Advanced Cervical Cancer
Is it possible to prevent cervical cancer?
Usually, there is a long gap between pre-cancerous and cancerous stage of cervical cancer. This gives ample opportunity for screening, detection & timely treatment.
In most cases, cervical cancer is preceded by a pre-cancerous lesion stage which slowly progresses into potentially fatal invasive cancer stage. The long gap between pre-cancer to cancer stage gives ample opportunity for screening, detection & treatment. A young woman can lower chances of getting cervical cancer by getting vaccinated and by performing regular screening.
The most preferred screening tests are Pap test and HPV test. In case of an abnormal Pap and HPV test, further tests such as colposcopy, cervical biopsy etc. are recommended.
i. Pap (Papanicolaou) test
Pap test is generally the first test done to screen for cervical cancer. If the results are positive, then, further tests are recommended. Pap test alone is generally recommended for women between 21 and 30. For women aged 30 and above, co-testing (i.e, with HPV test) is recommended. To know more on the guidelines, refer Box 2. In Pap test, cells collected from the cervix are carefully examined under the microscope to check for any abnormalities. A pap test is different from pelvic exam, where the latter is only a part of women’s routine reproductive health check-up. Pap test results are reported under 3 sub-categories:
- Negative for intraepithelial lesion or malignancy: This means there are no signs of pre-cancer, cancer or other major abnormalities. These reports may contain unrelated findings such as infection with yeast, herpes, or other vaginal parasite.
- Epithelial cell abnormalities: This means there might be a pre-cancerous or cancerous condition. Further, the report will contain type of abnormality – whether squamous or glandular. Further tests may be recommended in these cases.
- Other malignant neoplasms: This reporting is for other types of cancers that hardly affect the cervix.
ii. HPV test
Human papilloma virus (HPV) test is basically a DNA test, where, presence of HPV DNA in the cervix is tested. The test can be done at the same time as Pap test, with the same swab. HPV test along with Pap test (‘co-testing’) is recommended by the American Cancer Society for women above 30 years of age, at a frequency of once in 5 years. HPV testing is not recommended for women below 30 years of age.
HPV testing may also be done as a follow-up test for women who have showed abnormal results in Pap test. If Pap test result is normal while HPV test result is not, then, co-testing may be recommended again within one year.
iii. Colposcopy & Cervical biopsy
Colposcopy is recommended if Pap test result is abnormal. A colposcope is a device fitted with magnifying lenses which the doctor uses from outside of the body to examine a woman’s cervix. During the procedure, the doctor may apply a weak solution of acetic acid to the cervix to better visualize the abnormal areas. If any abnormality is found, a tissue section may be removed, to be then sent for biopsy (laboratory testing for cancer). A cervical biopsy is not painful, but may cause mild discomfort. However, vaginal biopsy (of the lower portion of vagina or vulva) may cause a slight pain a local anesthetic may be administered.
In case the tests show that I have cervical cancer, can I know how far the cancer has spread?
The ‘stage’ of the cervical cancer is the most important factor in determining the best treatment. If found positive for cervical cancer, the next step will be to stage the cancer. Staging is determining the size and spread of cancer. Clinical stage of cancer is found out based on the doctor’s physical exam, biopsies, imaging tests etc.
Most often, for cancers of the female reproductive organs, the FIGO (International Federation of Gynecology and Obstetrics) staging system is used. Another widely accepted staging system is the TNM staging system (American Joint Committee on Cancer AJCC) which is based on 3 main information: T (denoting ‘tumour’, based on how big the tumour has grown inside as well as nearby cervix); N (denoting ‘node’, meaning presence or absence of cancer in nearby lymph nodes and it’s extent of spread) and M (denoting ‘metastasis’, indicating how far the cancer has spread to areas distant from cervix). Both FIGO and AJCC systems give the same information regarding cancer stage. And in general, the rule is, lower the number, the lesser has the cancer spread and vice versa (Figure 2).
AJCC: American Joint Committee on Cancer CC: Cervical cancer DES: Diethylstilbersterol DNA: Deoxyribonucleic acid FIGO: International Federation of Gynecology and Obstetrics HPV: human papillomavirus Pap test: Papanicolaou test TNM: Tumor, node, metastasis staging system VEGF: Vascular Endothelial Growth Factor
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- Walboomers, J. M., Jacobs, M. V., Manos, M. M., Bosch, F. X., Kummer, J. A., Shah, K. V., … Muñoz, N. (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology, 189(1), 12-19. doi:10.1002/(sici)1096-9896(199909)189:1<12::aid-path431>3.0.co;2-f
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