"Cervical cancer is more common in younger women under the age of 45."

Overview

The cervix

The cervix is the lower part of the womb, also called the neck of the womb. The womb and the cervix are part of a woman's reproductive system.

The reproductive system is made up of the:

vagina
womb, including the cervix
ovaries

The cervix is the opening to the vagina from the womb. It is a strong muscle.

The diagram shows the position of these organs in the body.

Where it starts?

Cell types

The cervix is covered with a layer of skin-like cells on its outer surface, called the ectocervix. Inside of the cervix, there are glandular cells that produce mucus. This is called the endocervix.

The skin-like cells of the ectocervix can become cancerous, leading to squamous cell cervical cancer. This is the most common type of cervical cancer.

The glandular cells of the endocervix can also become cancerous, leading to adenocarcinoma of the cervix.

Transformation zone

The area where cervical cells are most likely to become cancerous is called the transformation zone. It is the area just around the opening of the cervix that leads on to the endocervical canal.

The endocervical canal is the narrow passageway that runs up from the cervix into the womb.

Cervical screening

The transformation zone is the area that your doctor or nurse checks during cervical screening.

Cervical screening is not a test for cancer. It is a test to pick up abnormal cervical cells. If left untreated, the abnormal cells might develop into cancer.

Lymph nodes

Like all other areas of the body, there are lymph nodes around the womb and cervix. The nearest large group of lymph nodes are at the top of the leg (the groin area).

Lymph nodes (also called lymph glands) are part of the lymphatic system. They:

help to protect the body against infections
filter, drain and circulate the tissue fluid that bathes all body cells and tissues

Lymph nodes are also important in cancer. The tissue fluid that bathes the area containing the cancer, drains to the nearest lymph nodes. So if any cancer cells break away from the tumour, the first place they can go is to the nearest lymph nodes.

When you have surgery for cervical cancer, your surgeon usually takes out some lymph nodes. They send them to the laboratory to check for cancer cells.

How common it is?

Cervical cancer is the fourth most common cancer in women with estimated around more than half a million new cases annually in the world and 122,844 cases in India with mortality of up to 17/100,000.

Who gets it?

Cervical cancer is more common in younger women under the age of 45.

The main cause of cervical cancer is long lasting (persistent) infection of certain types of the human papilloma virus (HPV).

HPV is a common virus, and in most cases your immune system clears the infection without any problems.

Screening

We do not have a national screening program.In other parts of the world women aged between 25 and 64 have cervical screening. The screening test can pick up abnormal cells that could develop into cervical cancer if left untreated. Smear test is done every three years between 21-29 and every 3-5 years between 30-64.

Stages, types and grades

The stage of a cancer tells you how big it is and whether it has spread. The type means the type of cell the cancer started from. The grade means how abnormal the cells look under the microscope.

Your doctor uses all of this information to help them decide on which treatment you need.

Types and grades

There are different types of cervical cancer. The most common type is squamous cell cancer. Cancer cells are divided into 3 grades and the other variety is adenocarcinoma arising from the glandular cells that line the cervical canal.

Stage 1

Stage 1 means that the cancer is only in the neck of the womb (cervix).

Stage 2

Stage 2 means the cancer has spread outside the cervix, into the surrounding tissues.

Stage 3

Stage 3 means the cancer has spread from the cervix into the structures around it and lymph nodes in lower half of the abdomen.

Stage 4

Stage 4 means the cancer has spread to the bladder or back passage (rectum) or further away.

Cancer cervix or cervical cancer

Cervical cancer is the second most common cancer and the commonest gynecological cancer in India and amongst Indian women. The cervix the opening of the uterus into the vagina.

Prevention and early detection

Cancer of the uterine cervix occurs due to infection by the human papilloma virus. Most infections of the human papilloma virus can be prevented be vaccination which should ideally be carried out prior to initiation of sexual activity.

A simple outpatient test called a Pap smear, which is examination of cells scraped off from the cervix, under a microscope, can help detect changes pre cancerous changes and non invasive cancer in asymptomatic patients. Regular pap smear examinations, carried out once every 3 years, are strongly recommended for prevention and early detection of cervical cancer.

Care at APCC

Apollo team offers you comprehensive care with compassion, clinical excellence and with multi-disciplinary team (MDT). We have nationally and internationally recognized doctors treating you, and are up to date with current evidence and research.

We discuss every patient in the tumour board to decide what treatment options are available and tailor it as appropriately on an individual basis.

We offer full range of treatment options under one roof in all aspects of cancer care such as chemotherapy, radiotherapy and surgery. We offer Laparoscopic, Robotic and open surgery options. We have state of the art radiotherapy equipment along with proton therapy to minimize complications associated with radiation.

We offer fertility preserving options, nerve sparing procedures and treatment on par with the best results in the world. We offer sentinel node dissection on the robot.

For fertility preserving we offer trachelectomy (removal of cervix along with tissues around it) and preserving the uterus we are one of the few centers in the world offering this procedure so that woman can have babies who are diagnosed with early cervical cancer.

We are currently offering clinical trials in treating some of the cervical cancers which could turn out to be tomorrows cure.

We can assure you that we support you in all aspects during and after your treatment and give you the best possible care available in the world.

Risks and Causes

Find out about the risks and causes of cervical cancer, including the human papilloma virus (HPV).

Anything that increases your risk of getting a disease is called a risk factor. Different cancers have different risk factors.

Having one or more risk factors does not mean that you will definitely get cervical cancer.

Age

Cervical cancer is more common in younger women. More than half of the cervical cancer cases in are diagnosed in women under the age of 45.

Human Papilloma Virus (HPV) infection

The human papilloma virus (HPV) is a major cause of the main types of cervical cancer.

HPV is common. Most sexually active people come into contact with HPV during their lifetime. But for most the virus causes no harm and goes away on its own.

Types of HPV

There are many different types of HPV. Most are harmless but some cause genital warts, and others cause changes that can develop into cancer. As well as cervical cancer, HPV can cause anal, vaginal, vulvar, penile and some types of mouth and throat cancers. HPV can be passed on through close skin to skin contact, usually during sexual activity.

Around 12 types of HPV are considered high risk for cancer of the cervix. Two of these types (HPV 16 and HPV 18) cause about 7 out of 10 (70%) cervical cancer cases.

For most people, the immune system clears the HPV infection within 2 years. But sometimes this doesn't happen. If you have a long lasting (persistent) infection with a high risk type of HPV, you are more at risk of developing cervical cancer.

Sex

Practicing safer sex by using barrier methods like condoms will reduce your risk of getting HPV and passing it on. But they won’t protect you completely. Practicing safer sex will also help to protect you against many sexually transmitted diseases.

Vaccines

There are now vaccines to prevent HPV infection. All girls aged 12 or 13 can be offered the HPV vaccine. In some countries it is part of the National Programme. These vaccines protect against the types of HPV that are most likely to cause cervical cancer. But they don't protect against all types. So you still need to take part in cervical screening, even if you have had the HPV vaccine.

Human immunodeficiency virus (HIV)

Having human immunodeficiency virus (HIV) or AIDS increases the risk of developing cervical cancer. This risk might be reduced in women who are having treatment for HIV.

Other sexually transmitted infections

The risk of cervical cancer may be increased in women who have a sexually transmitted infection (STI) alongside HPV.

Women with both HPV and chlamydia, might have a higher risk of cervical cancer.

Smoking tobacco

Smoking tobacco increases your risk of getting cervical cancer. The risk increases with the more cigarettes you smoke a day and the younger your age when you start smoking.

Smoking also makes it harder to treat abnormal cells on your cervix.

It’s never too late to stop smoking but the sooner you stop the better.

Contraceptive pill

1 in every 10 cases of cervical cancer is linked to taking the contraceptive pill.

Taking the pill for more than 5 years increases the risk of cervical cancer. The increased risk begins to drop as soon as you stop taking it. After 10 years the risk is the same as if you had never taken it.

The pill can also slightly increase the risk of breast cancer. But it is important to know that taking the pill can help reduce the risk of womb and ovarian cancers.

Pregnancy

Women who have had children are at an increased risk of cervical cancer compared to those who haven't.

Having your first baby before the age of 17 also gives a higher risk, compared to women who had their first baby after the age of 25. The reasons for this are unclear.

Family history

You have an increased risk of cervical cancer if your mother, sister or daughter has had cervical cancer. We don’t know whether this is linked to faulty genes, or whether it is due to common shared factors like smoking.

Previous cancer

You have an increased risk of cervical cancer if you have had cancer of the:

vagina
vulva
kidney
urinary tract (includes the bladder and the tubes from the kidneys to the bladder)

One of the reasons for this might be previous radiotherapy treatment.

Reducing your risk

There are ways you can reduce your risk of cancer.

Cervical screening

Regular cervical screening can prevent cervical cancer by picking up abnormal cell changes in the cervix. These changes could lead to cancer if left untreated.

Vaccination

Practice safe sex

Stop smoking