General Health

Understanding Cervical Cancer diagnosis and treatment

Due to the perceived taboo nature of the topic and the lack of awareness, women’s health and related issues were discussed or explored sparingly in diagnoses. Cervical Cancer was one such issue and is currently one of the leading causes of death in women in India (compared to the Western countries where breast cancer is the leading cause of death). 

Dr. Meenakshi Balasubramanian, practicing gynaecologist at KRIA Women’s Clinic, Adyar, Chennai and Andhra Mahila Sabha Hospital, R.A. Puram, Chennai, spoke about how preventative medicine has helped to detect, diagnose and treat cervical cancer in women. Dr Meenakshi Balasubramanian completed her graduation from Kilpauk Medical College and obtained her postgraduate diploma in Obstetrics and Gynaecology from Madras Medical College. She also has a certificate of fellowship in minimal access surgery and infertility. She is well known for her compassionate approach and prioritising discussions surrounding women’s health.

Preventative medicine consists of encouraging routine check ups which helps screen for any deadly disorder at the earliest and not just on the diagnosis and treatment aspects of medicine. With the advent of early detection techniques like pap smear, the specialists and the general public have understood the importance of what one can prevent over what one can treat. “Due to the preventative nature of modern medicine, our understanding of Cervical Cancer is much better now” says Dr. Subramanian. 

Cervical Cancer and the associated symptoms

The mouth of the uterus is the cervix which is around 3-4 cm in length and comprises two types of cells. The outer, visible part of the cervix is the ectocervix and the inner region is the endocervix. Between these two regions is the transformation zone, where the cells differentiate to become a part of either region (normal transformation). It is also usually where most cervical cancers originate. The cells become dysplastic before becoming malignant and the specialists aim to capture this dysplasia via early screening to prevent its progression to cervical cancer. 

Symptoms vary from one person to another as it depends on the kind of growth in the cervix and what the growth is producing. Some of the common symptoms of cervical cancer include: 

  1. Intermenstrual bleeding irrespective of the hormone changes
  2. Abnormal post coital bleeding 
  3. Abnormal, foul smelling and at times, blood-tinged vaginal discharge accompanied by chronic pelvic pain irrespective of the time in the menstrual cycle
  4. Post menopausal bleeding

It is also important to note that some of the above symptoms can occur in the absence of cervical cancer and hence the individual should consult a gynaecologist at the earliest. 

Screening techniques for Cervical Cancer

Dr Subramanian encourages women as young as 25 to get pap smears done. In pap smear, a brush is inserted into the cervix and the cells are collected and sent for cytology studies. The gynaecologist will determine the next steps of diagnosis based on the morphology of the cells. This test can be done once in 3 years or once in 5 years along with HPV (human papillomavirus) testing. 

Colposcopy is done when the pap smear results are abnormal. The specialist uses a colposcope (a magnifying instrument) to identify the diseased area and allows them to take a tissue sample for biopsy. The tissue sample is sent for histopathology to determine if the cells are undergoing normal transformation or carcinogenesis. 

Etiology of Cervical Cancer

Dr. Subramanian explains that, like other cancers, cervical cancer also has a complicated etiology. These risk factors, modifiable or non-modifiable, include:

  1. Family history (non-modifiable risk factor) 
  2. Smoking: Carcinogens from the smoke and the cigarettes change the cervical mucosa and also makes one susceptible to an HPV due to lowered immunity. 
  3. Prolonged use of contraception 
  4. Studies have shown that multiple childbirths and multiple sexual partners could lead to cervical cancer (due to sexual contact thus transmission of the HPV virus)
  5. Human Papillomavirus: The most common cause of cervical cancer is the HPV virus. There are almost 200 kinds of HPV virus of which types 16 and 18 cause cervical cancer and types 6 and 11 cause benign genital warts. The HPV virus activates the tumour suppressor genes which in turn triggers uncontrolled cell division. This is a modifiable risk factor and can be prevented by taking the vaccine against the HPV virus. 

Possible treatments after the cancer is detected

After the gynaecologist performs the initial screening and confirms the cancer, an oncologist helps with determining the treatment protocol depending on the stage and the type of cervical cancer. There are two types of cervical cancers 

  1. Adenocarcinoma: normally occurs in the columnar cells of the endocervix and is not that common
  2. Squamous Cell Carcinoma: more common than adenocarcinoma, this cancer occurs in the ectocervix region. This cancer presents either as high grade squamous intraepithelial lesions or low grade squamous intraepithelial lesions. High grade lesions are removed via conization, where a cone-shaped part of the cervical region is excised. Low grade lesions do not require any severe intervention as they normally occur due to the HPV virus which can be eliminated by the body’s immune system and only a follow up is required. 

Treatment protocols also vary based on the stage of progression and the age of the patient. Surgery in the form of radical hysterectomy or modified radical hysterectomy are done where the uterus, vagina, and cervix along with the lymph nodes are removed. Chemotherapy and radiotherapy are also possible treatment options. 

Life after Cervical Cancer Treatment

Patients after receiving the treatment for cervical cancer go through a lot of mental distress and sexual dysfuntion. A prematurely induced surgical menopause may reduce libido. Chemotherapy and Localised Radiotherapy leads to alopecia and scarring which may cause body image issues. 

“Open communication with the doctors and vice versa as well as support from the family is essential to help the survivors cope,” says Dr. Subramanian. Survivors can also reach out to online support groups that offer assurance and psychological help.

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