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Overview of Cervical Cancer in India
Cervical cancer develops in the cervix, the lower part of the uterus. In cervical cancer, the cells start to divide uncontrollably, primarily caused by a sexually transmitted infection. Usually symptoms include irregular bleeding, abnormal vaginal discharge and lower back pain. Treatment depends on the stage of the cancer. The following procedures are common in cervical cancer treatment: Conization, Chemotherapy, Hysterectomy, Radiation, and drug therapies.
Cervical Cancer Treatment cost in India for Indian patients is approximately between USD 2880 to USD 3840, cost of treatment for International patients would be approximately between USD 4320 to USD 5280. The overall costs will vary according to diagnosis, hospital facilities and patient(s) health when diagnosed.
The cost of treatment can also vary according to the number of blood tests and diagnostic tests required, the number of chemotherapy cycles, the types of medication and the length of stay in the hospital. The costs can also vary according to the type of cancer, the stage of cancer and complications relating to the cancer.
What Is Cervical Cancer?
Cervical cancer originates in the lining of the cervix. It develops when normal cells in the cervix turn into precancerous cells. Infection with HPV (human papillomavirus) is the cause of nearly all cervical cancer cases. HPV is a virus transmitted through sexual contact. You can lower your risk of cervical cancer by having regular cervical cancer screening tests (like Pap smears) and by getting the HPV vaccine.
Cervical cancer usually does not cause symptoms until it spreads. This is why it is so important to have regular screening tests and to get the HPV vaccine. Cervical cancer can be treated very well when found early. Your health care provider could treat it with surgery, radiation therapy, chemotherapy and/or other cancer medications.
About 14,000 people in the United States are diagnosed with cervical cancer each year. Most people diagnosed with cervical cancer are women between the ages of 35 years and 44 years.
Types of Cervical Cancer:
There are many types of cervical cancer, based on the type of cell from which they originate. The below types of cervical cancer are common:
Squamous cell carcinoma
The squamous cell carcinoma arises from squamous cells, which are the thin flat cells that line the outer portion of the cervix (the ectocervix). Squamous cell carcinoma is the most common type of cervical cancer and accounts for approximately 90% of cervical cancer cases. Squamous cell carcinoma often is located at the transformation zone where the outer squamous cells intersect the inner glandular cells.
Adenocarcinoma
This type of cervical cancer begins in the glandular cells located in the cervical canal (the endocervix) and produces mucus and other fluids. Adenocarcinoma is not as common as squamous cell carcinoma, but incidence has increased. Detecting adenocarcinoma with a Pap smear can be more difficult because it occurs higher in the cervical canal.
Adenosquamous/Mixed carcinoma
This rare form comprises features of squamous cell carcinoma and adenocarcinoma. Compared to the other two types, adenosquamous carcinoma is relatively rare. Clinically, adenosquamous carcinoma is a unique combination of both histological features with squamous differentiation and glandular differentiation.
Small cell neuroendocrine carcinoma
This is a rare type of cervical cancer that is highly aggressive and arises from neuroendocrine cells. Compared to the other types, small cell neuroendocrine carcinoma occurs much less often. The tumors associated with small cell neuroendocrine carcinoma tend to be faster growing and aggressive, and sometimes require more intensive treatment.
Depending on how far the cancer has gone, cervical cancer is categorised into various stages. The FIGO (International Federation of Gynaecology and Obstetrics) staging method is the most widely utilised. The stages of cervical cancer are as follows:
Stage 0
Carcinoma in Situ: Only the innermost lining of the cervix contains abnormal cells; deeper tissues have not been invaded.
Stage I
Stage IA: Cancer is present and detectable only microscopically. It has invaded cervical tissue but remains within the cervix and is no more than 5 mm deep.
IA1: On microscopic analysis, the depth of invasion is 3 mm.
IA2: The depth of invasion is at least 3 mm and less than 5 mm depth, but no deeper than 5 mm and less than or equal to 7 mm wide.
Stage IB: There is clinically evident but limited cancer confined to the cervix alone or a cancerous mass that has larger but still limited areas of invasion in the cervix.
IB1: Tumor depth of invasion is no less than 5 mm and the size of the tumor does not exceed 2 cm.
IB2: Tumor depth of invasion exceeds 2 cm but is not more than 4 cm.
IB3: Tumor depth of invasion is greater than or equal to 4 cm.
Stage II - The cancer has grown beyond the cervix into the upper two-thirds of the vagina but not to the tissues that surround the cervix, upper vagina and pelvic wall.
Stage IIA: Involvement limited to the upper two-thirds of the vagina but not to the side tissues of the uterus.
Tumor size is less than 4 cm in greatest dimension.
IIA2: tumor is 4 cm or greater in greatest dimension.
Stage IIB: Cancer has spread to the parametrial tissues but has not spread to the pelvic wall or to the lower third of the vagina.
Stage III
Stage IIIA: Cancer is in the lower third of the vagina, but has not spread to the pelvic wall.
Stage IIIB: Cancer has spread to the pelvic wall, and/or the cancer is causing kidney problems (hydronephrosis) or no longer functioning kidneys.
Stage IIIC: Cancer has spread to lymph nodes in the pelvis, and/or around the aorta.
IIIC1: Spread to pelvic lymph nodes.
IIIC2: Spread to para-aortic lymph nodes.
Stage IV
Stage IVA: Cancer has spread to nearby organs, such as the bladder or rectum.
Stage IVB: Cancer has spread to distant organs outside the pelvis, such as the lungs, liver, or bones.
Understanding the stage of cervical cancer has been important in order to develop the best treatment plan and prognosis. Regular screening and early detection are the best ways to identify cervical cancer early and at a stage when it is more treatable.
Procedure:
Treatment options for cervical cancer vary according on the disease's stage and extent, the patient's preferences, and general health. An explanation of the primary therapy options is provided below:
Radiation therapy
Radiation therapy employs high-energy rays to kill cancer cells. It can be a stand-alone treatment or sometimes combination with chemotherapy to further enhance effectiveness.
External beam radiation: In this method, radiation is directed from outside of the body. Radiation is usually targeted to the pelvic area and takes several weeks of radiation treatments.
Brachytherapy: In this method, radioactive material is placed in or near the tumor. Since this method is localized, higher doses of radiation can be delivered to the cancer while allowing surrounding healthy tissue to be preserved.
Chemotherapy
Chemotherapy utilizes drugs to eliminate cancer cells or hinder their development. Chemotherapy can be implemented at any stage of treatment for cervical cancer.
Systemic chemotherapy: Given in the bloodstream, and so will be able to affect cancer cells wherever they are found in your body. Systemic chemotherapy can be prescribed as a standalone treatment, or applied in combination with radiation (chemoradiation). This will be administered to patients with advanced or recurrent cervical cancer.
Surgery
Surgical procedures strive to eliminate cancerous tissue and, in select younger patients, even preserve fertility.
- Laser surgery: Uses a focused beam of light to eliminate or destroy cancerous tissue. This type of procedure is mostly used for treating precancerous changes or very early-stage cancers.
- Cryosurgery: Freezing and eliminating the abnormal cells in the cervix using a special cold probe is cryosurgery. Again, this method is usually used for early-stage cancer or precancers.
- Simple Hysterectomy: The removal of the uterus and cervix without the surrounding tissues, a simple hysterectomy is a procedure for early stages of cervical cancer.
- Trachelectomy: A surgery that preserves fertility the cervix and surrounding tissue are removed, but the uterus remains intact. This is a good option for early-stage cervical cancer if patients want to maintain their fertility.
Targeted therapy
Targeted therapy is a type of treatment that utilizes drugs developed to attack cancer cells based on one or more specific markers.
Bevacizumab (Avastin): Inhibits the creation of blood vessels that provide nutrients to the tumor, thereby slowing tumor growth. It is frequently used in combination with chemotherapy for locally advanced cervical cancer.
Immunotherapy
Immunotherapy utilizes the body's immune system to identify and eliminate cancer cells.
Checkpoint inhibitors: Immunotherapy drugs like pembrolizumab (Keytruda) enhance the immune system's ability to fight against cancer. They are used for advanced or recurrent cervical cancer that did not respond to prior treatments.
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Indications of Cervical Cancer:
Regular screening is essential since cervical cancer frequently exhibits no signs in its early stages. A number of symptoms and indicators may emerge as the cancer spreads. The following are typical symptoms and indicators of cervical cancer:
- Abnormal vaginal bleeding: This includes bleeding between periods, after sex, after menopause, or bleeding heavier than your normal menstrual period and lasting longer than the normal duration.
- Abnormal vaginal discharge: Watery, pink, or foul-smelling discharge, which is different than normal.
- Pain either when having sex: Discomfort or pain that occurs during sex.
- Pelvic pain: Pain in your lower stomach or pelvis that happens all the time or comes and goes.
- Painful urination: Discomfort or pain when you urinate. This may mean that the cancer has spread to surrounding tissue.
- Frequent urination or suddenly feeling like you can't hold yourself: Urinating more often or having the urgent feeling that you need to urinate.
- Back or leg pain: Ongoing pain in your back or legs. This may occur if cancer has spread to nearby tissues or nerves.
- Swelling in legs: Swelling of one or both legs that occurs without explanation. This could also mean that cancer spread to your lymph nodes and blocked blood flow.
Cervical cancer is not the only illness that can cause these symptoms. It's critical to visit a healthcare professional for assessment and necessary tests if you encounter any of these symptoms. Cervical cancer can be detected at an earlier, more treatable stage with the aid of routine screening procedures like Pap smears and HPV tests.
Major Causes of Cervical Cancer
Out of the more than 100 HPV kinds, the majority of cervical cancer cases are caused by 15 high-risk variants, of which two (16 and 18) are thought to be responsible for 70% of cases (76.7% in India). Nevertheless, a number of additional factors can raise the risk in addition to ongoing infection with high-risk HPV strains. Cervical cancer has the following causes:
- Human Papillomavirus (HPV) infection is the most relevant risk for cervical cancer. High-risk strains of HPV, especially types 16 and 18, are the cause of the majority of cervical cancer cases.
- Smoking: Women who smoke are approximately twice as likely as women who don't smoke to develop cervical cancer because tobacco smoke and its by-products can damage the DNA of cervical cells and potentially lead to cancer.
- Immunocompromised (weakened immune system): Women with weakened immune systems (ie. HIV/AIDS, or taking immunosuppressive drugs) are at a higher risk because their bodies may be less able to fight off HPV and other infections.
- Long term use of oral contraceptives: Long term use of the contraceptive pill (10+ years) can slightly increase the risk, but the benefits of taking the pill outweigh this slightly larger risk for most women.
- Multiple full-term pregnancies: A woman who has had three or more full-term pregnancies has a greater risk of developing cervical cancer, likely due to hormonal changes and also potentially increased HPV exposure.
- Family history of cervical cancer: A family history of cervical cancer could signify a genetic susceptibility to developing the disease.
- Exposure to Diethylstilbestrol (DES): Women whose mothers took DES (a hormone given to pregnant women from 1940 to 1971 to prevent miscarriage) have an increased risk of developing a rare type of cervical adenocarcinoma.
- Poor nutrition: Women who eat a diet low in fruits and vegetables are at a greater risk for cervical cancer due to the lack of vitamins and nutrients and potential antioxidants in fruits and vegetables that help to protect against cancer.
A number of processes are involved in the diagnosis of cervical cancer, including imaging investigations, diagnostic procedures, and screening tests. Here is a summary of the main techniques for identifying cervical cancer:
Screening tests
- Pap smear (Pap test): A Pap smear (Pap test) involves collecting cells from the cervix and examining those cells under a microscope to look for precancerous or cancerous changes. A Pap smear is a routine screening tool that helps in the early detection of cervical cancer.
- HPV DNA test: This test looks for high-risk types of human papillomavirus (HPV) that can lead to cervical cancer. The HPV DNA test is often done at the same time as the Pap smear.
Diagnostic procedures
- Colposcopy: If your Pap smear or HPV test indicates that you have abnormal changes, a colposcopy may be performed. Colposcopy is a procedure that uses a colposcope (a special magnifying instrument) to examine the cervix more closely. The colposcopist may use a vinegar solution to see areas that are abnormal.
- Biopsy: If suspicious areas are observed during the colposcopy, the colposcopist may take a biopsy. Biopsies can be performed in several ways:
- Punch biopsy: A small section of cervical tissue will be removed with a circular blade.
- Endocervical curettage: A small spoon-shaped instrument (curette) is used to scrape the cervical canal for any cells.
- Cone biopsy (conization)/ LEEP Biopsy: A larger cone of tissue is taken from the cervix. This is sent to the laboratory for examination. This is done with either a scalpel (cold knife cone biopsy) or with a loop electrosurgical excision procedure (LEEP) instrument.
Imaging tests
- X-ray: To determine whether cancer has spread to the lungs or other areas of the body.
- CT (Computed Tomography) scan: Gives detailed cross-sectional images of the body to locate tumours and determine their size.
- MRI (Magnetic Resonance Imaging): Utilizes magnetic fields to create detailed images of soft tissues and the extent of cancer.
- PET (Positron Emission Tomography) scan: Utilizes a very small amount of radioactive material to demonstrate the distribution of the cancer cells in the body.
- Ultrasound: Uses sound waves to creates images of the internal organs that can help assess for the spread of cancer.
Laboratory tests
Blood tests: While blood tests are not used to diagnose a cervical cancer specifically, they can help assess baseline levels of overall health, organ function and help assess if the cervical cancer has spread or had an effect on any organ system.
These diagnostic tests ultimately help provide the healthcare professional with information to assess the presence of, stage of and spread of cervical cancer in order to design a treatment plan that is based on best practice evidence. Early detection from screening is the best way to improve prognosis and treatment outcome.
Risk Factors:
Human Papillomavirus (HPV)
Most commonly affecting sexually active individuals, many infections clear easily. However, in some cases the virus can create a risk for developing cervical and prostate cancer. Of all the HPV types, HPV16 and HPV18 are the most widely recognized as high risks for cervical cancer. HPV vaccines can prevent HPV infections.
Compromised Immunity
Those who are taking steroids or immune therapy cancer treatment drugs for other conditions will have less immunity than the general public. For example, viral infection HIV (human immunodeficiency virus), which can produce acquired immune deficiency syndrome (AIDS) would compromise immunity overall.
Herpes
All these different types of sexually transmitted viral infections are a leading risk factor for cervical cancer and Herpes virus also produces cervical cancer in most the population.
Oral contraceptives
Oral contraceptives are the pharmacological agents for controlling birth. It has the potential for high prevalence of cervical cancer in women. It is probably because of the hormonal imbalance or improper regimen of the pills but more studies are warranted to determine the association.
Diethylstilbestrol (DES)
This drug is prescribed usually for the patients or clients with high probability of miscarriage. In later stages, the drug puts impregnated patients to a high risk for cervical and vaginal cancer.
Social and economic factors
Low- and moderate-income countries are at greater risk for the disease due to the social inability in screening adequately, and the lack of healthy sexual practices. High-income countries have a lower prevalence of cervical cancer incidences because they have access to regular reminders for screening.
Age
Younger individuals age 20 and younger are at decreased risk for developing cervical cancer. The age group that is most affected is 40-50 years of age. Menopause typically occurs after 40 years of age, which increases the risk for developing cervical cancer.
Smoking and drinking
Smoking increases the risk of cervical cancer two-fold, meaning that smokers are at higher risk of developing cervical cancer than non-smokers. Drinking alcohol (normally over 3-4 drinks a day) causes a high risk of cervical cancer in women as well.
Unsafe sex
People who have unsafe sex (without condoms or other barrier methods), have an increased risk of developing sexually transmitted diseases. When you have a sexually transmitted disease or simply the HPV, it can develop and ultimately cause cervical cancer.
Frequently Asked Questions (FAQ’s)
There live the blind texts separated they right at the coast of the Semantics.
The cost of treating cervical cancer for Indian patients ranges from USD 2880 to USD 3840. The price range for patients from abroad is USD 4320 to USD 5280.
Indeed, cervical cancer is curable, especially if caught early and treated. Radiation therapy, chemotherapy, immunotherapy, and surgery are available treatment options; the particular strategy used will depend on the stage and unique situation. For effective treatment and cure, early detection through routine screenings such as Pap smears and HPV tests is essential.
The stage of cervical cancer and the general health of the patient determine the optimal course of treatment. Surgery is frequently the recommended course of action for early-stage cancer, maybe followed by radiation therapy. Chemotherapy and radiation therapy are usually the main treatments for locally advanced malignancies.
Aster CMI Hospital, Apollo institutions, Manipal Hospital, and HCG Cancer Centre are just a few of the Bangalore institutions renowned for providing comprehensive cervical cancer treatment. For patients with cervical cancer, these hospitals provide specialised care, skilled oncologists, and cutting-edge treatment choices.