Roughly one-third of all cervical cancer fatalities worldwide are from India, with 122,844 cases diagnosed yearly. Cervical cancer affects 18.3 percent of Indian women, according to the Globocan 2020 report. 

Cervical cancer is one of the most successfully treated cancers once diagnosed. Early detection and effective management are the keys to the successful treatment of Cervical cancer. But unfortunately, only a small percentage of women in India are screened for cervical cancer due to lack of awareness, hesitancy, or restricted access to medical services. 

What is Cervical Cancer?

Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. This cancer can affect the deeper tissues of the cervix and may spread to other parts of the body, such as the lungs, liver, bladder, vagina, and rectum.

The most common cause of cervical cancer is the human papillomavirus (HPV). Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. There are around 100 different forms of HPV, with about 14 of them being high-risk cancer-causing strains. 

Though most HPV infections in women may clear without any intervention within 2 years, the high-risk strains of the virus can survive in the body for up to two years. This can integrate with cells and progress to cervical cancer. 

Early detection requires regular screening. Women between the age of 35 to 44 years are most likely to get it. More than 15% of new cases are in women over age 65. Getting regular screenings is, therefore, a life-saving factor.

Symptoms of Cervical Cancer

Most often, a woman might have no symptoms at all in the early stages of cervical cancer. Hence, regular pap smear tests are essential to identify the disease and reveal any cell alterations that may signify the onset of cancer so that treatment can begin sooner. 

Here are some of the most common signs of cervical cancer:

• Pelvic pain.
• Bleeding between periods.
• Bleeding after sexual intercourse.
• Bleeding in post-menopausal women.
• Vaginal discharge with a strong odour.
• Discomfort during sexual intercourse.

After it has spread, cancer can cause:

• Pelvic pain
• Trouble peeing
• Swollen legs
• Kidney failure
• Bone pain
• Weight loss and lack of appetite
• Fatigue

Risk factors for Cervical Cancer

• Multiple sexual partners
• Early sexual activity
• Use of contraceptive pills
• Other sexually transmitted infections (STIs)
• A weakened immune system
• Smoking
• Exposure to miscarriage prevention drug called diethylstilbestrol (DES)

Cervical Cancer Diagnosis

Many tests are used for diagnosing cervical cancer. Not all tests will be used for every person. Some or all of these tests will help your doctor to plan the treatment of your cancer. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected
• Your signs and symptoms
• Your age and general health
• The results of earlier medical tests

The following tests may be used to diagnose cervical cancer:

• Bimanual pelvic examination and sterile speculum examination 

This is a gynaecologic examination to check for any unusual changes in the patient's cervix, uterus, vagina, ovaries, and other nearby organs. During this examination, the doctor will look inside the vagina to visualize the cervix. A Pap test is often done at the same time. This exam typically takes a few minutes and is done in an examination room at the doctor’s office.

• Pap test

A Pap smear is part of a woman’s regular pelvic exam. During a Conventional Pap test, the doctor gently scrapes the outside and inside of the cervix (the lower, narrow end of your uterus that's at the top of your vagina), taking samples of cells for testing. Changes in your cervical cells can also be detected with a Pap test, which suggests whether cancer may develop in the future. Detecting these abnormal cells early with a Pap smear is your first step in halting the possible development of cervical cancer.

• Liquid-based cytology in cervical screening

Traditional Pap tests can be hard to read because cells can be dried out, covered with mucus or blood, or may clump together on the slide. Improved Pap test methods have made it easier for doctors to find cancerous cells. 

Liquid-based cytology (LBC) is a new method of preparing cervical samples for cytological examination. Liquid-based cervical cytology was developed to improve the diagnostic reliability of Papanicolaou (Pap) smears. The liquid-based cytology test, also referred to as ThinPrep or SurePath, transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. liquid-based cytology often results in fewer unsatisfactory specimens and allows for HPV testing on the same sample. 

The LBC technique will likely reduce the number of false-negative test results. 

• Human papillomavirus (HPV) typing test

An HPV test is similar to a Pap test. The test is done on a sample of cells from the cervix. An HPV test may be done at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. 

Certain strains of HPV, such as HPV16 and HPV18, are called high-risk HPV and are seen more often in people with cervical cancer. If the HPV test is “positive,” this means the test found the presence of high-risk HPV. Many people have HPV but do not have cervical cancer, so HPV testing alone is not enough for a diagnosis of cervical cancer.

ACS’s Guidelines for Cervical Cancer Screening

The American Cancer Society’s new guideline has two major differences from previous guidelines.

Prevention Measures for Cervical Cancer

You can reduce your risk of getting cervical cancer by adopting the following means:

• HPV vaccine

Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers as well. Consult a Gyneachologist to know whether an HPV vaccine will be appropriate for you.

• Have routine Pap tests

Pap tests help detect precancerous conditions of the cervix. Hence, they are helpful in monitoring or treating conditions and thus prevent the onset of cervical cancer. Medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.

• Practice safe sex

Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections.

• Don't smoke

If you do smoke, talk to your doctor about strategies to help you quit.

Conclusion

Despite the benefits of cervical cancer screening, not all women are getting screened. Most cervical cancers are found in women who have never had a Pap test or who have not had one recently.

Screening tests offer the best chance to have cervical cancer found early when treatment can be most successful. Screening can also actually prevent most cervical cancers by finding abnormal cervical cell changes so that they can be treated before they have a chance to turn into cervical cancer.

The most important thing to remember is to get screened regularly.