Cervical Cancer

How it is Diagnosed

The best way to detect cervical cancer early is through screening. Screening means testing women who have no symptoms, to catch the disease before it starts or in its very earliest stages.

There are three main screening methods:
• Pap smear (a simple test where cells are collected from the cervix and checked under a microscope for early changes).
• HPV DNA test (a test that looks for the virus itself).
• VIA – Visual Inspection with Acetic Acid (a test where vinegar is applied to the cervix and abnormal areas turn white, allowing doctors or nurses to see them).

Sadly, in India, only 3 out of 10 women (about 30%) between ages 15–49 have ever had a screening test. Because of this, 7 out of 10 women are diagnosed when the disease is already in an advanced stage.

Who Catches it Early and Who Misses the Bus

In countries like the US and UK, 6 out of 10 women are diagnosed in early stages because screening is routine. In India, the situation is the opposite. Only 25–30% of women (about 1 in 4) are diagnosed early, while 70–75% (3 out of 4) come to the doctor too late.

This late detection is often due to lack of awareness, hesitation to undergo pelvic examinations, or ignoring symptoms like abnormal bleeding or foul-smelling discharge. That is why awareness is as important as treatment.

How Cervical Cancer is Staged and How Doctors Decide on Treatment

After confirming cervical cancer, doctors need to know how far it has spread. This is called staging. Staging is done using a pelvic examination, imaging tests (like MRI, CT, or PET scan), and sometimes procedures such as cystoscopy (looking into the bladder) or proctoscopy (looking into the rectum). The stages range from Stage I (very small, only in the cervix) to Stage IV (spread to distant organs like lungs or liver).

Treatment decisions depend mainly on this stage, but also on a woman’s age, overall health, and whether she wishes to have children in the future. For example:
– Early stages (Stage I): Surgery is usually preferred, and in select young women, fertility-preserving surgery may be possible.
– Locally advanced stages (Stage II–III): Chemoradiation (combined radiotherapy and chemotherapy) is the standard.
– Advanced stages (Stage IV or recurrent cancer): Treatment focuses on controlling the disease with chemotherapy, targeted therapy, or immunotherapy, while also improving quality of life.

Doctors usually discuss each case in a multidisciplinary tumor board (a team of experts) to ensure the most effective and personalized plan is chosen.

After Diagnosis – The Right Treatment Journey

Once cervical cancer is diagnosed, the treatment depends on the stage (how far the disease has spread).

• Stage I (very early stage, cancer only in the cervix): Surgery is the main treatment, where the uterus and cervix may be removed. Cure rates are 80–90%, meaning 8–9 women out of 10 survive long term.
• Stage II–III (cancer has spread beyond the cervix but not very far): A combination of radiotherapy (high-energy rays to kill cancer cells) and chemotherapy (medicines that make radiotherapy more effective) is given. Cure rates here are 50–60%.
• Stage IV (cancer has spread widely in the body): Treatment usually focuses on controlling symptoms and improving quality of life. Long-term cure is difficult, and survival is less than 20%.

At each step, it is best for the case to be discussed in a multidisciplinary tumor board (a team of gynecologists, oncologists, radiation specialists, and counselors) so that the patient gets the most suitable and evidence-based treatment.

What to Expect During Treatment

Treatment can be physically and emotionally challenging, but doctors and nurses will guide patients through each step.

• Surgery: Women may need to stay in the hospital for about a week. There may be pain and temporary difficulty in passing urine. If the uterus is removed, pregnancy is no longer possible.
• Radiotherapy and Chemotherapy: Treatment takes 5–6 weeks. Common side effects are tiredness, nausea, loose stools, burning while passing urine, and skin irritation. These usually improve after treatment ends.
• Long-term effects: Some women may experience dryness of the vagina, early menopause (stopping of periods), or changes in sexual function. With counseling, pelvic exercises, lubricants, and medical support, these can be managed well.

What Will Be the Quality of Life After Treatment

The chances of living a normal life after treatment depend on how early the cancer was found.

• In Stage I, about 80–90% of women survive five years or more and can live long, healthy lives.
• In Stage II, about 60–70% survive five years.
• In Stage III, survival falls to 40–50%.
• In Stage IV, less than 20% survive five years.

Most women who complete treatment in early stages return to their family and daily life within a few months. Many are able to work, take care of their children, and live independently.

Younger women with very early cancers may sometimes be offered fertility-preserving surgery (called trachelectomy, where only the cervix is removed but the uterus is kept), allowing them to still have children.

Survivors often say that life after cervical cancer may be different, but it is still fulfilling. With the support of family, friends, and healthcare teams, women regain confidence and strength.

The Role of HPV Vaccination in Prevention

The most powerful tool against cervical cancer is the HPV vaccine.

• The vaccine works best if given before a girl is exposed to the virus – ideally between 9 and 14 years.
• It can also be given up to 26 years of age, and in some cases later, though the benefit is highest when taken young.
• India introduced its own vaccine, Cervavac, in 2023, making it more affordable.
• Studies show that HPV vaccination can prevent 90% of cervical cancers if combined with regular screening.