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Cervical Cancer Treatment in India

Cervical Cancer

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it’s found early. It is usually found at a very early stage through a Pap test.

Cervical cancer is one of the most common cancers in women worldwide

Types of Cervical Cancer

here are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Each one is distinguished by the appearance of cells under a microscope.

  • Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix. This type of cervical cancer accounts for 80 to 90 percent of cervical cancers.
  • Adenocarcinomas develop in the glandular cells that line the upper portion of the cervix. These cancers make up 10 to 20 percent of cervical cancers.

Sometimes, both types of cells are involved in cervical cancer. Other types of cancer can develop in the cervix, but these are rare.

  • Metastatic cervical cancer is cancer that has spread to other parts of the body.

Causes of Cervical Cancer

GENERAL

  • Pregnancy: Women who have had three or more full-term pregnancies, or who had their first full-term pregnancy before age 17, are twice as likely to get cervical cancer.

GENETICS

  • Family history: Women with a sister or mother who had cervical cancer are two to three times more likely to develop cervical cancer.

LIFESTYLE

  • Sexual history: Certain types of sexual behavior are considered risk factors for cervical cancer and HPV infection. These include: sex before age 18, sex with multiple partners and sex with someone who has had multiple partners. Studies also show a link between chlamydia infection and cervical cancer.
  • Smoking: A woman who smokes doubles her risk of cervical cancer.
  • Oral contraceptive use: Women who take oral contraceptives for more than five years have an increased risk of cervical cancer, but this risk returns to normal within a few years after the pills are stopped.

OTHER CONDITIONS

  • Weakened immune system: In most people with healthy immune systems, the HPV virus clears itself from the body within 12-18 months. However, people with HIV or other health conditions or who take medications that limit the body’s ability to fight off infection have a higher risk of developing cervical cancer.
  • Diethylstilbestrol (DES): Women whose mothers took DES, a drug given to some women to prevent miscarriage between 1940 and 1971, have a higher risk of developing cervical cancer.
  • HPV: Though HPV causes cancer, having HPV does not mean you will get cancer. The majority of women who contract HPV clear the virus or have treatment so the abnormal cells are removed. HPV is a skin infection, spread through skin-to-skin contact with a person who has the virus

Symptoms of Cervical Cancer

Common symptoms of cervical cancer may include:

  • Vaginal bleeding: This includes bleeding between periods, after sexual intercourse or post-menopausal bleeding.
  • Unusual vaginal discharge: A watery, pink or foul-smelling discharge is common.
  • Pelvic pain: Pain during intercourse or at other times may be a sign of abnormal changes to the cervix, or less serious conditions.

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Signs of advanced stages of cervical cancer

Cervical cancer may spread (metastasize) within the pelvis, to the lymph nodes or elsewhere in the body. Signs of advanced cervical cancer include:

  • Weight loss
  • Fatigue
  • Back pain
  • Leg pain or swelling
  • Leakage of urine or feces from the vagina
  • Bone fractures

Stages of Cervical Cancer

Stage 0: Stage 0 cervical cancer means that the cancer cells are confined to the surface of the cervix. This stage is also called carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III (CIN III).

Stage 1: In stage I cervical cancer, the cancer has grown deeper into the cervix, but has not spread beyond it. This stage is further separated into two subcategories:

  • Stage IA: There is a very small amount of cancer, less than 5 mm deep and less than 7 mm wide, that can only be seen under a microscope.
  • Stage IB: The cancer can be seen and measures 4 cm or less; or the cancer can only be seen under a microscope and measures more than 5 mm deep and 7 mm wide.

Stage II : Stage II cervical cancer means that the cancer has grown beyond the cervix and uterus, but has not reached the walls of the pelvis or the lower part of the vagina. In this stage of cervical cancer, the disease has not spread to lymph nodes or distant sites. Stage II has two additional subcategories:

  • Stage IIA: The cancer has not spread into the tissues next to the cervix, the parametria, but it may have grown into the upper part of the vagina.
  • Stage IIB: The cancer has spread into the tissues next to the cervix, the parametria.

Stage III:

Stage III cervical cancer means that the cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to nearby lymph nodes or other parts of the body. This stage is separated into two subcategories:

  • Stage IIIA: The cancer has spread to the lower third of the vagina, but not to the walls of the pelvis.
  • Stage IIIB: The cancer has grown into the walls of the pelvis and/or has blocked both ureters, but has not spread to the lymph nodes or distant sites. Or the cancer has spread to the lymph nodes in the pelvis, but not to distant sites.

Stagr IV

In this cervical cancer stage, the disease has spread to nearby organs or other parts of the body. Stage IV is separated into two subcategories:

  • Stage IVA: The cancer has spread to the bladder or rectum, but not to the lymph nodes or distant sites.
  • Stage IVB: The cancer has spread to organs beyond the pelvis, such as the lungs or liver.

Diagnosis of Cervical Cancer

·         Medical history and physical exam

·         Colposcopy

If you have certain symptoms that suggest cancer or if your Pap test shows abnormal cells, you will need to have a test called colposcopy

·         Cervical biopsies

Several types of biopsies can be used to diagnose cervical pre-cancers and cancers

Colposcopic biopsy

For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed.

Endocervical curettage (endocervical scraping)

Sometimes the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope and something else must be done to check that area for cancer. This means taking a scraping of the endocervix by inserting a narrow instrument (called a curette). The curette is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the laboratory for examination.

Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. A cone biopsy can also be used as a treatment to completely remove many pre-cancers and some very early cancers.

·         Cystoscopy, proctoscopy, and examination under anesthesia

These are most often done in women who have large tumors. They are not necessary if the cancer is caught early.

In cystoscopy a slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for pathologic (microscopic) testing. Cystoscopy can be done under a local anesthetic, but some patients may need general anesthesia. Proctoscopy is a visual inspection of the rectum through a lighted tube to check for spread of cervical cancer into your rectum.

  • XRay,PET,CT scan

Treatment of Cervical Cancer

Common types of treatments for cervical cancer include:

variety of procedures are performed  depending on the type and stage of cervical cancer, as well as individual fertility concerns.

  • Hysterectomy: During this type of cervical cancer surgery, the uterus and cervix are removed.
  • Radical hysterectomy: For all but a very small percentage of women with early cervical cancer, a radical hysterectomy will be necessary. This involves removing the uterus and cervix, as well as all of the surrounding tissue (the parametria) and the upper part of the vagina. During this cervical cancer surgery, the lymph nodes in the pelvis are also removed. For young women, the ovaries are left behind to preserve ovarian function. For older women, they are removed.
  • Pelvic extenteration: For women with recurrent or advanced cervical cancer, pelvic extenteration may be an option. During this surgery for cervical cancer, the uterus, cervix, vagina, ovaries, bladder, rectum and nearby lymph nodes are removed. Tissue from elsewhere in the body is used to reconstruct the vagina, and urine and stool are passed into external bags.
  • Radiation therapy

Some radiation therapy delivery methods include:

  • External beam radiation therapy – radiation is directed from a machine outside the body onto cancerous cells within the body. (Examples: 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy, stereotactic radiosurgery)
  • Internal radiation therapy – radioactive material is placed (via a catheter or other carrier) directly into or near a tumor. (Example: high-dose rate brachytherapy)
  • Systemic radiation therapy – a radioactive substance (that is swallowed or injected) travels through the blood to locate and destroy cancerous cells. (Example: radioactive iodine therapy)
  • Chemotherapy

Systemic chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and can reach all areas of the body, making this treatment useful for killing cancer cells in most parts of the body. Chemo is often given in cycles, with each period of treatment followed by a recovery period.