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Cervical Cancer

In developing countries, cervical cancer remains a leading cause of cancer-related death amongst women.

According to the World Health Organization (WHO); among all the cancers affecting women, cervical cancer is the fourth most frequent cancer with an estimated 570,000 new cases recorded in 2018.

• In developing countries, cervical cancer remains a leading cause of cancer-related death amongst women.
• Nearly 90% of cervical cancer related deaths have occurred in low- and middle-income countries.
• In India, a population of 436.76 million women aged 15 years and older, are at a risk of developing cervical cancer.

The HPV (Human Papilloma Virus) is accountable for 99% of cervical cancer cases. HPV-16 and HPV-18 are the two strains of virus, which affect more than 70 percent of cervical cancer cases. These are referred to as high-risk HPV types.

Risk factors for cervical cancer are smoking, multiple births, prolonged use of oral contraceptives, early sexual contact, multiple sexual partners, HIV infection, fetus’s exposure to Diethylstilbesterol (DES).

Cervical cancer doesn’t usually cause symptoms until it’s in an advanced stage. Usually the first signs are abnormal bleeding, for eg. between menstrual periods, after a pelvic exam, or after menopause; an unusual discharge that differs in colour, consistency, or smell; frequent and painful urination; pelvic pain.

American Cancer Society (ACS) recommends regular screening check-ups for cervical cancer. The screening tests include:
• Pap smear test
• HPV DNA test

Cervical cancer doesn’t usually cause symptoms until it’s in an advanced stage. Usually the first signs are abnormal bleeding, for eg. between menstrual periods, after a pelvic exam, or after menopause; an unusual discharge that differs in colour, consistency, or smell; frequent and painful urination; pelvic pain.

American Cancer Society (ACS) recommends regular screening check-ups for cervical cancer. The screening tests include:
• Pap smear test
• HPV DNA test

Various international cervical cancer bodies have given current screening recommendations for specific age groups, charting out guidelines by ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology (ASCP), the US Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynaecologists (ACOG). The recommendations are as follows:

• < 21 years: No screening recommended
• 21-29 years: Cytology (Pap smear) every 3 years
• 30-65 years: Human papillomavirus (HPV) and cytology co-testing every 5 years or cytology alone every 3 years
• >65 years: No screening recommended if prior screening has shown negative results and high risk is not present

The treatment regimen includes:
• Surgery
• Radiation therapy
• Chemotherapy with drugs such as cisplatin, carboplatin, paclitaxel, topotecan, 5-flouroracil
• Targeted therapy

Targeted therapy

Bevacizumab, a monoclonal antibody that inhibits angiogenesis (growth of new blood vessels), is a newer drug that works in a different way from chemotherapy and radiation. It directly binds vascular endothelial growth factor (VEGF) to inhibit angiogenesis. This drug is often given together with chemotherapy.

WHO recommends a comprehensive approach to cervical cancer prevention and control. The recommended set of actions includes interventions across the life course. It should be multidisciplinary, including components from community education, social mobilization, vaccination, screening, treatment and palliative care.

In October 2018, the U.S. Food and Drug Administration (FDA) approved the use of human papillomavirus (HPV) vaccine for people aged 27–45 years. The vaccine was already approved for people aged 9–26 years.

Useful links :
• https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en
• https://www.nhp.gov.in/disease/reproductive-system/female-gynaecological-diseases-/cervical-cancer
• https://www.acog.org/Patients/FAQs/Cervical-Cancer?IsMobileSet=false
• https://www.mayoclinic.org/diseases-conditions/cervical-cancer/diagnosis-treatment/drc-20352506
• https://www.cdc.gov/cancer/cervical/index.htm
• https://www.cancerresearchuk.org/about-cancer/cervical-cancer/treatment/chemotherapy/drugs

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