Cervical cancer may be asymptomatic in early stages; regular screenings essential

Cervical cancer may have no symptoms in its early stage. To diagnose cervical cancer early and in it’s precancerous condition, women should visit their gynaecologists regularly and get periodic health tests, says Dr. Rama Joshi, gynae oncologist and director- gynaecology oncology, Fortis Memorial Research Institute, Gurugram.

A pap smear every 3 years, and an HPV test, which looks for the human papillomavirus, every five years are recommended by gynaecologists around the world as routine screening procedures for cervical cancer.

Research says that cervical cancer accounts for about 6–29% of all cancers in women in India. “Cervical cancer, mainly caused by Human Papillomavirus infection (HPV), is the leading cancer in Indian women and the second most common cancer in women worldwide,” says a study. According to the World Health Organisation, about 570,000 women were diagnosed with cervical cancer worldwide and it claimed the lives of about 311,000 women in 2018.

Dr Joshi spoke to us about the causes, symptoms, and prevention of cervical cancer. Edited excerpts:

• What is cervical cancer?
• Who is the most impacted?
• What are the causes of cervical cancer?
• How can it be prevented?
• Tell us about sexual hygiene.
• What are the symptoms of cervical cancer?

What is cervical cancer and what are the age groups that are most affected by it?

It is the cancer of the cervix. The cervix is the part of the womb which projects into the vagina, it opens into the vagina. It is the part that dilates during labour and delivery of the baby. Another way of defining it is the mouth of the uterus. When the cancer starts in the cervix, it is called cervical cancer. This cancer usually is common in the age group of 35-45 year-old women in India.

When the cancer starts in the cervix, it is called cervical cancer. This cancer usually is common in the age group of 35-45 year-old women in India.

Is there a number on how many women in India are impacted by it?

Actually the prevalence in India varies with age. The younger the age group, the more prevalence of the HPV infection, in comparison to older women over 50 years of age. Even in the age group of 20-25 years, the prevalence is about 7-8%. 

Almost all cervical cancers are caused by HPV, which can be passed from one person to another during sex. Tell us more about that and the other causes.

Cervical cancer is primarily caused by the human papillomaviruses. Out of these human papillomaviruses also, there are particular viruses which cause cervical cancer.  There are about 100 variants of the HPV, but not all of these can cause cervical cancer. There are about 15 high-risk HPV strains that can cause cervical cancer, these are also known as oncogenic HPV. These oncogenic HPV are the ones which have the potential to cause this cancer. The most common HPV, which cause cervical cancer, are HPV 16 and HPV 18. These are responsible for cervical cancer in about 80% of the women in India, and globally in about 70% of women. The prevalence of these viruses varies in different parts of the globe.

The most common HPV, which cause cervical cancer, are HPV 16 and HPV 18. These are responsible for cervical cancer in about 80% of the women in India, and globally in about 70% of women. The prevalence of these viruses varies in different parts of the globe.

Apart from HPV, there are other risk factors also. If HPV coexists with other risk factors, the potential of cervical cancer increases. These risk factors are smoking, starting sexual activity at a very young age, or having multiple sexual partners. Basically, it is related to sexual hygiene. There is also a co-relation with women who have a higher number of pregnancies, those who have more children, they are also at increased risk. Other than that, immunodeficiency is a risk factor as well. Suppose someone has HIV (human immunodeficiency virus) and the immune system is deficient, they are likely to have a higher risk of cervical cancer as well.

However, like I said the primary cause is the oncogenic HPV.

What can women do to reduce their risk of cervical cancer?

I think when you know and understand the risk factors, it can help them prevent it. Women should not smoke, they should not begin sexual activity very early, and they should really take care of their sexual hygiene. These are the things that will protect them against the risk of cervical cancer to a certain extent.

You mentioned sexual hygiene, and that girls shouldn’t start having sex at a very young age. Could you elaborate on what sexual hygiene is, and what is the appropriate age that is safe for women to start having sex?

You shouldn’t be younger than 18 years of age. The incidence is much higher if the sexual activity started at less than 18 years of age.

You should always have protected sex. Protection is very important, contraception must be used. Ofcourse, it has not yet been related to the cause of cervical cancer but protection from HPV can only occur when healthy sexual practices are being used.

What are the symptoms, and what should we do if we see early signs and symptoms?

If cervical cancer is in its early stage, it doesn’t have any symptoms. To pick up cervical cancers early and in it’s precancerous condition, one needs to go for regular health checks and screening tests.

In symptomatic patients, the most common symptom is spotting or bleeding after sexual intercourse. That is an early sign. The patient might not have discomfort. It is very important that if you see any signs, you must take notice of it and take it seriously.

In symptomatic patients, the most common symptom is spotting or bleeding after sexual intercourse. That is an early sign. The patient might not have discomfort. It is very important that if you see any signs, you must take notice of it and take it seriously.

Other common symptoms are irregular bleeding and spotting in between periods, or pinkish vaginal discharge. Some women also have vaginal discharge mixed with blood. Sometimes increased discharge without blood can also be a symptom, and one should make a note of it. Increased discharge can also be from an infection, but you should get yourself tested either way. Women who have achieved menopause may have vaginal bleeding or spotting.

What I want to emphasise is that people think if they have pain, it is only then they should go for a check up. They consider that as a sign of cancer, and they ignore other signs and symptoms. Even if you don’t have discomfort, but some bleeding, don’t wait for the pain to start. Pain is seen in the advanced stage of the disease. Some patients have severe backaches and pain in the lower abdomen. These signs come when the disease has already reached its advanced stage. Then it infiltrates the bone and at that stage, successful treatment is difficult.

What I want to emphasise is that people think if they have pain, it is only then they should go for a check up. They consider that as a sign of cancer, and they ignore other signs and symptoms. Even if you don’t have discomfort, but some bleeding, don’t wait for the pain to start.

These could also be signs for cancer of the vulva or the vagina, which are seen in the elderly age group, after 55. These aren’t common. But seeing a doctor on seeing any of these signs is absolutely essential.

(Stay tuned for the next part of the interview, which will talk in detail about screening and vaccination for HPV.)

Sources:

• Burden of cervical cancer and role of screening in India. Saurabh Bobdey, Jignasa Sathwara, Aanchal Jain, and Ganesh Balasubramaniam
• Cervical cancer in India and HPV vaccination. K. Kaarthigeyan
• Cervical cancer, World Health Organisation.

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