Do you know what cervical cancer is and what causes this complicated condition in women? Do you know what part of the body is called the “neck of the womb?” That is precisely where this condition called “cervical cancer” occurs. It is the lower part of the uterus and cervical cancer here is caused by the Human Papilloma Virus (HPV).
“Cervical cancer refers to the formation of cancerous cells on the surface of the cervix- the lower part of the uterus or the womb. The cervix connects the upper part of the womb (where the fetus grows) to the vagina or the birth canal. The cervix has two different types of cells, namely glandular and squamous cells which are on the two opposite ends of the uterus,” explains Dr. Kanika Gupta, Senior Director - Gynae Oncology, Max Hospital, Vaishali.
Cervical cancer can be detected in the pre-cancerous stage by going for a Pap test, also called a Pap smear. The process involves collecting cells from the cervix (the lower, narrow end of the uterus that is on the top of the vagina). “The condition is easy to detect and still, ironically, India remains to be the country with the highest number of deaths due to cervical cancer. These deaths are painful. By the time the condition reaches the fatal stage, a patient goes through a lot of troubles like the tumor infiltrating nerves, ligaments and bones; obstructing lymphatics and blood vessels,” says Dr. Suversha Khanna, Director, Dharamshila Rahat Supportive and Palliative care centre.
It can also create rectovaginal and vesicovaginal fistulas that pass urine/ stool through the vagina. Foul smell from vaginal discharge and incontinence (inability to control urine) leads to social isolation, broken marriages, depression and guilt.
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Symptoms of cervical cancer
“The pre-cancerous stage might not have any symptoms but as the condition advances some of the signs include bleeding from vagina, foul-smelling white discharge through the vagina, passing of urine/ stool through the vagina, blood in urine, loss of bladder control, change in bladder bowel habit, severe bone pain and pain in the back or side due to hydronephrosis/kidney failure, swelling in one of the legs, constipation, and nausea/ vomiting,” adds Dr Khanna.
Treatment for any kind of cancer is often according to the severity of the cancer and its symptoms. Some of the ways cervical cancer can be treated are-
Surgery- Surgeries is used to remove the cancer as much as possible. “In some cases, just the area of the cervix that contains cancer cells and in some extreme cases where the cancer is more widespread, surgery can involve removing the cervix and other organs in the pelvis,” says Dr Gupta.
Radiation Therapy- Internal or external radiation is used to kill the cancer cells or limiting their tendency to grow.
Chemotherapy- “Doctors use certain medications over a period of time to kill cancerous cells present inside the body,” adds Dr Gupta.
Targeted Therapy- It is another form of treatment where medications attack specific features of cancer cells to stop them growing and spreading. This type of surgery is used when other forms of treatment fail.
“Hysterectomy (surgical removal of uterus, cervix, part of vagina and nearby lymph nodes) is the treatment of choice. Hysterectomy can cure the early stages of cancer and prevent a recurrence. A full range of treatment options includes radiotherapy, brachytherapy, chemotherapy, targeted drug therapy, and immunotherapy,” opines Dr Khanna.
Myths around Cervical Cancer
Myth: It’s not possible to become a mother after being diagnosed with cervical cancer
Truth: Even though this was true back in the days due to the patient undergoing a hysterectomy, radiation, and chemotherapy. “But nowadays, with the help of advanced treatment modules, a patient can be cured of cervical cancer without hampering her prospects of giving birth,” says Dr Gupta.
Myth: This type of cancer is hereditary
Truth: This is not the case, only breast or ovarian cancers can be passed down in the family in females, not cervical cancer.
How can palliative care make a difference?
Palliative care is a basic human right, recognized under international human rights law. Essential components of palliative care include prevention anticipation and management of symptoms by a multidisciplinary team, which addresses not only physical symptoms but also emotional, psychosocial and spiritual problems.
“The multidisciplinary team consists of pain and palliative care specialists, radiotherapists, palliative care nurses, counselors (psychologists), social workers, physiotherapists, dieticians and caregivers. Pain and palliative care specialist evaluates the patient to understand the gravity of the problems and the need for involving other members of a multidisciplinary team. After a joint discussion with the members of a multidisciplinary team; and an understanding of the patient’s wishes, and religious and cultural beliefs; an initial treatment plan is made to provide maximum relief from the above-mentioned symptoms,” adds Dr Khanna.
Once the patient improves and is ready to be discharged, the family members/caretaker are trained to manage the patient at home under the supervision of the multidisciplinary team. In spite of a bundle of advantages, unfortunately, less than 1% of India’s population has access to palliative care. Most regions with the exception of Kerala, have very few palliative care facilities in India.
Benefits of Palliative Care
As discussed above, palliative care is most effective in complicated conditions. When it comes to cancer, palliative radiotherapy reduces the size of tumors, vaginal discharge, vaginal bleeding, size of fistulas, nutritional problems, bedsores and contractures. It improves quality of life, interpersonal relations and survival rates. The services here makes people understand that with willpower and medical support, they can regain their normal lifestyle, and live symptom-free.
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