Cervical Cancer Treatment in India
The cervix is the narrow end of the uterus and leads from the uterus to the vagina or the birth canal. When the cells of the cervix turn malignant, the condition is called as cervical cancer. One of the major risk factors for the development of cervical cancer is the Human Papilloma Virus(HPV).
It usually begins with dysplasia of the cervical cells and these are easily detected in cervical cancer screening tests. Since there are no signs or symptoms of early-stage cervical cancer, screening tests like the Pap Smear are absolutely crucial to detect the disease and improve the treatment success rates.
Apart from the HPV, other risk factors of cervical cancer include–
- Cigarette smoking
- Giving birth to many children
- Use of oral contraceptives for a very long time
- Intrauterine sxposure to the drug DES (diethylstilbestrol)
- Multiple sexual partners
- Being sexually active at a very young age
Though early-stage cervical cancer shows no signs and symptoms, one must visit their doctor if they have any of the following symptoms:
- Unusual vaginal discharge
- Pelvic Pain
- Vaginal bleeding
- Pain during sexual intercourse
The cervical cancer treatment in India depends upon many factors:-
- The type of cervical cancer
- Stage of cervical cancer
- Patient’s age
- The woman’s wish to have children in the future
- Overall health of the patient
There are two types of cervical cancers –
- Squamous cell carcinoma: are 80-90% of all cervical cancer cases and these cancers begin in the cells that form the outer covering of the cervix
- Adenocarcinoma: They form 10-20% of all cervical cancer cases and originate from the glandular cells that are found at the lower end of the cervix
Cervical cancer is staged using the FIGO stages and this divides the cancer into four possible stages of the disease. If anyone is diagnosed with cervical cancer and want peer to peer guidance then it is important to join international cancer forums which would assist.
Stage I Cervical Cancer
The cancer has spread from the cervix into the deeper tissues but still contained within the uterus. This stage is further divided into sub-stages–
- IA: To diagnose this stage, the cells need to viewed under the microscope.
Stage IA1 is when the cancerous area is <3 mm in depth, whereas stage IA2 is when the area of cancerous cells is more than 3mm but less than 5mm in depth.
In the IA1 stage of cancer, if the woman desired to bear kids and maintain her fertility, a cervical cone biopsy is performed to make sure the margins of the removed tissue have no cancer cells and a hysterectomy is performed after child bearing is complete. If fertility is not a factor at the time of diagnoses, a hysterectomy is performed immediately.
In IA2 stage of cancer, if the woman desires fertility, a large cone with negative margins or a radical trachelectomy with node evaluation is performed. If fertility is not a concern, modified radical hysterectomy and node dissection is performed.
- IB: In this stage, the tumour is larger than in stage IA but still confined to the cervix. There is not spread of the tumour.
Stage IB1 is when the tumour is deeper than 5mm and less than 2 cm wide, stage IB2 is when the tumour is deeper than 2cm and less than 4 cm in width, and stage IB3 is when the tumour is 4cm or wider.
In the case of IB1 and IB2 cervical cancer where the cancerous area is less than 4cm in width, modified radical hysterectomy is performed followed by radiotherapy with concurrent chemotherapy.
In the case of IB3 cervical cancer, radical hysterectomy and pelvic node dissection is done. Radiotherapy and/or chemotherapy may or may not be done based on the surgeon’s evaluation of the risk of recurrence. Radiations can cause ovarian failure in pre-menopausal women and so care should be taken to explain to the woman the possibilities of her conceiving post-treatment.
Stage 2 Cervical Cancer
In stage 2, the cancer spreads beyond the uterus to nearby tissues such as the vagina, but still remains within the pelvic region. It has not spread far. This stage can be sub-classified into:
- IIA: The tumour is confined to the upper 2/3rds of the vagina. When this tumour is less than 4cm wide, it is designated as IIA1 and when it is greater than 4cm in width, it is IIA2.
- IIB: The tumour spreads further but still doesn’t reach the pelvic wall but has involved the parametrial area(the tissues just next to the cervix)
Stage 2 cervical cancer treatment in India includes radical hysterectomy, pelvic node dissection and radiation with concurrent chemotherapy.
Stage 3 Cervical Cancer
Stage 3 cervical cancer involve the bottom 1/3rd of the vagina and the cancer cells have also spread to the pelvic wall. It can also cause swelling of the kidney and involve the regional lymph nodes. However, there is no metastasis or distant spread of the cancer. For Stage 3 cancer patient would benefit from finest gynaecological oncologists at best cancer centres in India.
This stage is further divided into sub-stages. Due to the involvement of kidneys, it results in a condition called as hydronephrosis. Cervical cancer treatment in India for this stage is done by radical hysterectomy, node dissection, radiation and chemotherapies. It is also imperative at this stage to look at genetic testing and tumour profiling to provide exact chemotherapy sensitivity for the tumour.
Stage 4 Cervical Cancer
Like most stage 4 cancers, stage 4 cervical cancers spread to pelvic wall and even distant organs. The cervical cancer treatment in India for this stage of cancer is very individualized based on the patient’s condition and spread of the disease. Many a time, patients benefit from palliative care
It is also important to note that International Second Opinion from U.K and USA can have life changing implications in terms of consultants specialising in fertility saving surgery or targeted therapies. Cervical cancer needs to be treated early so that the prognosis is better but patients recover from Stage 3 and 4 if treated at best cancer centres through skilled gynaecological oncologists.