Cervical Cancer: Treatment, Procedure, Cost and Side Effects

Cervical cancer is a type of cancer that occurs in the cells of the cervix. Cervix is located in the lower part of the uterus that connects to the vagina. Cervical cancer is one major cause of cancer and cancer caused deaths in women.

Early-stage cervical cancer generally do not produce any signs or symptoms. Signs and symptoms start to develop when the cells start affecting the surrounding cells of the cervix. Signs and symptoms of cervical cancer include abnormal pain, heavy abnormal discharge, pain during urination etc. Symptoms of more-advanced cervical cancer include vaginal bleeding after intercourse, between periods or after menopause, watery, bloody vaginal discharge that may be heavy and have a foul odor and severe pelvic pain or pain during intercourse.

Cervical cancer is caused when the cells in the cervix are infected by high-risk types of HPV or human papillomavirus

The different staging of cancer is based on the extent up to which the disease has spread. Cervical Cancer is divided primarily into four stages. It starts with Stage 0 which shows the only superficial spread of the infection, followed by Stage 1 which is characterized by the invasion into the cervix and uterus as well, along with the nearby lymph nodes.

In Stage 2, the spread is evident outside of the cervix and uterus, up to the vaginal upper part, while stage 3 shows the infection in the vaginal lower part and pelvis also. The most advanced one is Stage 4 in which cancer involves other body organs as well as distant lymph nodes.

Cervical cancer which is detected early can be cured faster and better and also alleviates the risk of other problems. Patients affected with cervical cancer are first screened and diagnosed properly before moving onto the treatment. Screening tests include a PAP test and HPV DNA test.

• PAP test :

  During a Pap test, cells from the cervix are taken by the doctor using scrapes and brushes. These cells are then examined in a lab for abnormalities.A Pap test help to detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.

• HPV DNA test :

  The HPV DNA test helps to diagnose cells collected from the cervix for infection with any of the types of HPV. These cells are most likely to lead to cervical cancer. This test is prescribed for women of age 30 and older, or for younger women with an abnormal Pap test.

• Colposcope

  A special magnifying instrument (colposcope) is used to check for abnormal cells in the cervix which show signs and symptoms of being infected with cancer cells.

• Other Test Include:

  Punch biopsy, Endocervical curettage, Electrical wire loop and cone biopsy are the several ways to detect the stage and extent of cancer in the body. For this purpose, imaging tests like X-rays, CT scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) are used. These tests along with visual examination of the bladder and rectum help the doctor to determine whether the cancer has spread beyond the cervix region.

Treatment for cervical cancer depends on several factors. These factors include the stage of the cancer, other health problems associated etc. Treatment methods include surgery, radiation, chemotherapy or a combination of the three.

• Surgery:

  Surgery removes the cancer cells from the body, depending on the location and extent of cancer spread. Surgery also takes into consideration the choice of bearing babies. Surgery is done when the tumor cells can be removed overall. Surgical procedures include conization, hysterectomy, cryosurgery, laser surgery, pelvic exenteration. etc. These procedures include laser beams or freezing and destroying methods to kill the cancer cells developed and prevent further multiplication of the same.

• Radiation:

  Radiation passes high-dose X-rays or implants in the vaginal cavity to kill the cancer cells. Radiotherapy can be of two types, external and internal. Radiotherapy may be given for larger tumours in the cervix and it is usually given if the cancer cells have spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery when there is a high risk that the cancer may come back. It is often given in combination with chemotherapy (chemoradiation).

• Chemotherapy:

  Chemotherapy is a method which uses medications which are usually injected into a vein, to kill cancer cells. These anti-cancer drugs aim to destroy all cancer cells with the least damage to normal cells. Chemotherapy is used in the advanced stage of cervical cancer. Chemoradiation is a combination of chemotherapy and radiation therapy.

There are several side effects of the methods used in the treatment of cervical cancer.

• Side effects of Surgery:

  Surgery can also require removal of the ovaries which means one will not be able to bear children anymore. Surgeries can leave behind parts of the cancer cells, which may later develop into something severe.

• Side effects of Radiation therapy:

  Radiation therapy for cervical cancer can cause side effects on the patient like fatigue (tiredness), upset stomach, diarrhea or loose stools (if radiation is given to the pelvis or abdomen), nausea and vomiting and skin changes.

• Side effects of Brachytherapy radiation:

  Brachytherapy radiation only travels a short distance and causes irritation on the cervix and the walls of the vagina. Long term side effects of radiation therapy includes vaginal stenosis and vaginal dryness. They cause the cells and tissues to scar which make the vagina narrower and stretching limited.

• Side effects of Radiation to the pelvis:

  Radiation to the pelvis can weaken the bones, leading to low bone density and bone fractures. Hip fractures are the most common. Legs can also become swelled because of the fluid drainage problems in the leg. This is called lymphoedema.

• Women may also face side effects of menopause, which takes on after three months of the beginning of the treatment.

After cervical cancer surgery, patients are encouraged to start moving about as soon as possible. This is done to encourage faster recovery and it is an essential part of recovery. If movement is not possible, patients must do regular leg movements and deep breathing exercises. Taking further medicines as prescribed and maintaining a proper life style will aid recovery faster. People should also consult their doctors after treatment for check-ups.

For a laparoscopic or vaginal hysterectomy, people stay at the hospital for two or three days. They need about three to four weeks to recover. For an abdominal hysterectomy, patients stay at the hospital is for three to five days and complete recovery takes about four to six weeks.

Recovery from total pelvic exenteration takes a long time. They take around six months to recover completely. Some may even take a year or two. Radiation therapy and chemotherapy usually occur in sessions, thus, recovery takes a greater time.

Treatment of cervical cancer is very expensive. Surgeries and session wise radiation and chemotherapies are highly out of pocket for most of the mass. The cost of the cervical cancer treatment in India is around Rs 3,00,000- Rs 10,00,000. Some people incur even greater costs due to extended treatment and other associated complications.

Treatment aims to permanently cure cancer or to bring about a complete remission of the disease. Usually, people with early detection of cervical cancer get treated permanently. But, the consequences of the procedures last life long for the majority of the people.

Also, treatment may fail to save the patient from the life threatening cancer cells if they are detected at a late stage when recovery is impossible. Later stages of cancer cannot be cured by treatment. Early detection may help the person live normal life expectancy but with some side effects.

There are several types of alternative treatments available for cervical cancer. Apart from the standardized surgeries and therapies, people may use other methods like acupuncture, massage therapy, herbal products, spiritual healing, visualization etc for curing cervical cancer. Meditation and a proper diet rich in vitamins can also be used to prevent cancer cells from growing and reproducing.

Many patients claim that these alternative treatments help them feel better. It is important to remember that these alternative treatments can only be done alongside the main treatment. These complementary treatments are done to provide relief from the symptoms and side effects of cancer treatments. Some types of alternative treatment may interfere with standard treatment. In some cases, the combination of alternative treatment and standard treatment may even be harmful. Hence, it is always better to consult a doctor at every step.

Summary: Cervical Cancer is a common form of cancer that occurs due to abnormal cell changes as a result of HPV infection in the cervix. It is quite easily diagnosed at the early stage and can be successfully eliminated if it undergoes the proper treatment at this stage. In case it is left untreated, it will lead to an advanced stage which starts invading the other organs and the spread becomes faster.