Cervical Cancer Treatment in Delhi, India

There are two main types of cervical cancer:

• Squamous cell carcinoma: It is the most common type of cervical cancer which develops from the flat cells that cover the outer surface of the cervix at the top of the vagina.
  
• Adenocarcinoma: This type of cervical cancer develops from the glandular cells that line the cervical canal (endocervix). As adenocarcinoma starts in the cervical canal, it can be more challenging detecting with cervical screening tests.

Cervical cancer often develops between the ages of 40 and 55. Symptoms usually do not appear until abnormal cervical cells become cancerous and invade the nearby tissues. A cervical tumour usually starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. The initial 'pre-cancerous' abnormality of cervical cells is usually caused by a prior infection with the Human Papillomavirus (HPV).

Cervical Cancer Causes Are:

• Sexual activity before the age of 18 years
• A partner previously involved with a woman having cervical cancer
• Personal history of sexually transmitted viruses such as herpes infection or HPV. 99.7% of women with cervical cancer have an HPV infection.
• More than three pregnancies
• A weakened immune system
• Smoking
• Unsupervised long term use of oral contraceptives

Very early-stage cervical cancer may have no symptoms at all. This means it’s important to attend regular cervical screening so that any cell changes can be picked up early. Some signs and symptoms of cervical cancer include:

• Contact spotting or bleeding
• Increased/blood-stained vaginal discharge
• Abnormal bleeding between menstrual periods or excessively heavy periods
• Postmenopausal vaginal bleeding
• Back pain
• Fatigue
• Leg pain
• Pelvic pain
• Single swollen leg
• Weight loss
• Heavier periods than usual

Regular screening is the best way to reduce the risk of cervical cancer.

At Max Institute of Cancer Care, cervical screening is an important way of detecting early changes in cells of the cervix so that treatment can be given to prevent cancer from developing. It involves taking a sample of cells from the cervix using a test known as liquid-based cytology. The age range for screening varies between the ages of 25-64.

If abnormal cells are found during the cervical screening test, to confirm the diagnosis, a colposcopy is advised. For this test, a speculum is gently put into the vagina so the cervix can be seen in detail using a magnifier (colposcope). During colposcopy, it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope to look for cancer cells.

• Computerized Tomography Scan (CT Scan)
• Magnetic Resonance Imaging (MRI Scan)
• Chest X-ray
• Ultrasound
• Colposcopy
• Cone Biopsy
• Blood test or other tests

• How much the tumour has grown, and whether it has extended to other nearby structures such as the bladder or rectum.
• Whether the cancer has spread to local lymph glands
• Whether the cancer has spread to other areas of the body

When it comes to cervical cancer, Max Institute of Cancer Care believes in the philosophy of providing holistic, integrated care. This includes a consolidated review of each and every case from experts in surgical oncology, radiation oncology and other concerned specialities depending on the need. The cases are discussed in the Tumor Board. Based on international evidence-based guidelines, a plan of action is formulated. The options of management offered are surgery, radiotherapy, chemotherapy or a combination of all the above modalities. The treatment decided depends on the clinical staging of cervical cancer. Surgery to remove cervical cancer may be an option when the cancer is confined to the cervix.

• Primary prevention: HPV vaccines have the potential for preventing cervical cancer. Routine vaccination with proper counseling is recommended for the female ages 11 to 26. Please consult your gynaecologist and understand the risk and benefits.
• Secondary prevention: By diagnosing and optimally treating the precancerous conditions of cervical cancer.

Depending on the stage of the cancer, patients are grouped in early and locally advanced cancer types. In early cervical cancer, patients are treated by surgery and radiation is followed, if required. In Locally advanced cervical cancer, patients are treated by chemotherapy and radiotherapy. Most cervical cancers are preventable and treatable with hopes of a cure. Cervical cancer treatment options includes the following:

• Loop Electrosurgical Excision Procedure (LEEP): A procedure that employs electricity to remove abnormal tissues.
• Cryotherapy: This procedure involves freezing abnormal cells.
• Laser Therapy: This therapy uses light to destroy cancerous tissue.
• Radical Hysterectomy: This involves removal of the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
• Pelvic Exenteration: A rare surgery in which all the organs of the pelvis, including the bladder and rectum, are removed.
• Radiation Therapy: Internal or external radiation may be used to treat the cancer that has spread beyond the pelvis, or cancer that has returned.
• Chemotherapy: This involves the use of certain drugs that kill the cancer tissues.

Max Institute of Cancer Care (MICC) at Max Hospitals, India, is one of the leading facilities in India, which offers the latest treatments under surgical oncology, radiation oncology, and medical oncology. It is one of the largest cancer centres in North India, with presence in Saket, Patparganj, Shalimar Bagh, Vaishali, Mohali and Bathinda. It offers high-end treatments like Intensity Modulated Radiotherapy (IMRT), and Image-Guided Radiation Therapy (IGRT) with facilities like Cone-beam Computerized Tomography (CBCT) and ExacTrac.

Max Institute of Cancer Care offers comprehensive cervical cancer care which is delivered by trained/certified surgical oncologists, radiation oncologists and medical oncologists with a complete back-up of requisite speciality services. Skilled professionals on the multidisciplinary team include genetic counselors, medical geneticists, medical oncologists, nurse navigators, nurse practitioners, pathologists, plastic and reconstructive surgeons, radiation oncologists, radiologists, Social workers, surgical gynecologists, and surgical oncologists

When it comes to cervical cancer, we have a wide range of diagnostic tests and various types of treatment options available for you.

• What is Cervical Cancer?
• Learn about Cervical Cancer Awareness
• Know the Symptoms of Cervical Cancer
• Cervical Cancer & its Prevention by Vaccination
• What Women Should Know about Cervical Cancer?

1. What is the purpose of the HPV vaccine?
Ans: The HPV vaccine is designed to protect against Human Papillomavirus (HPV) that can cause cervical cancer. Routinely, 3 doses at 0, 1, and 6 months are recommended for 15 to 26 years.

2. How often should women undergo a pap test?
Ans: Women between the age of 21 and 29 should have a pap test every three years. Women between the age of 30 and 65 can have a pap test combined with an HPV test every five years.

3. What should a woman do if she gets an abnormal Pap test result?
Ans: When faced with abnormal Pap test results, the recommended course of action depends on whether it indicates Low-Grade Squamous Intraepithelial Lesion (LSIL) or High-Grade Squamous Intraepithelial Lesion (HSIL). For LSIL, further Pap testing is typically recommended, while for HSIL, a colposcopy examination is necessary, along with biopsies of any suspicious areas.

4. Can cervical cancer be cured?
Ans: The curability of cervical cancer depends on factors such as the stage of cancer and the overall health of the patient. When detected early, cervical cancer is often curable through treatments like surgery, radiation therapy, or chemotherapy.

5. Which is the best test to screen for cervical cancer?
Ans: The Pap test (Pap smear) and the HPV (human papillomavirus) test are both important screening methods for cervical cancer. The best choice between these tests depends on various factors, including a person's age, medical history, and specific risk factors. The presence of HPV association is not diagnostic of cervical cancer. Moreover, its presence does not alter treatment (in oropharyngeal cancer. Hence, the best test to detect is biopsy.

FAQs reviewed by Dr. Sandeep Batra, Director, Cancer Care / Oncology, Gynecologic Oncology.