Expert Talk: Gynaecologist Dr Madhushree Shares Causes, Symptoms, Prevention & Treatments For Cervical Cancer

Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570000 women were diagnosed with cervical cancer worldwide. Occurring most commonly in women past the age of 30, this condition alters life significantly. And the myths, concerns and overall lack of awareness about this cancer can cause a lot of damage. 

In conversation with TC46, Dr Madhushree Vijaykumar, Consultant Obstetrician and Gynaecologist at Motherhood Hospitals, shares signs to look out for, stages of cervical cancer and treatment options that work.

1. What is cervical cancer and what are the factors and causes that contribute to it?

Cervical cancer is a type of cancer where cells change in women’s cervix, which connects their uterus with the vagina. A major cause of cervical cancer is the beginning of unusual changes in the tissue of the cervix. Most cases of cervical cancer are linked to infection with human papillomavirus (HPV). HPV is common and for most people, there are fewer chances of the virus developing into cancer. This means other factors — such as your lifestyle choices or environment factors— also determine whether you’ll develop cervical cancer.

2. What are some signs and symptoms of cervical cancer to look out for?

There are no symptoms or signs in early-stage cervical cancer but for more advanced level cancer spread, it includes signs such as:

• Unusual vaginal bleeding after intercourse, between periods or after menopause
• Bloody or watery vaginal discharge that may be heavy and have a foul odour
• Pelvic pain or pain during sex

3. How do the symptoms vary in different stages of cervical cancer?

There are 4 stages of cervical cancer:

1. Stage 0: Precancerous cells are present. At this stage, there are none or zero symptoms.
2. Stage 1: In this stage cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes. Symptoms at this stage are less.
3. Stage 2: In this stage cancer has now moved beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes and have symptoms like pelvic pain during intercourse, vaginal discharge.
4. Stage 3: This is an advanced stage where cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes and may have symptoms like trouble peeing, swollen legs and bone pain along with stage 2 symptoms.
5. Stage 4: This is the last stage where cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes. Symptoms spread to the whole body resulting in Weight loss and lack of appetite, fatigue, kidney failure, pelvic pain.

4. How does cervical cancer affect your body?

Generally, cervical cancer does not have an opportunity to affect the rest of the body, mainly because it is often diagnosed in its earliest stages. But if not diagnosed at an early stage, it can spread to other parts of their body (metastasize), often the lungs, liver, bladder, vagina, and rectum.

5. Who is most at risk of developing cervical cancer?

For cervical cancer, these factors may raise a woman’s risk of developing on:

• Human Papillomavirus (HPV) infection: HPV is the most important risk factor, though there are fewer chances of it developing into cancer. But cervical cancer is frequently associated with HPV16, HPV18. People who are infected with a high risk of HPV types are people who have sex at an earlier age or have multiple sexual partners.
• Immune system deficiency: Women with low immune systems have higher chances of developing cervical cancer.
• Herpes and oral contraceptives: Women who have genital herpes and who take birth control pills, may be associated with an increase in the risk of cervical cancer.
• Smoking and age: There are more chances for women to develop cervical cancer who smokes twice a day compared to non-smokers. Women with the age group of above 20 to mid-30s are exposed to this risk more.

6. Is cervical cancer curable? Can cervical cancer spread quickly?

Cervical cancer is often curable if diagnosed at an early stage. For early cervical cancer, doctors recommend surgery to remove the cervix and some or all of the womb, or radiotherapy, or a combination of both. For advanced level radiotherapy with or without chemotherapy, and surgery is also sometimes used. Cervical cancer cells are slow in growth, once cells in the cervix begin to undergo abnormal changes, it can take several years for the cells to grow into invasive cervical cancer. So there are many opportunities for early detection and treatment before cancer has progressed to later stages.

7. How do STIs increase your chances of cervical cancer? What is HPV and how does it affect your chances of getting cancer? 

STIs like HPV increases your chance of cervical cancer. HPV is Human Papillomavirus Infection it is the most important risk factor for cervical cancer. It’s related to a group of 150 viruses. Low-risk HPV causes warts on or around the female and male genital organs and in the anal area. High-risk HPV causes cancers, including cancer of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women. It is a common virus and in most people, the body can clear the infection by itself. 

8. What are some preventive measures that can lower your chances of cervical cancer?

Cervical cancer is a slow and deadly disease whose symptoms cannot be predicted at the early stages. However, some prevention can reduce the risk of cervical cancer such as regular screening or pap smear test to detect and prevent precancers, getting the HPV vaccine, delaying first sexual intercourse until late teens or older, limit the number of sex partners and practice safe sex by using a condom, avoid sexual intercourse with people who had many sexual partners or are infected with genital warts or show other symptoms, quit smoking.

9. What are the different treatment options for cervical cancer? 

Cervical cancer, if detected at the earliest stage, can be cured if not then various treatments are prescribed by the doctors for different stages such as surgery if cancer cells have not spread from the cervix, this is the most common treatment. Radiation therapy is suggested if doctors feel the cancer cells are present inside the body. In advanced stages, radiation and chemotherapy are recommended. In later stages, palliative therapy is provided to relieve symptoms and improve the patient’s quality of life and living. Treatment for cervical cancer is a long process and takes plenty of time.

10. How long does it take to recover from cervical cancer treatments?

After the treatment, it takes about 8 weeks for side effects to resolve although in some cases it can be permanent. There’s also a possibility that side-effects can occur after years or months of treatment.