Signs and symptoms of cancer cervix

Dr. Bhagyalaxmi Nayak, M.D., Ph.D.
Asst. Professor, Gynaecologic Oncology,
Acharya Harihar Regional Cancer Centre, Cuttack-753007, India

Worldwide around 450,000 – 500,000 cases of cancer cervix are diagnosed each year. In developing countries, it is the most common cause of cancer death, 275,000 deaths in 2008, and four fifths of these occurred in the low and medium resource countries. In spite of organized screening protocols in the US still 15,000 women are diagnosed annually out of which there are 4,800 annual deaths.Persistent Infection with Oncogenic HPV is THE NECESSARY CAUSE of cervical cancer.

It has been a great disgrace for humanity as a whole and medical fraternity in particular that cervical cancer a preventable disease still remains at bay. Death due to cervical cancer can aptly be described as death due to incompetency. What has made us incompetent is the point of concern. We have all gathered here today for a great and noble cause to eradicate the darkness that surrounds this very common disease. It is the most common gynaecological cancer worldwide.

We have to understand that cancer cervix has no symptoms. It is symptomatic only in advanced stages and that will be the success to all screening programmes.

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby organs.When this happens, the most common symptoms are abnormal vaginal bleeding, such as bleeding after vaginal intercourse, bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual. Bleeding after douching, or after a pelvic exam is a common symptom of cervical cancer .An unusual discharge from the vagina — the discharge may contain some blood and may occur between periods or after menopause.

These signs and symptoms can also be caused by conditions other than cervical cancer. For example, infections or a simple polyp in the cervix or sometimes irregular bleeding due to hormonal changes can cause pain or bleeding. Having any of these problems should warrant a urgent check-up by a professional right away – in spite of regular Pap tests. If it is an infection, or hormonal bleeding or a simple polyp, it will need to be treated. If it is cancer, ignoring symptoms may allow it to progress to a more advanced stage and lower chances for effective treatment. Persistent vaginal discharge especially blood stained or foul smelling should never be ignored. Most often it is a telltale sign of cervical cancer.

Having said that , it is always better, not to wait for symptoms to appear. Screening regularly is the key to pick this disease in a precancerous or very early stage where treatment is very rewarding and almost 100% successful.

The cervical cancer grows by extending upward to the endometrial cavity and downward to the vagina and laterally to the pelvic walls. The tumor can also extend to the bladder and rectum directly.

Hence the other common symptoms include:

• Vaginal discomfort,
• Dysuria. · Constipation, hematuria, fistula and anuria in late stages where the ureters are completely engulfed by the disease itself.
• Leg edema and pain suggests lymphatic or vascular obstruction due to tumor infiltration and hydronephrosis suggests that disease has spread upto pelvic wall and has engulfed the ureters. Pain may also be due to nodal metastasis, pressure on nerve trunks by the disease mass or occasionally due to bony deposits in the vertebrae. This is a advanced disease and prognosis is guarded in spite of treatment.
• As the disease advances, the cervix shows abnormal appearance with erosion, ulcer or mass development. · On PR examination rectum may also show an external mass or bleeding from the tumor.
• Urinary problems arise due to blockage of urethra or ureter.
• If metastasis has occurred to liver, then hepatomegaly (enlargement of the liver) is observed.

Cancer cervix is preventable but yet to be prevented.

Factors that have prevented its prevention are:

• Inhibition: Feeling of shame to express themselves and a shy attitude towards healthcare personnel, unable to disclose their problem
• Ignorance: Many women think that the symptoms are a natural phenomena and should be allowed to continue. • Illiteracy: Lack of education is the key factor that prevents knowledge to be perceived.
• Inadequate resources: Of course finance is a great hindrance and ironically cervical cancer is a problem in the low income countries.
• Inertia: Inability to understand the urgency of the problem is a great hindrance .It delays the diagnosis and hence worsens outcome. Our efforts as responsible citizens:
• Create cancer consciousness
• Propagandas
• Proper Health education
• Motivate for screening
• Each one teach one

Summary
Cancer cervix is a disease of great public health importance.HPV is a necessary cause for cancer cervix. HPV 16 & 18 account for 70% of all cancer cervix. Fortunately vaccine is now available for the above strains. In spite of that screening is mandatory because there are no symptoms in early stages. At this time down staging by Visual inspection is the most important tool in our armamentarium. However spreading awareness is our onus.