Cervical Cancer Treatment in Noida, Delhi, India

An Overview

Cervical cancer, commonly known as cancer of the uterine cervix, affects the lower part of the uterus that extends slightly into the upper part of the vagina. This form of cancer develops when cells on the cervix’s surface become infected with Human Papillomavirus (HPV) and begin to grow abnormally, leading to the formation of a cervical tumor. In India, cervical cancer is the most prevalent cancer among women and the second most common worldwide. Each year, approximately 130,000 new cases are diagnosed in India, leading to around 74,000 deaths.

What is Cervical Cancer?

Cervical cancer is a malignant tumor that arises from the cervix, the lower part of the uterus that connects to the vagina. This condition typically starts when the cells on the cervix’s surface are infected with HPV, a common sexually transmitted virus. Over time, these infected cells can undergo abnormal changes and grow uncontrollably, forming a tumor. In its early stages, cervical cancer may not cause noticeable symptoms, making regular screening crucial for early detection.

Types of Cervical Cancer

Cervical cancer is primarily classified into two types, each requiring a tailored approach to treatment:

1. Squamous Cell Carcinoma: The most common type of cervical cancer, squamous cell carcinoma, develops from the flat cells covering the cervix’s outer surface at the top of the vagina.
2. Adenocarcinoma: This type of cervical cancer originates from the glandular cells lining the cervical canal (endocervix). Adenocarcinoma can be more challenging to detect with regular cervical screening tests, as it starts within the cervical canal.

In addition to these, there are less common types of cervical cancer, including adenosquamous, clear-cell, and small-cell carcinomas.

Causes of Cervical Cancer

Cervical cancer typically develops between the ages of 40 and 55, although it can occur at any age. The disease often begins with an infection caused by HPV. While the exact cause of why certain cells become cancerous is not fully understood, several factors are known to contribute to the development of cervical cancer:

• Early Sexual Activity: Engaging in sexual activity before the age of 18 can increase the risk of HPV infection.
• Sexual History: Having a partner who has been involved with a woman who had cervical cancer or a history of sexually transmitted infections, such as herpes or HPV, significantly increases the risk. Approximately 99.7% of women with cervical cancer have an HPV infection.
• Multiple Pregnancies: Women who have had more than three pregnancies are at a higher risk.
• Weakened Immune System: A compromised immune system, due to conditions like HIV or long-term use of immunosuppressive drugs, increases susceptibility to HPV and cervical cancer.
• Smoking: Smoking is a significant risk factor as it weakens the immune system and contributes to the development of abnormal cervical cells.
• Long-term Use of Oral Contraceptives: Prolonged use of oral contraceptives without medical supervision can increase the risk.

Symptoms of Cervical Cancer

In its earliest stages, cervical cancer may not present any noticeable symptoms. As the disease progresses, the following symptoms may develop:

Contact Spotting or Bleeding: Unexplained bleeding after sexual intercourse or a pelvic exam.

• Increased or Blood-Stained Vaginal Discharge: Unusual vaginal discharge that may be watery, thick, or tinged with blood.
• Abnormal Menstrual Bleeding: Bleeding between menstrual periods or excessively heavy periods.
• Postmenopausal Vaginal Bleeding: Any bleeding after menopause should be promptly investigated.
• Pelvic Pain: Ongoing discomfort in the pelvic area, particularly noticeable during intercourse.
• Back and Leg Pain: Pain that radiates to the lower back and legs.
• Fatigue and Weight Loss: Unexplained fatigue and weight loss in the absence of other causes.
• Single Swollen Leg: Swelling in one leg, often caused by a blocked blood vessel due to the spread of cancer.

Risk Factors for Cervical Cancer

Understanding the risk factors associated with cervical cancer is vital for its prevention and early detection. While having one or more risk factors does not guarantee the development of cervical cancer, it can significantly increase the likelihood:

• Lack of Regular Screening: Women who do not undergo routine cervical screenings, such as Pap smears or HPV tests, are at higher risk of developing advanced cervical cancer.
• HPV Infection: HPV, particularly types 16 and 18, is the leading cause of cervical cancer. Multiple sexual partners or early sexual activity can increase the risk of contracting HPV.
• Sexual History: A history of other sexually transmitted infections, like chlamydia or gonorrhoea, can elevate the risk.
• Smoking: Smoking compromises the immune system, making it more difficult for the body to eliminate HPV infections.
• HIV Infection: Women with HIV have a weakened immune system, making them more susceptible to persistent HPV infections and cervical cancer.
• Long-term Use of Birth Control Pills: Prolonged use of certain oral contraceptives has been linked to a slightly increased risk.
• Multiple Pregnancies: Hormonal changes during multiple pregnancies may affect the cervix, raising the risk.
• Weakened Immune System: Conditions that weaken the immune system, such as HIV or immunosuppressive medications, increase the risk.
• Family History: A family history of cervical cancer may indicate a genetic predisposition, slightly elevating the risk.

Cervical Cancer Screening & Diagnosis at Metro Cancer Institute

At Metro Cancer Institute, cervical cancer screening is a critical process that enables the early detection of precancerous changes in cervical cells. Early intervention can prevent the progression to cervical cancer, significantly improving patient outcomes. Screening typically involves a liquid-based cytology test, where a sample of cells is taken from the cervix. This test is recommended for women between the ages of 25 and 64.

Initial Screening Process

• Liquid-Based Cytology (LBC): This test is the primary method for cervical cancer screening at Metro Cancer Institute. It involves collecting a sample of cervical cells using a small brush, which is then placed in a liquid preservative for analysis. This method is more accurate than the traditional Pap smear and is used to detect abnormal cells in the cervix.

If abnormal cells are detected, further diagnostic procedures are necessary to confirm the presence of cervical cancer.

Confirmatory Diagnostic Procedures

• Colposcopy: When abnormal cells are found during the initial screening, a colposcopy is recommended. This procedure involves the insertion of a speculum into the vagina to allow the healthcare provider to examine the cervix using a colposcope, a magnifying device. If necessary, a biopsy (a small tissue sample) may be taken for further analysis.
• Biopsy: During colposcopy, a biopsy may be performed to collect a tissue sample from the cervix. This sample is examined under a microscope to determine the presence of cancerous cells.

Additional Diagnostic Tests

To assess the extent of cancer (staging), several imaging and laboratory tests may be conducted:

• Computerised Tomography (CT) Scan: Provides detailed images of the body’s internal structures, helping to determine if cancer has spread beyond the cervix.
• Magnetic Resonance Imaging (MRI) Scan: Offers detailed images of soft tissues, allowing for precise evaluation of the cervix and surrounding areas.
• Chest X-ray: Used to check if cervical cancer has spread to the lungs.
• Ultrasound: Helps evaluate the size and extent of the tumor, especially in the pelvic area.
• Blood Tests: Can include tests for general health and specific markers related to cancer.

These diagnostic tests collectively determine the cancer stage, guiding the development of an individualized treatment plan.

Staging of Cervical Cancer

Staging is crucial for understanding the extent of cervical cancer and determining the most appropriate treatment approach. The stages of cervical cancer are categorized as follows:

• Stage 0 (Carcinoma in Situ): Cancer is confined to the surface layer of the cervix and has not invaded deeper tissues. This stage is commonly known as “pre-cancerous”.
• Stage I: Cervical cancer, the cancer is limited to the cervix and has not spread to other parts of the body.

• Stage IA: Microscopic cancer, visible only under a microscope.
• Stage IB: Cancer is visible without a microscope but remains confined to the cervix.
• Stage II: The cancer has extended beyond the cervix but has not yet involved the pelvic wall or the lower third of the vagina.

• Stage IIA: Cancer involves the upper two-thirds of the vagina without spreading to the tissues around the uterus.
• Stage IIB: Cancer has spread to the tissues surrounding the uterus but not to the pelvic sidewall.
• Stage III: Cancer has extended to the pelvic sidewall, lower third of the vagina, or caused kidney issues (hydronephrosis).

• Stage IIIA: Cancer has spread to the lower third of the vagina.
• Stage IIIB: Cancer has reached the pelvic sidewall or caused kidney problems.
• Stage IIIC: Cancer has spread to nearby lymph nodes.
• Stage IV: Cancer has advanced to nearby organs outside the pelvis, such as the bladder or rectum, or distant organs like the lungs or liver.

• Stage IVA: Cancer has spread to nearby organs.
• Stage IVB: Cancer has metastasized to distant organs.

Understanding the stage of cervical cancer is essential for selecting the most effective treatment strategy.

Cervical Cancer Prevention at Metro Cancer Institute

Metro Cancer Institute emphasizes a holistic and integrated approach to cervical cancer care, including both primary and secondary prevention strategies.

Primary Prevention

• HPV Vaccination: Vaccination against HPV is a crucial preventive measure. Metro Cancer Institute recommends routine vaccination for females aged 11 to 26, as it significantly reduces the risk of developing cervical cancer. Proper counselling is provided to discuss the benefits and potential risks associated with the vaccine.

Secondary Prevention                                                    

• Regular Screening and Early Intervention: Regular cervical screening, including Pap smears and HPV testing, is essential for early detection of precancerous changes. When abnormalities are detected, timely and appropriate treatment can prevent the progression to invasive cervical cancer.

Treatment Options for Cervical Cancer

At Metro Cancer Institute, the treatment of cervical cancer is tailored to each patient based on the cancer stage, overall health, and individual preferences. Treatment options include:

• Surgery: Early-stage cervical cancer may be treated with surgery to remove the tumor, which may involve a simple hysterectomy (removal of the uterus) or a radical hysterectomy (removal of the uterus, part of the vagina & surrounding tissues).
• Radiotherapy: High-energy rays are used to target and kill cancer cells. Radiotherapy may be used alone or in combination with surgery & chemotherapy.
• Chemotherapy: Drug treatment that uses powerful chemicals to kill fast-growing cancer cells. It may be used in advanced stages or alongside radiotherapy.
• Combination Therapy: In many cases, a combination of surgery, radiotherapy, and chemotherapy is used to ensure comprehensive treatment of the disease.

Cervical Cancer Treatment

Overview of Treatment Approaches: Cervical cancer treatment varies depending on the stage of cancer. Patients are typically categorized into two groups: early-stage and locally advanced cervical cancer. In the early stages, surgery is often the primary treatment, possibly followed by radiation therapy if necessary. For locally advanced cervical cancer, a combination of chemotherapy and radiation therapy is the standard approach. With proper treatment, many cases of cervical cancer are curable.

Surgical Treatment Options:

• Loop Electrosurgical Excision Procedure (LEEP): This technique uses a loop-shaped wire heated by electric current to remove abnormal cervical tissues.
• Cryotherapy: Involves freezing abnormal cells on the cervix, effectively destroying them.
• Laser Therapy: Utilizes concentrated light to target and destroy cancerous tissue.
• Radical Hysterectomy: The surgical removal of the uterus, including surrounding tissues, lymph nodes, and the upper part of the vagina.
• Pelvic Exenteration: A highly complex surgery where all pelvic organs, including the bladder and rectum, are removed. This is generally reserved for advanced or recurrent cervical cancer.

Non-Surgical Treatment Options:

• Radiation Therapy: Can be delivered internally (brachytherapy) or externally to target cancer cells that have spread beyond the cervix or recurred after initial treatment.
• Chemotherapy: This treatment uses medications to destroy cancer cells or inhibit their growth. Often used in conjunction with radiation therapy for more advanced stages.
• Cervical Biopsy: A procedure where tissue samples are taken from the cervix for testing to detect abnormal or cancerous cells. Multiple biopsy methods can be employed depending on the extent of the abnormality.

Cost of Treatment: The cost of cervical cancer treatment in India varies significantly based on the procedure required, the stage of cancer, and individual patient needs. After a thorough assessment, the appropriate treatment plan and associated costs will be discussed.

Cervical Cancer Vaccine

The HPV (Human Papillomavirus) vaccine is a powerful preventive measure against cervical cancer. It works by stimulating the immune system to produce antibodies against specific HPV strains responsible for most cervical cancer cases. The vaccine is most effective when administered before the onset of sexual activity and is typically recommended for girls and young women aged 11 to 26. It is given in a series of shots over several months.

Expertise in Cervical Cancer Surgery

Metro Cancer Institute at Metro Hospitals, India, is a premier facility offering state-of-the-art treatments in surgical oncology, radiation oncology, and medical oncology. With locations across North India, including Saket, Patparganj, Shalimar Bagh, Vaishali, Mohali, and Bathinda, the institute provides cutting-edge treatments like Intensity Modulated Radiotherapy (IMRT) and Image-Guided Radiation Therapy (IGRT), equipped with Cone-beam Computerised Tomography (CBCT) and ExacTrac technology.

Metro Cancer Institute delivers comprehensive cervical cancer treatment, supported by a multidisciplinary team of experts, including surgical oncologists, radiation oncologists, medical oncologists, and various other specialists. The team is dedicated to providing personalized care based on the latest evidence-based practices.

Frequently Asked Questions (FAQs)

Q: Is cervical cancer curable?

A: Yes, cervical cancer is curable, especially when detected early through regular screenings. Early detection allows for more effective treatment options, significantly improving the chances of a positive outcome.

Q: What are the most common early signs of cervical cancer?

A: Common early signs include abnormal bleeding (especially between periods), pelvic pain, unusual discharge, and pain during intercourse. Early recognition of these symptoms and prompt medical consultation can lead to timely diagnosis and treatment.

Q: What is the most effective treatment for Stage 3 cervical cancer?

A: Stage 3 cervical cancer is usually treated with a combination of surgery, radiation therapy, and chemotherapy. The treatment plan is tailored to the individual patient’s needs.

Q: Which type of doctor treats cervical cancer?

A: Gynecologic oncologists specialize in treating cervical cancer. These doctors have advanced training in managing gynecological cancers and provide comprehensive care throughout the treatment process.

Q: Does cervical cancer screening have any risks?

A: While cervical cancer screening is generally safe, there are rare risks, such as false-positive or false-negative results. It’s important to discuss any concerns with your healthcare provider.

Q: How common is cervical cancer?

A: Cervical cancer is one of the most common cancers affecting women worldwide, though its prevalence varies by region and population.

Q: Can cervical cancer be prevented?

A: Yes, cervical cancer can be prevented through HPV vaccination and regular screenings. These preventive measures are essential in reducing the risk of developing cervical cancer.

Q: Does cervical cancer affect fertility?

A: Some cervical cancer treatments can affect fertility. It’s important to discuss fertility preservation options with your healthcare provider before starting treatment.

Q: What are the five key warning signs of cervical cancer?

A: The five key warning signs include bleeding between periods, pelvic pain, unusual discharge, pain during intercourse, and swollen legs. Early detection of these symptoms is crucial for timely treatment.

Q: Which hospitals are recognized as the top facilities for treating cervical cancer?

A: Metro Hospitals is one of the leading hospitals in India for cervical cancer treatment. However, many other renowned institutions in India also offer excellent care for cervical cancer patients.

Q: Who is the best cervical cancer oncologist at Metro Cancer Institute?

A: Metro Cancer Institute has a team of highly skilled cervical cancer specialists. Each doctor is experienced and equipped to provide the highest standard of care.

Q: What is the cervical cancer treatment cost in India?

A: The cost of treatment depends on the specific procedure required and varies from patient to patient. A thorough assessment is necessary to determine the exact costs involved.

Review

Reviewed By: Dr. Piyusha Kulshrestha, Sr. Consultant & HOD – Radiation Oncology, on 21 Aug 2024.