News Excerpt:

In a significant step that can reduce the incidence of cervical cancer - the second most common cancer in women in India - the government is set to roll out human papillomavirus (HPV) vaccination campaigns for girls in the 9-14 years age group.

About the human papillomavirus (HPV) vaccination campaign:

• The immunization drive is planned in three phases over three years.
• The vaccine also offers protection against the HPV strains that cause cancer of the anus, vagina and oropharynx. Additionally, it also protects against the HPV strains that are responsible for genital warts.
• Currently, the two-dose HPV vaccine is available commercially for about Rs 2,000 per dose. 
• But once the government includes it in its immunization programme, it will be available for free.
• A third of the children (girls) between the ages of 9 and 14 will be immunized yearly for three years.
• Nearly 8 crore children between the ages of 9 and 14 years will be eligible for the vaccine nationwide.
• The immunization drive will be conducted through schools and existing vaccination points.

About Cervical Cancer:

• Cancer is a disease in which cells in the body grow out of control. 
• Cervical cancer occurs when healthy cells on the cervix become infected with HPV and multiply rapidly, forming a mass or tumour, which can be cancerous or benign. 
• Initially, these changes are not cancerous, but they can gradually lead to cancer. 
• Precancerous tissue needs to be removed to stop cancer from developing. 
• If the precancerous cells change into cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer or invasive cervical cancer.
• There are two main types of cervical cancer named for the type of cell where the cancer starts:
• Squamous cell carcinoma makes up about 80 to 90 % of all cervical cancers.
• Adenocarcinoma makes up 10 to 20 % of all cervical cancers.

Location of the cervix:

• The cervix is the lower, narrow end of the uterus at its junction with the vagina. 
• When cells lining this part of the uterus undergo neoplastic-cancerous change, we call it cervical cancer.
• The location of cervical cancer is usually where the endo cervix meets the ecto cervix – what is commonly referred to as ‘transformational zone.

How does this part of the uterus get cancer?

• Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. 
• HPV is a common virus that is passed from one person to another during sex. 
• At least half of sexually active people have HPV at some point in their lives, but few get cervical cancer.
• Persistent infections with certain high-risk HPV strains lead to nearly 85 % of all cervical cancers. 
• At least 14 HPV types have been identified as oncogenic (potential to cause cancer). 
• Among these, HPV types 16 and 18, considered to be the most oncogenic, have been found to be responsible for about 70 per cent of all cervical cancer cases globally.

Who is more prone to cervical cancer?

• It occurs most often in people over age 30. 
• Individuals who are infected with HPV are prone to cervical cancer. 
• Since males do not have a cervix, they cannot get cervical cancer; however, sexually active men can be infected with HPV. 
• Due to HPV infection, men may develop HPV-associated cancer of the mouth and throat, penis, or anus from particular strains of the virus. 
• Currently, no tests are available to check for this virus in men.

Symptoms:

• Experts suggest that early-stage cervical cancer, generally, has no signs or symptoms.
• Most women present with complaints of irregular menstrual cycles, intermenstrual bleeding, post-coital bleeding, foul-smelling vaginal discharge, and lower abdominal/back pain, post-menopausal bleeding and discharge can be a symptom of cervical cancer in 10 % of cases.

How is it diagnosed?

• Many tests are used for diagnosing cervical cancer, depending on -
  • The type of cancer suspected
  • Signs and symptoms
  • Age and general health
  • The results of earlier medical tests
• The following tests are used to diagnose:
  • Bimanual pelvic examination
  • Pap test
  • HPV typing test
  • Colposcopy- to help guide biopsy of the cervix
  • Biopsy
  • MRI is used to measure the tumour’s size
  • PET scan
  • Biomarker testing of the tumour.