Cervical cancer - Part 1

Article written by Sreyashree Bose and Infographic by Rutuja Chalke

Cervical cancer

Cervical cancer is the 4th most common cancer that contributes to the cancer-related deaths in women. In 2018, ~570 000 women were diagnosed with cervical cancer worldwide, and about 311 000 women died from this disease. Cervical cancer is usually detected between the age of 35 – 44, while the average age of diagnosis is 50. Women aged 65 and above, who did not undergo appropriate screening for cervical cancer, contribute to almost 20% of all the reported cases. Although 66% of women diagnosed with cervical cancer have a 5-year survival rate, several factors including race, ethnicity, and age, contribute heavily to the survival rate among patients. Based on a 2018 survey, India reported an estimated 96 922 new cervical cancer cases (9.2%) with an age-standardized incidence rate of 14.7/10^5 which is higher than the rates observed in many other countries across the globe and 60 078 cervical cancer deaths (8.4%) with a mortality rate of 9.2/10^5, also higher than many other countries in the world. Therefore, it is critical to empower women, especially in India with the knowledge of cervical cancer.

What is cervical cancer?

Cervical cancer occurs due to abnormal cell growth in the cervix, a part of the female reproductive system that connects the vagina to the uterus. A woman’s cervix has two major parts – Endocervix and Ectocervix. The part of the cervix opening to the uterus is called the endocervix and is composed of glandular cells while the ectocervix, the lower part opening to the vagina, is composed of squamous cells. The transformation zone is a region between the endo- and ectocervix where the flat squamous cells meet with the uterine/cervix-specific glandular cells. This zone can shift with age and during pregnancy. Most cervical cancer originates in the transformation zone.

Cancer is an unwanted transformation of normal cells into abnormal cells. In cervical cancer, this transformation involves a pre-cancerous state where the cells start showing atypical behavior. This is often described as cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia by doctors. Unfortunately, detecting the pre-cancerous stage in cervical cancer depends entirely on the screening tests due to lack of symptoms.

However, it is essential to consult a physician in case of the following symptoms –

Blood spots or light bleeding between or following periods
Menstrual bleeding that is longer and heavier than usual
Bleeding after intercourse, douching
Increased vaginal discharge
Pain during sexual intercourse
Bleeding after menopause
Unexplained, persistent pelvic and back pain

“it is critical to empower women, especially in India with the knowledge of cervical cancer”

The Viral Factor

Human Papillomavirus or HPV has emerged as a significant factor that causes cervical cancer. Interestingly, HPV infection is common, and most women contracting HPV might never get cancer. However, in a few women, the HPV can utilize its biological machinery to generate unwanted mutations in the DNA of cervical cells, which ultimately nudges the normal cells into the path of becoming pre-cancerous. At this point, if the body’s immune system is successful in fighting the infection, the pre-cancerous cells are wiped off, and disease progression stops. However, inability to fight the infection can promote the successful growth of cancerous cells, thereby giving rise to cervical cancer. Some of the factors which increase the risk of developing cervical cancer are –

Immune system deficiency – Women immunocompromised from medications, organ transplantation, or secondary infections like HIV have a high risk of developing cervical cancer when infected by HPV.
Herpes
Smoking – Women smokers are twice likely to develop cervical cancer as compared to non-smokers
Age – Women aged 30 and above are at a high risk of cervical cancer. So, it is critical to keep getting screened with a pap smear test every couple of years.
Socioeconomic factors – Women in developing countries often struggle to access pap smears and other screening procedures, eventually increasing their risk of developing undetected cervical cancer.
Oral contraceptives – Preliminary research indicates taking oral contraceptives increases the risk of cervical cancer, but this needs further evaluation.
Exposure to diethylstilbestrol (DES) – Women whose mothers were on diethylstilbestrol to prevent miscarriages are at high risk for developing cervical cancer as well

Overall, cervical cancer might seem like a brutal disease, but it is also one of the few diseases which can be prevented by taking care of certain critical aspects of a healthy lifestyle, regular checkups and cured through early detection. So, stay tuned for our next article, where we will talk about the resources to prevent cervical cancer.

References

Mayo Clinic, Cervical Cancer
American Cancer Society, Cervical Cancer
Center for Disease Control, Cervical Cancer
Cancer.net
Bobdey, S., Sathwara, J., Jain, A., & Balasubramaniam, G. (2016). Burden of cervical cancer and role of screening in India. Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology, 37(4), 278–285. https://doi.org/10.4103/0971-5851.195751
World Health Organization, Cervical Cancer
Balasubramaniam G, Gaidhani RH, Khan A, Saoba S, Mahantshetty U, Maheshwari A. Survival rate of cervical cancer from a study conducted in India. Indian J Med Sci, doi: 10.25259/IJMS_140_2020

Meet the team

Content writer

Sreyashree Bose

Sreyashree Bose is currently working as a Scientist, Process Development at Lonza Inc. Earlier she worked preclinical translational studies for metastatic breast cancer as a Postdoc.

Illustrator

Rutuja Chalke

Ms. Rutuja Dattatray Chalke is a science illustrator determined to embark on her successful journey in scientific illustration. She has completed her Master’s in Biotechnology from St. Xavier’s College (Autonomous), Mumbai. She started her professional career as a copy editor at Scholarly Editing and Translation Services Pvt Ltd, Mumbai. She simultaneously did a certificate course in graphic design from Xavier Institute of Communications, St. Xavier’s College (Autonomous), Mumbai. Currently, she is a full-time UI/UX designer at Techstalwarts LLP, Mumbai, and a part-time freelance science illustrator. She creates scientific illustrations, zines, infographics, and 2D animations to communicate science engagingly; her artworks are available on Instagram under ‘Tela di scienza.’

Edited by: Nivedita Kamath