Understanding cervical cancer in India: Prevention, symptoms, and treatment options

Cervical cancer is one of the key causes of cancer-related deaths in women in India. However, it is a disease that can be both prevented and cured. Much of its burden can be reduced through early detection through screening and vaccination.

Statistics of Cervical Cancer in India
India accounts for the highest global incidences of cervical cancer. Data from Globocan 2020 shows:

1. India annually reports around 123,000 new cases of cervical cancer.
2. It causes over 77,000 deaths every year, which makes it responsible for 17% of global cervical cancer deaths.
3. Cervical cancer is the second most common cancer in Indian women, and it primarily occurs among those in the 15-44 years age group.

Compared to the rural setting, awareness and health programs have gained momentum in urban areas, and there is a balance in their access to screening and preventing measures because of education.

Cervical Cancer Symptoms
Cervical cancer often does not have early signs; however, in the advanced stages some of the symptoms are:

1. Unusual vaginal bleeding, even between periods or after intercourse, or postmenopausal bleeding.
2. Abnormal vaginal discharge, could be watery, thick or blood-tinged
3. Pain during sexual intercourse.
4. Pelvic pain that does not relate to menstrual cycle
5. Heavier and longer menstrual period

These symptoms can also be due to other medical conditions so if a patient has experienced them then they should consult a doctor for proper diagnosis.

Causes and Risk Factors
The major risk factor for cervical cancer is a persistent infection with high-risk human papillomavirus ( HPV ), especially HPV 16 and 18, which alone accounts for about 70% of the incidents. Other risk factors include:

1. Engaging in sexual activity at an early age and having multiple sexual partners raise the risk of exposure to HPV.
2. Immune deficiency, like HIV infection.
3. Smoking is associated with an increased risk.
4. Irregular screening, often from limited access in rural areas.
5. Multiple pregnancies may also be risk-increasing.

Diagnosis of Cervical Cancer
Routine screening is crucial for early detection. The following are the diagnostic strategies available:

1. Pap Smear Test: This is one of the major screening measures carried out to detect abnormal cervical cells.
2. HPV DNA Test: This determines whether or not there are certain types of high-risk HPV.
3. Colposcopy: It is a detailed examination of the cervix if some abnormality is detected
4. Biopsy: Confirms if the abnormal cells are cancerous
5. Imaging Tests: These include diagnostic tests and processes like CT, MRI, or PET scans when the disease has progressed to more advanced stages.

Treatment Options for Cervical Cancer
Treatment varies with the stage of cancer, the health condition of the patient, and the preference of the patient.

1. Surgery:
- Conization is the removal of early-stage cancerous tissues.
- Hysterectomy is used for more advanced cases, involving removal of the uterus and cervix.
- Radical hysterectomy may be required depending on the spread of the cancer

2. Radiation Therapy: Mainly External Beam Radiation or Brachytherapy (internal radiation) are in practiceIt is generally given along with chemotherapy in advanced cases.

3. Chemotherapy: Drugs like Cisplatin are employed, especially in the later stages often paired with radiation therapy.

4. Targeted Therapy and Immunotherapy: Newer treatments of cervical cancer include targeted therapy that involves the drug bevacizumab and immunotherapy Pembrolizumab.

Prevention
HPV vaccine is a very effective preventive measure and is best given prior to initiating sexual activity. The vaccines are Cervarix and Gardasil, and they target the high-risk HPV strains. The Government programs initiated towards immunizing adolescent girls are still on an increase, even in terms of awareness and uptake.

Pap smears and HPV testing regularly are an element in early detection of cancers and obviate the development of cervical cancer.

In conclusion, though cervical cancer is one of the most prevalent diseases in India, its impacts can very much be reduced with preventive measures, such as vaccination, screening, and other timely treatments.

(Author: Dr. Pooja Babbar, Consultant, Medical Oncology, CK Birla Hospital, Gurugram)