Cervical Cancer: Causes, Symptoms, Diagnosis & Treatment

Cervical cancer, often referred to as cancer of the uterine cervix, affects the lower part of the uterus, extending slightly into the upper part of the vagina. The condition starts to develop when the cells on the cervix’ surface get infected with Human Papillomavirus (HPV) and start growing abnormally, resulting in a cervical tumour. In India, cervical cancer holds the unfortunate distinction of being the most common cancer among women and ranks as the second most frequent worldwide. Each year, approximately 1.3 lakh new cases of cervical cancer are diagnosed in India, resulting in the tragic loss of around 74,000 lives.

Cervical cancer treatment cost in India

Cervical cancer treatment cost in India starts from INR 420,000 (USD 5,000). Treatment of cervical cancer is popular in India due to the cost-effectiveness along with the availability of a dedicated team of highly skilled surgeons, nurses, and other paramedical staff.

Country	Cervical Cancer Treatment Cost
India	$5,000 – $7,400
US	$24,000 – $28,500
UK	$25,200 – $30,000

Types of Cervical Cancer

There are two primary types of cervical cancer, requiring a tailored approach to treatment. The team of specialists, one of India's best cervical cancer hospitals, has extensive experience in the staging, diagnosis, and treatment of both types of cervical cancer, which are:

• Squamous Cell Carcinoma: The most common type of cervical cancer that develops from the flat cells covering the cervix's outer surface at the top of the vagina. 
• Adenocarcinoma: This type of cervical cancer develops from the epithelial cells that line the cervical canal (endocervix). Ascervical adenocarcinomastarts in the cervical canal, it can be more challenging to detect with cervical screening tests.

There are also less common types of cervix cancer, known as adenosquamous, clear-cell, and small-cell carcinomas.

Cervical Cancer Causes

Cervical cancer often develops between the ages of 40 and 55. Symptoms usually do not appear until abnormal cervical cells become cancerous and invade the nearby tissues. A cervical tumour usually starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. The initial 'pre-cancerous' abnormality of cervical cells is generally caused by a prior infection with the Human Papillomavirus (HPV).

Cervical Cancer Causes are:

• Sexual activity before the age of 18 years
• A partner was previously involved with a woman who had cervical cancer.
• Personal history of sexually transmitted viruses such as herpes infection or HPV. 99.7% of women with cervical cancer have an HPV infection.
• More than three pregnancies
• A weakened immune system
• Smoking
• Unsupervised long-term use of oral contraceptives

Cervical Cancer Symptoms

Very early-stage cervical cancer may have no symptoms at all. This means going for regular cervical screenings is essential so that any cell changes can be picked up early. Some signs and symptoms of cervical cancer include:

• Contact spotting or bleeding
• Increased/blood-stained vaginal discharge
• Abnormal bleeding between menstrual periods or excessively heavy periods
• Postmenopausal vaginal bleeding
• Back pain
• Fatigue
• Leg pain
• Pelvic pain
• Single swollen leg
• Weight loss
• Heavier periods than usual

Risk Factors for Cervical Cancer

Understanding the risk factors is important for cervical cancer prevention and early detection. While having one or more of these risk factors does not guarantee the development of the disease, it can increase the overall risk significantly. 

Screening History: Regular cervical screening, including Pap smears (Pap tests or cervical cytology) and HPV testing, is crucial in reducing the risk of cervical cancer. Women who do not undergo routine screenings or neglect follow-ups on abnormal results face a higher risk of advanced cervical cancer.

HPV Infection: Cervical cancer is primarily caused by the human papillomavirus (HPV), making it the most significant risk factor. HPV types 16 and 18 are strongly associated with cervical cancer development. Risk factors related to HPV include having multiple sexual partners or engaging in early sexual activity, as HPV is a sexually transmitted infection.

Sexual History: A history of other sexually transmitted infections (STIs), such as chlamydia or gonorrhoea, can also increase the risk of cervical cancer.

Smoking: Women who smoke are at a higher risk of developing cervical cancer. Smoking can weaken the immune system's ability to combat HPV infections and contribute to the progression of cervical cell abnormalities.

HIV Infection: HIV weakens the immune system, making it more challenging to fight HPV infections, further increasing the risk of cervical cancer among individuals with HIV.

Birth Control Pills: Long-term use of certain birth control pills has been associated with a slightly increased risk of cervical cancer.

Multiple Children: Having multiple children can increase the risk of cervical cancer, possibly due to hormonal changes during pregnancy and childbirth that can affect the cervix. Regular screening remains crucial for early detection and prevention.

Weak Immune System: Conditions like HIV infection or immunosuppressive medications can weaken the immune system, making it harder for the body to clear HPV infections and increasing the risk of cervical cancer.

Family History: A family history of cervical cancer may slightly elevate the risk, suggesting a potential genetic predisposition.

Cervical Cancer Screening & Diagnosis

Testing for cervical cancer is an important way of detecting early changes in the cervix cells, so that treatment can be given to prevent cancer from developing. It involves taking a sample of cells from the cervix using a test known as liquid-based cytology. The age range for screening varies between the ages of 25-64.

If abnormal cells are found during the cervical screening test, to confirm the diagnosis, a colposcopy is advised. For this test, a speculum is gently put into the vagina so the cervix can be seen in detail using a magnifier (colposcope). During colposcopy, it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope for cancer cells.

• Computerised Tomography Scan (CT Scan)
• Magnetic Resonance Imaging (MRI Scan)
• Chest X-ray
• Ultrasound
• Colposcopy
• Cone Biopsy
• Blood test or other tests

This assessment is known as 'staging' of the cancer. Staging aims to find out:

• How much the tumour has grown and whether it has extended to other nearby structures such as the bladder or rectum.
• Whether the cancer has spread to local lymph glands
• Whether the cancer has spread to other areas of the body
• Accordingly, your individualised cervical cancer treatment modality is determined.

Cervical cancer screening typically involves two primary tests: a Pap smear (Pap test) and, if indicated, an HPV test. These screenings play a crucial role in the early detection of cervical cancer, allowing for timely intervention and improved outcomes.

Preparation: To ensure accurate results, it's essential to schedule your cervical cancer screening when you're not menstruating. Additionally, for a few days before the test, avoiding douching, using tampons, or applying vaginal creams or medications is advisable.

Arrival: On the day of your screening, you'll visit your healthcare provider's office or a clinic. It's a routine procedure in a medical setting to ensure your comfort and safety. 3. Gown and Privacy: Upon arrival, you will be given a gown and asked to undress from the waist down. Rest assured, you'll be given privacy to change, ensuring your comfort throughout the process.

Positioning: You'll then be asked to lie on an examination table with your feet in stirrups. This position allows the healthcare provider better access to the cervix, ensuring a thorough examination.

Speculum Insertion: The next step involves the gentle insertion of a speculum into the vagina. This instrument widens the vaginal canal, allowing the healthcare provider to visualise the cervix clearly.

Pap Smear: Using a small brush or spatula, the provider will collect a sample of cells from the surface of the cervix. While this may cause mild discomfort, it should not be painful. This sample is essential for the Pap smear, detecting abnormal cervical cells.

HPV Test (if indicated): In some cases, an HPV test can be performed simultaneously with the Pap smear. A swab is used to collect a sample of cervical cells to check for the human papillomavirus (HPV), a common cause of cervical cancer.

Speculum Removal and Conclusion: Following the collection of samples, the speculum is gently removed, and you can proceed to get dressed. The procedure is generally quick and straightforward.

Results: Your collected samples will be analysed in a laboratory. Typically, it takes a few weeks to receive your results. You can receive them via phone or a letter from your healthcare provider.

Follow-up: Depending on your results, your healthcare provider will discuss the next steps with you. This may involve further testing, such as a colposcopy, or recommendations for regular screening intervals to monitor your cervical health.

What are the Different Stages of Cervical Cancer?

Cervical cancer staging is crucial for understanding the extent of the disease and guiding treatment decisions. The International Federation of Gynecology and Obstetrics (FIGO) staging system is commonly used. It categorises cervical cancer into various stages:

Stage 0 (Carcinoma in Situ)

At this stage, cancer is confined to the surface of the cervix and has not invaded deeper tissues. It's often referred to as "in situ" cancer or pre-cancer.

Stage I

 Cancer is limited to the cervix, with two sub-stages:

• Stage IA: The cancer is microscopic and requires a microscope.
• Stage IB: The cervical tumour is visible without a microscope but is still confined to the cervix.

Stage II

Cancer has spread beyond the cervix but has not reached the pelvic sidewall or the lower third of the vagina. Stage II is further divided into:

• Stage IIA: Cancer involves the upper two-thirds of the vagina but has not spread to the tissues around the uterus.
• Stage IIB: Cancer has spread to the tissues around the uterus but not to the pelvic sidewall.

Stage III

 Cancer has extended to the pelvic sidewall, the lower third of the vagina, or has led to kidney problems (hydronephrosis). It is categorised into:

• Stage IIIA: Cancer has spread to the lower third of the vagina.
• Stage IIIB: Cancer has spread to the pelvic sidewall or has caused kidney problems.
• Stage IIIC: Cancer has spread to nearby lymph nodes.

Stage IV

 Cancer has advanced to nearby organs outside the pelvis, such as the bladder or rectum, or distant organs like the lungs or liver. Stage IV is divided into:

• Stage IVA: Cancer has spread to nearby organs.
• Stage IVB: Cancer has metastasized to distant organs.

These stages help cervical care surgeons determine the appropriate treatment plan for individuals diagnosed with cervical cancer. Understanding the stage of the disease is vital in providing the best possible care and outcomes for patients.

Cervical Cancer Treatment

Depending on the cancer stage, patients are grouped into early and locally advanced cancer types. In the early stages, patients are treated with cervical cancer surgery, followed byradiation if required. In Locally advanced cervical cancer, patients are treated by chemotherapy and radiotherapy. Most cervical cancers are curable and preventable with hopes of a cure. Cervical cancer medical procedureoptions include the following:

• Loop Electrosurgical Excision Procedure (LEEP): A procedure that employs electricity to remove abnormal tissues.
• Cryotherapy: This procedure involves freezing abnormal cells.
• Laser Therapy: This therapy uses light to destroy cancerous tissue.
• Radical Hysterectomy: This involves the removal of the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
• Pelvic Exenteration: A rare surgery in which all the organs of the pelvis, including the bladder and rectum, are removed.
• Radiation Therapy: Internal or external radiation can be used to treat the cancer that has spread beyond the pelvis or cancer that has returned.
• Chemotherapy: Chemotherapy involves the use of certain drugs that kill the cancer tissues.
• Cervix Biopsy: A cervical biopsy is a medical procedure that involves removing tissue from the cervix to test for any abnormal or precancerous conditions, as well as cervical cancer. The cervix, the lower and narrower part of the uterus that forms a canal opening into the vagina, can be biopsied in various ways.

The cervical cancer treatment cost depends on the type of procedure required for the patient and it varies patient to patient.