Let’s take a moment to contemplate the intricate beauty and complexity of the human body. It’s a harmonious network of cells, tissues, and organs working together to sustain life. However, within this remarkable system, there is a vulnerability, a flaw that, if left unchecked, can lead to devastating consequences. Cervical cancer serves as a stark reminder of this vulnerability, a disease that can alter the course of lives, families, and communities. To understand cervical cancer and its various aspects, THIP Media spoke to renowned gynaecologist and obstetrician Dr Ekta Singh.
Dr Ekta Singh commenced her professional journey as a senior resident at Lady Harding in Delhi and currently serves as a distinguished senior consultant at Cloud Nine Hospital in Noida. Dr Singh is the recipient of prestigious accolades, including the Sri Prabhu Daya Babaja Memorial and UP Ratna Ayushman awards. With over two decades of experience overseeing more than 10,000 deliveries, Dr Ekta Singh holds prominent roles within NOGS, serving as both the Treasurer and former Joint Secretary.
What is cervical cancer?
Dr Ekta Singh: Cervical cancer is a type of cancer that develops in the mouth of the womb, known as the cervix. The cervix is part of the uterus in a female body, which consists of three parts: the body, the neck, and the cervix itself. When cancer forms in the cervix, it is referred to as cervical cancer. It is preventable for two key reasons. Firstly, around 70-80% of cervical cancer cases are a result of infections caused by human papillomavirus (HPV). By preventing this infection, we can also prevent the cancer. Secondly, cervical cancer typically takes years to develop from precancerous lesions to cancerous ones. Detecting and treating the precancerous lesions early is relatively easy, making early intervention highly effective. These two factors contribute to its preventability.
Are there any other risk factors associated with cervical cancer?
Dr Ekta Singh: Indeed, because this cancer is primarily caused by HPV infection, it is closely linked to factors that increase the risk of this infection. Better hygiene, practising safe and protected sexual intercourse, such as using barrier contraceptives like condoms, and avoiding multiple sexual partners are risk-reduction strategies. Additionally, unhealthy lifestyle habits like smoking and sedentary lifestyles can compromise the immune system, increasing the risk of cervical cancer.
What are the symptoms or warning signs of cervical cancer?
Dr Ekta Singh: In the early stages, cervical cancer may be asymptomatic. As it progresses, several symptoms may emerge. The initial symptoms may include vaginal discharge and spotting, which can occur between menstrual periods. Notably, post-coital bleeding, which is bleeding after intercourse, is a specific symptom of cervical cancer. It’s important to distinguish this from other common causes of vaginal discharge, as cervical cancer-related discharge typically has a foul odour and may include blood. However, one may not typically experience itching and redness.
What is the significance of routine cervical cancer screening, and what screening methods and schedules are advised?
Dr Ekta Singh: Routine cervical cancer screening is vital in preventing and detecting cervical cancer early. There are two primary screening methods: Pap Smear and liquid-based cytology. We perform these tests during a speculum examination. Pap Smear involves taking a swab and creating a slide, while liquid-based cytology uses a sample that is rinsed in a fluid, offering higher sensitivity and specificity. The guidelines for screening are as follows:
- Begin screening at the age of 21-25, with testing every three years.
- If a person becomes sexually active before the age of 21, they should undergo screening within three years of their first sexual activity.
- Continue with Pap Smear or liquid-based cytology every three years until the age of 30.
- After the age of 30, combine HPV DNA testing with Pap Smear testing.
- If HPV DNA testing is negative, continue screening every five years until the age of 65.
- Discontinue screening at 65 years of age if three consecutive smears are normal.
What treatment options are available for cervical cancer, and does the choice of treatment depend on the cancer’s stage?
Dr Ekta Singh: Regular screening tests significantly reduce the risk of cervical cancer. In cases of early diagnosis of cancer, various treatment options are available. The choice of treatment depends on the cancer’s stage. These options include:
- Conization: Removal of a cone-shaped piece of the cervix.
- LEEP (Loop Electrosurgical Excision Procedure): Removal of a specific portion of the cervix.
- Radical Trachelectomy: Removal of the entire cervix while preserving the uterus.
- Hysterectomy: Removal of the uterus, which can be radical, involving the cervix, ovaries, and tubes.
- Radiotherapy: Can be used alone or in combination with surgery for advanced cases, termed neoadjuvant radiotherapy.
- Immunotherapy and chemotherapy are also available for treatment, and sometimes a combination of therapies is used.
What are the preventive measures and vaccines for cervical cancer?
Dr Ekta Singh: Prevention involves primary, secondary, and tertiary stages. Primary prevention focuses on avoiding the disease entirely. Maintaining a healthy lifestyle, including a balanced diet, exercise, and safe sexual practices, such as using barrier methods and minimizing multiple sexual partners are important measures to prevent cervical cancer. A robust immune system is also crucial. Since almost all sexually active individuals contract HPV infection, the body’s immune system usually clears it before the age of 30. However, if the virus persists beyond 30, it becomes a risk factor for cervical cancer. Reducing stress, maintaining proper sleep patterns, and avoiding smoking and excessive alcohol consumption are essential.
Vaccines for cervical cancer target the human papillomavirus (HPV). HPV comprises approximately 150 types of related viruses, with high-risk HPVs, such as variants 16 and 18, being the most common culprits for cervical cancer. Three vaccines are available for prevention:
- Bivalent: Targets HPV types 16 and 18.
- Quadrivalent: Targets HPV types 6, 11 (causing genital warts), 16, and 18.
- Nonavalent: Targets HPV types 6, 11, 16, 18, and others.
- Vaccination should ideally begin at nine years of age for both males and females, with two doses below the age of 15 (zero dose and five-six months later). After 15 years, three doses are recommended (zero, two, and six). If the third dose is missed, it’s advisable to get it as soon as possible, rather than repeating the entire course.
How does health literacy impact health outcomes in the context of cervical cancer, and how can doctors contribute to promoting this health literacy among patients?
Dr Ekta Singh: Health literacy plays a crucial role in increasing awareness of any health issue. To address health problems effectively, people must receive accurate information from authentic sources. As health workers, we always try to counsel. If a young woman comes to us, we talk to them about cancer and its various aspects. We discuss cervical cancer with new mothers as well. Nowadays, a lot of young women also come to us seeking screening tests and vaccines.
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