Cervical cancer: Gynae-oncologist talks about screening, diagnosis, and treatment

In the low-risk group, getting a pap smear and HPV test every five years is recommended for cervical cancer screening, but the frequency should be every three years for those at higher risk, says Dr. Rama Joshi, gynae oncologist and director-gynaecology oncology, Fortis Memorial Research Institute, Gurugram.

According to the World Health Organisation (WHO), as many as 99% of cervical cancer cases are linked to the human papillomaviruses (HPV), which is transmitted through sexual contact.

“Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women,” says the organisation. It adds that cervical cancer is the fourth most common cancer in women globally. 

Becoming sexually active at a very young age, having multiple sexual partners, smoking, or having a partner who is high risk for HPV, puts women at a higher risk of cervical cancer. Those with immunodeficiency are at a higher risk as well.

Read more about the risk factors, prevention, and symptoms of cervical cancer here.

• Tell us about the screening for cervical cancer.
• Will you talk to me about the diagnosis of cervical cancer?
• Tell us about the treatment of cervical cancer.

Dr Joshi tells us about screening for cervical cancer, and the diagnosis, and treatment. Edited excerpts:

Tell us about the screening for cervical cancer. Can an ultrasound help diagnose it or can it only be diagnosed with a pap smear?

Ultrasound will not pick up any problems in the cervix until it is large enough to be seen on imaging. 

The important thing to remember here is that cervical cancer is preventable, and protection from the human papillomavirus (HPV) can provide protection from cervical cancer. The other thing is that we have to diagnose this disease in its precancerous condition, and for that every woman has to ensure that they get their regular gynae health checks and a pap test. For those who don’t know, in a pap smear, we just wipe the surface of the cervix and collect some cells, which we take for examination. These are checked for signs of pre-cancer. But women shouldn’t worry that a pap smear means there is cancer, the results can be perfectly normal as well. Your cervix can be absolutely healthy. 

The other test which is incorporated into the pap smear or the pap test, is the HPV DNA testing. However this can only be done for women in the age group of 30 and above. 

In the low risk group, getting a pap test every five years is good enough, but those who are at increased risk, they should consider an interval of about three years or so for the screening.

In the low risk group, getting a pap test every five years is good enough, but those who are at increased risk, they should consider an interval of about three years or so for the screening.

Will you talk to me about the diagnosis of cervical cancer?

The diagnosis is done on the basis of a histopathology, which is a very small biopsy from the representative area. This is tested by a histopathologist after which a diagnosis of cervical cancer is confirmed. This is important for defining the proper treatment of the patient so we can deliver the best results in terms of survival as well as the quality of life. Many people think that the biopsy will spread the cancer but it is not so, we are going to treat the patient after the biopsy. If the patient gets a biopsy and doesn’t get treatment, the disease is going to progress, but it is going to progress even if they don’t get a biopsy.

Many people think that the biopsy will spread the cancer but it is not so, we are going to treat the patient after the biopsy. If the patient gets a biopsy and doesn’t get treatment, the disease is going to progress, but it is going to progress even if they don’t get a biopsy.

Tell us about the treatment of cervical cancer.

Once the diagnosis is made, it is important for us to define the stage of the disease. The stage of the disease means whether there is any spread from the site that it has originated to the nearby areas or structures. After defining the stage of the disease, we offer treatment. In early stages, patients can still have a good quality of life. Many of the patients coming to us for cervical cancer are in a comparatively younger age group, who are coming in a very early stage.

For these patients, we can offer treatment wherein we can preserve their fertility. But this is in very selective cases, in the early stage of the disease. Otherwise we can’t preserve their fertility and we have to go for a kind of surgery where we cannot preserve the uterus. When we say we are preserving fertility, we are essentially preserving the uterus. But we are taking out the cervix. This is called a radical trachelectomy, where we remove the cervix, the upper part of the vagina and the surrounding supporting tissues. But we are preserving the uterus, so younger patients can still conceive, use assisted reproduction and still bear a child. Otherwise we have to  go in for a radical hysterectomy wherein we remove the uterus, cervix, and part of the vagina.

In some cases, we have to consider giving the patient radiation therapy after the surgery, this depends on what the risk factors are in the final histology and what is the final surgical stage. But when the patient is coming to us in advanced stages then the treatment cannot be done by surgery. In those cases, when the patients have to be treated with radiation, or a combination of radiation and chemotherapy. 

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