What is cancer of cervix and how it occurs? Cancer of the cervix, also the mouth of uterus or the lower most part of womb (where baby grows), Is easily accessible for examination by the gynecologist per vaginal examination. Cancer of cervix is probably caused by high risk strains of the human papilloma-virus (16,18,31,45 etc), a common sexually transmitted infection. In more than 90 percent of the infections, HPV clears up on its own, but in 10 percent of cases either cancer or genital warts develops. Multiple sex partners increases risk of HPV infection and the more partners the current partner has had, the higher is the risk that he will transmit HPV. Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human immunodeficiency virus (HIV) and other factors like smoking, diet, oral contraceptives are other important high risk cofactors in cervical carcinogenesis. Early age of marriage and early child bearing are contributing factor in our country. The HPV virus causes cervix cancer was established by the research work of Nobel laureate Professor Herald Har Hassen, and this led to development of a vaccine for it . The HPV vaccine can prevent 70 percent of cancer cervix and current guildlines recommend immunization all girls is adolescent age groups i.e. before sexual exposure with 3 doses of HPV vaccine. During cancer development, the HPV viral particles get integrated with DNA of human nucleus resulting in mutation and rapid cancerous proliferation. This process cervical takes a few decades, for precancerous or cancerous changes to occur in cells. What are the aims of cervical cancer screening and the available methods for it? Screening aims are to detect cancer cervix the precancerous or early stages , when it is treatable. The Pap smear is the most widely available and effective method for this. Efforts are going on to develop an alternative cost effective method to suite low resource setting, to cater the vast population of developing poor countries. For this VILI /VIA/Low cost HPV DNA testing are being investigated in various research trials. What is Pap smear? For a PAP smear of vaginal secretions and spreading on slide which is then ….. in the pathology laboratory and examined under the microscope by a trained pathologist to detect precancerous changes in the cells. It is well recognized , that widespread use of Pap smear can reduce cancer rate by more than 50 percent sd precancerous lesions are picked up and treated . For Patient Related Queries, for Cervical Cancer Treatment call at 91-11-43066353

1. What is cancer of cervix and how it occurs?
Cancer of the cervix, also the mouth of uterus or the lower most part of
womb (where baby grows), Is easily accessible for examination by the
gynecologist per vaginal examination. Cancer of cervix is probably caused
by high risk strains of the human papilloma-virus (16,18,31,45 etc), a
common sexually transmitted infection. In more than 90 percent of the
infections, HPV clears up on its own, but in 10 percent of cases either
cancer or genital warts develops. Multiple sex partners increases risk of
HPV infection and the more partners the current partner has had, the
higher is the risk that he will transmit HPV. Sexual and reproductive
factors, socio-economic factors (education and income), viruses e.g.,
herpes simplex virus (HSV), human immunodeficiency virus (HIV) and
other factors like smoking, diet, oral contraceptives are other important
high risk cofactors in cervical carcinogenesis. Early age of marriage and
early child bearing are contributing factor in our country.

2. What is cancer of cervix and how it occurs?
The HPV virus causes cervix cancer was established by the research work
of Nobel laureate Professor Herald Har Hassen, and this led to
development of a vaccine for it . The HPV vaccine can prevent 70 percent
of cancer cervix and current guildlines recommend immunization all girls
is adolescent age groups i.e. before sexual exposure with 3 doses of HPV
vaccine. During cancer development, the HPV viral particles get
integrated with DNA of human nucleus resulting in mutation and rapid
cancerous proliferation. This process cervical takes a few decades, for
precancerous or cancerous changes to occur in cells.

3. What are the aims of cervical cancer screening and the
available methods for it?
Screening aims are to detect cancer cervix the precancerous or early stages ,
when it is treatable. The Pap smear is the most widely available and effective
method for this. Efforts are going on to develop an alternative cost effective
method to suite low resource setting, to cater the vast population of
developing poor countries. For this VILI /VIA/Low cost HPV DNA testing are
being investigated in various research trials.

4. What is Pap smear?
For a PAP smear of vaginal secretions and spreading on slide which is
then ….. in the pathology laboratory and examined under the microscope
by a trained pathologist to detect precancerous changes in the cells. It is
well recognized , that widespread use of Pap smear can reduce cancer rate
by more than 50 percent sd precancerous lesions are picked up and
treated .

5. What to do, if one a precancerous lesions & role of Colposcopy?
If an abnormality is detected on a Pap smear one should immediately seek
expert advice from a Gynecology oncologist . Further evaluation is by
colposcopy is required and close follow up must be done, as about 30-50
percent of severe dysplasias may transform into cancer. Colposcopic
evaluation visualizes the precancerous lesion in a magnified way, to help
the gynecologist in taking a biopsy from the most affected area. After a
colposcopy and biopsy reports, a patient may just require close
observations with frequent Pap smears or wider local excision of cervix
with LEEP ( Loop Electric Excision Procedures ) or cold knife conization of
the lesion. Wherever facilities are available and affordable, triage HPV
DNA testing can be done . in a few cases the Pap Smear/ Biopsy may
reveal cancer.

6. What are the sign and symptoms of cancer of the cervix?
• Persistent white discharge or foul smelling discharge
• Bleeding per vagina (Post-coital, Post-menaupausal or irregular
menstruation)
• Vomiting with decreased urination or pain in pelvis or sacral areas.
• Incontinence of urine or faces may be signs of advances stages of cancer
cervix

7. Stages of cervical cancer are
• Precancerous stage CIN(Mild/Moderate/Severe Dysplasia)
• Stage 0 carcinoma in situ
• Stage I disease is localized to cervix
• Stage II spread to adjacent parts in the pelvic
• Stage III: spread upto pelvic walls or into lymph glands
• StageIV: spread to distant organs

8. Treatment of precancerous and Cancer of Cervix
Precancerous dysplasias are treated either with local destructive
procedures ( cyro or electric cauterization) or local excision ( LEEP or cold
knife excision). Early cervical cancers are best treated surgically with
radical cancer surgeries, while in advanced cases killing the cancer cells
with radiation is more suitable. Such radical surgeries are best and safely
done by doctors with specialized training in Gynec cancer surgeries.

9. Facilities available to treat cancer of cervix at Dharamshila
Cancer Hospital, Vasundhara Enclave, Delhi
Dedicated cancer hospitals like Dharamshila Cancer Hospital and Research
Center have a well knit Gynecology Oncology department to deal with
gynecological malignancies with highly sophisticated trained doctors who
have the technical know ow to provide most advanced and ultimate
comprehensive preventive ,curative and rehabilitative treatment with
multidisciplinary approach. Each and every case is discussed on individual
basis in tumor board with a team consisting of Gynecology oncologist,
medical and Radiation Oncologist; to decide most suitable and
appropriate treatment. Besides facilities of preventive aspects (Pap’s
smear, HPV DNA test, Colposcopy, LEEP, Cryo, Cone Biopsy), the hospital
surgical facilities are of international standard backed by NABL accredited
laboratory facilities. Radiotherapy is delivered with most advanced linear
accelerator Electra Synergy (IGRT /IMRT).

10. How to win over cancer cervix & to aim for cancer cervix free
India?
It is achievable through regular Pap’s smears along with immunization (of
adolescent uninfected girls). It requires political will power with social
commitment. Empowerment of women and to educate them about health
needs are other essential aspects, to win over cancer cervix. The non
governmental organization can contribute a lot, by organizing screening
camps and in facilitation of follow up of suspicious cases for colposcopy at
higher centers. Not only that, they can provide immense support at time
of need, when a mother of young children is detected with cervix cancer.
They can help in clearing many doubts and myths about the disease and
treatments. Identification of individual hindrances in receiving
unrestricted complete treatments and resolving the issues need special
attention in Indian scenario.

11. Contact Us
Dharamshila Hospital and Research Centre
Near New Ashok Nagar Metro Station,
Vasundhara Enclave, Delhi - 110096, INDIA
Tel: 011 - 43066353
Fax: 011 - 22617770 / 22619033 / 22618574
Email: contact@dhrc.in