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Cervical Cancer is the second most form of cancer in females in India, a study by WHO reports; is radiation a preferred treatment option?

By Dr  Gagan Saini, Associate Director, Department of Oncology, Max Healthcare

Dr  Gagan Saini

Cervical cancer accounts for one third of all global deaths, and is the second leading cause of cancer deaths in women in India. Nearly 50 per cent of middle-aged women in India were found were found to have positive cases of high-risk human papillomavirus or the HPV, the main risk factor for cervical cancer. The Human Papilloma Virus (HPV) is a group of viruses that are most common worldwide. At least 14 of these HPV are known to cause cancer particularly, 16 and 18 that cause 70% cervical cancers and precancerous cervical lesions.Cervical cancer is a type of cancer that occurs in the cells of the cervix. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancers.

Dr Gagan Saini, Associate Director, Department of Oncology, Max Healthcare says, “The risk factors are many in contracting cervical cancer. With the onset of sexual activity moving to younger ages, early age of unprotected sexual activity could be a leading factor. The others include early marriage, multiple pregnancies, multiple sexual partners of self or of partner, persistent HPV (Oncogenic), smoking, HIV as risk factors for Cervical Cancer.”

Dr Gagan Saini elaborates on the tests that can confirm an individual having contracted cervical cancer, “Pap Test and HPV DNA testing are major screening tests for Cervical Cancer. HPV DNA testing is offered to women at 30 years and above. In women of the ages between 21-30 years screening is recommended every three years using Pap Test. In women ages 30 and above, Pap test combined with HPV DNA testing is recommended every 5 years. In high risk women may be screened at shorter interval.”

Dr Saini says, “The early symptoms of cervical cancer include abnormal bleeding, bleeding between menstrual periods, after sex, after a pelvic exam, or after menopause; any unusual amount of discharge, color, consistency or smell; frequent & painful urination; pelvic pain.”

The stage of a cervical cancer is the most important factor in choosing treatment. Other factors affecting your treatment options include the exact location of the cancer within the cervix, the type of cancer, age and overall health. For many common cancers, such as breast cancer, bowel cancer and prostate cancer, radiation therapy is highly effective in reducing the risk of cancer recurrence after surgery or making the surgery more successful. Radiation therapy uses high energy x-rays or radioactive particles to kill cancer cells and is appropriate for cervical cancer.

Dr Saini explains, “Radiation therapy uses high energy x-rays or radioactive particles to kill cancer cells. Radiation therapy may be used for cervical cancer as a part of the main treatment for some stages of disease. The preferred treatment for early stages is radiation alone or surgery followed by radiation. For stage two and more, radiation and chemo given together (called concurrent chemoradiation) has stood the test of time and is the preferred treatment. High quality research from India and Europe has found that even after surgery up to half the patients end up needing radiation therapy also (due to the high risk factors). The two treatments given together bring no extra benefit but do add problems of two heavy treatments. Therefore radiation therapy with concurrent chemotherapy is safe and effective without compromising on outcomes. Concurrent chemo helps the radiation work well. Radiation therapy may also be used to treat cervical cancer that has spread or that has come back after treatment to treat cancers that have spread to other organs and tissues.”

The types of radiation therapy most often used to treat cervical cancer are external beam radiation or EBRT and Brachytherapy. The external beam radiation therapy (EBRT) is a radiation to aim x-rays at the cancer from outside the body. Treatment is similar to a regular x-ray, but the radiation dose is stronger. Each radiation treatment lasts only a few minutes, but preparing the patient for treatment usually takes longer. The procedure is painless. It is also be used by itself to treat areas of cancer spread or as the main treatment of cervical cancer in patients who cannot tolerate chemoradiation.

Advising prevention of the disease, Dr Gagan Saini says, “Prevention of cervical cancer is possible with simple life style modifications. A combination of regular exercises with balanced diet can work well. One should also increase consumption of fruits and vegetables and eat in the portion of 2-3 servings. Avoid becoming obese, that means no binge eating, smoking, following healthy sexual practices and regular screening even when healthy after 30 years of age in women.

India accounts for one fourth of the global burden of cervical cancer. It also accounts for 17% of cancer deaths among women. The maximum number of cases is reported in women in the age groups between 50 – 59 years.Bottom of Form

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