Cervical cancer originates in the cells of the cervix, which is the lower, narrow part of the uterus that connects to the vagina (birth canal). It generally affects women between the ages of 20 and 50.
The widespread use of the Papanicolaou test (Pap test) has been crucial in reducing the mortality rate from cervical cancer in India by helping doctors detect it in its earliest, most treatable stages. Furthermore, increased uptake of the Human Papillomavirus (HPV) vaccine is expected to decrease the number of cervical cancer cases even further.
Before cancer develops, the cells of the cervix often undergo precancerous changes known as dysplasia. This process is typically very slow, developing over many years. Regular Pap tests, usually recommended every three to five years, look for these changes. If precancerous cells are found, they can often be removed, preventing the formation of cancer. If left untreated, these abnormal cells can eventually become cancerous and spread into the cervix and surrounding tissues.
The vast majority of cervical cancer cases are caused by infection with Human Papillomavirus (HPV), which is commonly passed through sexual contact. While the average person's lifetime risk of contracting HPV is high (around 80%), the immune system successfully clears the virus in most people before it causes cell changes. However, in a small percentage of individuals, the virus persists, leading to the cellular changes that may result in cancer.
Cervical cancer is classified according to the cell type where it develops. The most common types include:
This is the most prevalent type, accounting for 80% to 90% of cases. It develops on the surface of the cervix.
This type develops in the gland cells that produce cervical mucus, representing about 10% to 20% of cases.
Occasionally, a cancer may exhibit features of both squamous cell carcinoma and adenocarcinoma.
In rare instances, other forms of cancer, such as neuroendocrine tumours (small and large cell cervical cancer), melanoma, sarcoma, and lymphoma, can be found in the cervix.
Factors that increase the risk of cervical cancer are generally those that increase the chance of acquiring HPV, decrease the ability to receive regular screening, or weaken the immune system. These risk factors include:
The risk increases with age, most often found in women over 40. However, younger women frequently have precancerous lesions that require treatment.
Chemicals in cigarette smoke can damage the body's cells and increase the risk of precancerous changes, particularly in women with HPV.
Since HPV is sexually transmitted, certain behaviours can increase infection risk, such as having multiple sexual partners, high-risk male partners, first intercourse at an early age, or not using condoms during sex.
Lack of regular Pap tests, having a sexually transmitted disease (like chlamydia), HIV infection, a weakened immune system (from an organ transplant or taking steroids), and Diethylstilbestrol (DES) exposure before birth (if the mother took the drug between 1940 and 1971).
It is important for women with risk factors to discuss them with a healthcare provider.
In its earliest stages, cervical cancer typically presents with no noticeable symptoms, which underscores the critical importance of regular Pap tests, especially for sexually active women.
When symptoms do occur, they may vary and can include:
Abnormal vaginal bleeding, such as excessively heavy periods, bleeding between menstrual periods, or bleeding after menopause.
Vaginal discharge that is tinged with blood.
Vaginal bleeding and/or pain during sexual intercourse.
Increased frequency of urination.
Pelvic pain.
These symptoms are not exclusive to cervical cancer and may indicate other health issues. Any concerning symptoms should be discussed promptly with a doctor.
Accurate and early diagnosis is vital for choosing the most effective treatment plan and determining if the cancer has spread. At SSCHRC, our specialised pathologists, diagnostic radiologists, and technicians use advanced equipment to diagnose and stage the disease.
If symptoms or Pap test results suggest precancerous cells or cervical cancer, a doctor will perform an examination and inquire about the patient's health, lifestyle, and family medical history. One or more of the following tests may be used for diagnosis and staging:
An instrument called a colposcope (a type of microscope) is used to examine an area of abnormal tissue on the cervix, vagina, or vulva more closely.
A small amount of tissue is removed from the cervix and examined under a microscope. Types of cervical biopsies include:
If there is concern about spread, lighted tubes may be used to view the inside of the bladder (cystoscopy) or the anus, rectum, and lower colon (proctoscopy).
These non-invasive tests help determine the extent of the disease and may include CT (Computed Axial Tomography) scans, MRI (Magnetic Resonance Imaging) scans, PET (Positron Emission Tomography) scans, Chest X-rays, and Ultrasounds.
Lymph nodes may be removed surgically to check for cancer spread.
Following a cancer diagnosis, staging is performed to classify the extent of the disease in the body, which guides the development of the treatment plan. The staging for cervical cancer is set by the International Federation of Gynecology and Obstetrics (FIGO) and ranges from Stage I to Stage IV. Higher stages indicate more advanced disease.
Abnormal cells are found only in the inner lining of the cervix, but they have not yet become invasive cancer.
The cancer is confined to the cervix only.
The cancer has spread beyond the cervix and uterus but has not reached the lower third of the vagina or the pelvic wall.
The cancer has spread to the lower third of the vagina and/or extends to the pelvic wall, and/or has caused kidney problems (hydronephrosis), and/or involves nearby lymph nodes.
The cancer has spread to distant organs or has invaded the bladder or rectum.
The optimal treatment for cervical cancer is individualised and depends on several factors, including the stage and size of the tumour, whether it has spread, the patient's age and overall health, and the desire to have children in the future. Treatment for pregnant patients is also carefully tailored based on the stage of pregnancy and cancer.
At SSCHRC, treatment plans are customised, and one or more of the following therapies may be recommended:
Surgical options vary depending on the size and spread of the cancer:
Uses an instrument to freeze and destroy precancerous tissue.
Electrical current is passed through a thin wire loop to remove precancerous lesions.
A procedure identical to a cone biopsy that removes all cancerous tissue. It may be an option when the cancer is small, and the woman wishes to preserve fertility.
Removal of the uterus and the cervix. Minimally invasive laparoscopic or robotic surgery may be an option.
Removal of the fallopian tubes and ovaries, sometimes performed concurrently with a hysterectomy, particularly for women nearing menopause.
Removal of the cervix and surrounding tissue but preserving the uterus. This procedure is generally reserved for younger women with specific, larger tumours (usually up to 2 centimetres) who wish to retain the ability to have children.
Removal of the cervix, uterus, part of the vagina, the surrounding tissues (parametria), and nearby lymph nodes.
A complex surgery, sometimes performed for recurrent cancer, that removes the organs and tissues of a radical hysterectomy along with the bladder, vagina, rectum, and part of the colon.
Used to identify the key lymph nodes in the initial spread of the cancer, often performed as part of a larger surgical procedure.
Radiation therapy uses powerful, focused energy beams to kill cancer cells while minimising damage to healthy tissue. It is often used to treat cervical cancers that have spread beyond the cervix, for very large lesions (greater than 4 centimetres), or as an alternative to surgery. It may also be delivered after surgery to reduce the risk of recurrence.
Two main types of radiation therapy are:
Focuses multiple beams of different intensities directly on the tumour for the highest possible dose.
Delivers radiation using small pieces of radioactive material placed on or inside the patient's body, close to the tumour. This allows for a very high, concentrated dose of radiation directly to the tumour.
Chemotherapy involves the use of drugs to kill cancer cells, control their growth, or relieve symptoms. It may involve a single drug or a combination of drugs. SSCHRC offers modern and advanced chemotherapy options, along with supportive care to manage side effects such as nausea and constipation.
As a leading research centre, SSCHRC actively participates in clinical trials that investigate new treatments for cervical cancer. Research initiatives are focused on improving treatment outcomes, including tumour response and quality of life. Recent research has contributed to new standards of care, such as demonstrating that chemotherapy combined with radiation improves patient survival outcomes, and pioneering minimally-invasive and fertility-sparing surgical strategies. SSCHRC is also committed to global initiatives for prevention and detection in low-resource settings.