cancer is the second most common cancer in India among women and the second most common cancer among women ages 15–44. It accounts for 6-29% of all cancers among women in India. Cervical cancer is one of the few cancers that can be prevented, diagnosed early, and effectively treated, and unlike many cancers, it is possible to cure it even if diagnosed in an early stage. This blog will discuss the etiology, risk factors, preventions, diagnostic techniques, and treatment of cervical cancer.
Synopsis
Etiology: Cervical Cancer
Cervical cancer is recognized today as being primarily due to persistent infection by high-risk types of human papillomavirus (HPV), a sexually transmitted infection. HPV is a group of more than 200 viruses ranging into low-risk types (causing genital warts) and high-risk types (causing most cancers related to HPV). Time and again, HPV infections are transient, and the infected individual clears the virus from their system within months to years. Sometimes, however, some high-risk HPV infections become persistent and can lead to cervical precancerous changes, even cervical cancer.
The virus damages and causes dysplastic changes in epithelial cells of the cervix. Untreated precancerous lesions can lead to invasive cervical cancer. HPV-related cancers include those of the vulva, vagina, penis, anus, oropharynx, and other parts of the body besides the cervix.
Risk Factors for Cervical Cancer
Several factors increase your risk of developing cervical cancer:
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HPV Infection: Persistent infection with high-risk HPV types is the most significant risk factor.
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Early Sexual Activity: Engaging in sexual activity at a younger age increases your exposure to HPV.
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Multiple Sexual Partners: Having multiple partners or a partner with multiple partners raises your risk of HPV infection. It is also possible to contract HPV even with one sexual partner.
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Weakened Immune System: Conditions like HIV or long-term use of immunosuppressants can reduce your ability to clear HPV.
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Smoking: Tobacco byproducts can damage cervical cells, making them more susceptible to HPV.
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Long-term Use of Oral Contraceptives: Extended use of hormonal birth control has been associated with a slightly increased risk.
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Lack of Screening: Failure to undergo regular cervical screening can lead to delayed diagnosis of precancerous changes.
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High Parity: Women who have had multiple full-term pregnancies may have a slightly higher risk.
Preventive Methods
Cervical cancer is largely preventable through vaccination, screening, and lifestyle modifications.
HPV Vaccination
The HPV vaccine effectively protects against the high-risk types of HPV responsible for most cervical cancers. Administering the vaccine before the onset of sexual activity maximises its efficacy:
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Target Age: 9–14 years (two doses at 0 and 6 months).
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Catch-Up Immunization: 15–26 years (three doses at 0, 1, and 6 months).
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Older Adults: For those aged 27–45, three doses are recommended (0, 2, 6 months or 0, 1, 6 months).
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WHO Guidelines: One or two doses for girls aged 9–20 years; two doses for women older than 21 years at a six-month interval.
The vaccine does not treat existing infections but prevents new ones. Vaccination, combined with safe sexual practices and regular screening, provides robust protection.
Cervical Screening
Routine screening helps identify precancerous changes, allowing for timely intervention. Recommended methods include:
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Pap Smear: Detects abnormal cells in the cervix.
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HPV DNA Test: Identifies high-risk HPV strains.
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Screening Frequency: Once every 3–5 years for women aged 25–65, depending on the method used.
Lifestyle Modifications
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Avoid smoking, alcohol, and other substances to reduce cellular damage and support overall immune health.
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Practice safe sex by using condoms to lower the risk of HPV infection, the leading cause of cervical cancer. Also, limit the number of sexual partners to minimize exposure to HPV.
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Engage in regular physical activity, manage stress, and ensure adequate sleep to strengthen the immune system and maintain a healthy weight.
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Sexual education is important for good cervical health. Learn about HPV and get vaccinated against it to lower the risk of infection and cervical cancer.
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Personal hygiene, especially in intimate areas, reduces the risk of infections that can contribute to cervical health issues.
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Good nutrition, including antioxidant-rich foods, vitamins (especially A, C, and E), and folate, can further help improve cervical cell health and the immune system.
Colposcopy and Pre-Invasive Lesions
Colposcopy is a diagnostic procedure performed after an abnormal Pap smear or HPV test. It involves using a colposcope to magnify and examine the cervix for abnormal areas. If lesions are observed, a biopsy is taken for histopathological analysis.
Preinvasive Lesions: These include cervical intraepithelial neoplasia (CIN), classified into grades:
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CIN 1: Low-grade changes often regress spontaneously.
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CIN 2 and CIN 3: High-grade changes that carry a higher risk of progression to cancer.
Treatment for high-grade lesions may include excisional or ablative procedures such as loop electrosurgical excision (LEEP), cold knife conisation, or cryotherapy.
Treatment of Cervical Cancer
Treatment depends on the stage of cervical cancer and your overall health. Modern advances ensure effective management with minimal side effects.
Early-Stage Cancer
For cancers confined to the cervix:
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Surgery: Options include hysterectomy (removal of the uterus) or fertility-sparing procedures.
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Radiation Therapy: Often combined with surgery to ensure complete removal of cancerous cells.
Locally Advanced Cancer
For cancers that have spread beyond the cervix:
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Chemo-radiation: Combines chemotherapy with radiation to shrink tumours and kill cancer cells.
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Brachytherapy: Internal radiation targeting the tumour directly.
Advanced Cancer
For metastatic cervical cancer:
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Systemic Chemotherapy: Slows cancer progression
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Targeted Therapy: Drugs are used to inhibit tumour blood vessel growth
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Immunotherapy: Enhances the immune system’s ability to fight cancer cells
Fertility-Sparing Surgeries
For younger women desiring future fertility, early-stage cervical cancer can be managed with fertility-preserving surgeries:
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Conisation: Removes a cone-shaped section of the cervix containing cancerous tissue. Suitable for microinvasive cancers.
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Trachelectomy: Surgical removal of the cervix while preserving the uterus. It is performed in carefully selected cases of early-stage cancer.
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Sentinel Lymph Node Mapping: Identifies lymph nodes at risk of metastasis, reducing the need for extensive lymph node removal.
These options require a thorough evaluation by a top cancer care specialist to balance oncological safety with fertility preservation.
The Road to Eradication
Cervical cancer is preventable and treatable when detected early. By adhering to WHO’s 90–70–90 targets, 90% HPV vaccination coverage, 70% cervical screening, and 90% treatment for identified cases, it is possible to reduce cervical cancer incidence below 4 per 100,000 women.
Timely vaccination, regular screening, and prompt treatment are the pillars of cervical cancer prevention. Empower yourself with knowledge, prioritise your health, and take the necessary steps to protect yourself and your loved ones from cervical cancer
FAQ's
Cervical cancer is mainly due to the constant infection with high-risk types of human papillomavirus (HPV), especially types 16 and 18.
Women should undergo cervical cancer screening at age 25 with PAP smear tests every 3 years or an HPV DNA test every 5 years after age 30.
Although the HPV vaccine protects against most high-risk HPV types, it cannot prevent existing HPV infections in the body. So, the defense against cervical cancer would be HPV vaccination and regular screening.
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