Key Facts
- Second most common cancer in India in women accounting for 22.86% of all cancer
- Commonly presents in 3rd and 4th decade of life
- Third largest cause of cancer mortality in India (10% of all cancer related deaths)
- One woman dies of cervical cancer every 8 minutes in India
- Women of all ages are at risk of cervical cancer
Risk Factors
- Human Papilloma Virus (HPV) Infection (>90% cases) : contracted via sexual intercourse
- Early age of first sexual activity
- History of multiple sexual partners
- More number of pregnancies
- History of sexually transmitted diseases
- Cigarette smoking
Clinical Signs And Symptoms
Common
- Foul smelling sero-sanguinous or yellowish vaginal discharge
- Metrorrhagia (intermenstrual bleeding), Menorrhagia (heavier menstrual flow) or postcoital bleeding.
- Anemia (fatigue, generalised weakness etc)
Advanced Stages
- Pelvic pain, flank and/ or leg pain
- Painful micturition or blood in urine
- Rectal bleeding
- Persistent edema of lower extremities
- Bowel obstruction (advanced disease)
- Renal failure (advanced disease)
Investigations
- Routine blood investigations including complete blood count, Kidney function test, Liver function test and urinalysis to see general well being of the patient
- Punch biopsy to confirm histopathological diagnosis
- Chest Xray to rule out lung metastasis
- CECT/ MRI Contrast of Lower abdomen and pelvis to see tumor extension and lymph node involvement
- Cystoscopy (to see urinary bladder invasion)
- Recto sigmoidoscopy (to rule out rectum and bowel involvement)
- PET CT Whole body scan (on clinician’s decision)
Treatment
Treatment options depend upon stage and prognostic factors. Common decisions are:
- Surgery only
- Surgery followed by post operative radiotherapy
- Chemoradiotherapy
- Only brachytherapy/ only External Beam Radiotherapy (EBRT)
Surgery
It is generally preferred in early stages.
- Cryosurgery or cryotherapy
- LEEP (Loop Electrosurgical Excision Procedure)
- Conization
- Hysterectomy with bilateral salpingo-oophorectomy.
Radiotherapy
- Treatment by radiotherapy is commonly done by two techniques:
- External beam radiotherapy by Cobalt-60/ Linear Accelerator (LINAC)
- Brachytherapy by intra-cavitary applicators to give dose to the primary site
- Common Radiotherapy protocol is a dose of 50 Gy in 25 fractions, 5 days a week for 5 weeks by EBRT followed by 3 cycles of brachytherapy 1 week apart. Total treatment duration is 8 weeks (should be strictly followed).
- Advanced technologies like 3D- Conformal Radiotherapy (3D-CRT)/ Intensity Modulated Radiotherapy (IMRT) are helpful to decrease the dose to normal structures (Urinary bladder, Rectum, Small intestine, both Femur and Bone marrow).
Chemotherapy
- Chemotherapy drug commonly used is Cisplatin as weekly schedule on OPD basis (commonest protocol).
Side Effects Of Radiotherapy
- Burning sensation in urine
- Increased frequency of urine
- Burning sensation during defecation
- Diarrhea
- Skin changes
- Vaginal stenosis
- Painful sexual activity
Chemotherapy related
- Nausea and vomiting
- Loss of appetite
- Possibility of derangement in kidney (more common) and liver function
- Hair Loss (less likely with Cisplatin)
Prophylactic Human Papilloma Virus (HPV) Vaccination
- Administered in females of 9-26 years
- More effective when given before becoming sexually active
- Dose schedules: 0,1,6 months and 0,2,6 months (as per Clinician’s decision)