Beyond period problems: Subtle symptoms that could signal cervical cancer

Cervical cancer is the fourth most common cancer in women worldwide. It is one of the most preventable and treatable forms of cancer, yet it remains one of the most common causes of death for women (IGCS -International Gynaecologic Cancer Society).

The cervix is the lower and narrow part of the uterus, which connects the body of the uterus to the vagina.

Cervical cancer is an abnormal growth of cervical cells. It is caused almost entirely by HPV (Human Papilloma Virus). HPV types 16 and 18 are the commonly involved types in invasive cancer (more than 75%).




High-risk types of HPV can lead to early cervical changes, which, over time, can lead to cervical cancer. Early detection can be done by screening, by doing HPV testing and Papanicolaou (Pap) smears. HPV testing identifies exposure to high-risk and low-risk types of HPV, whereas Pap smears will detect early and late cell changes.

Cervical cancer is a preventable disease. Screening and primary prevention are very effective modalities for decreasing the incidence and death due to cervical cancer.

Although HPV testing is not recommended in women younger than 30 years, low-risk younger women should begin screening with Pap tests at age 21 and continue until age 65, per the United States Preventive Services Task Force (USPSTF) recommendations. Newer recommendations offer 3 to 5 year intervals between screenings based on a patient's prior results and the use of Pap and HPV testing.

• Colposcopy is the diagnostic procedure for any positive result from the screening methods.
• In very early-stage cancer and precancer stage, if detected, the prognosis is very favorable.
• Early-stage cancer is usually asymptomatic, and that makes it difficult to diagnose. Consequently, the prognosis becomes poor.
• Here comes the role of educating people about the subtle symptoms of cervical cancer
• As cervical cancer is a sexually transmitted infection (STI), it is preventable, and the global incidence can be reduced through targeted education, screening, and intervention.

Risk factors for HPV and cervical cancer include multiple sexual partners, young age at sexual initiation, herpes simplex, high parity, HIV, coinfection with other genital infections, smoking, and oral contraceptive use.

History taking is very important in cervical cancer. Any history of sexually transmitted diseases, multiple sexual partners, high risk behaviour should be asked. The history of tobacco use and prior HPV vaccination should be taken.

Key facts by WORLD HEALTH ORGANIZATION(WHO)

Cervical cancer is largely preventable through HPV vaccination and regular screening, as recommended by national guidelines, and it can be cured if detected early and treated promptly.

Cervical cancer is the fourth most common cancer in women globally, with around 660 000 new cases and around 350 000 deaths in 2022.

The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities driven by a lack of access to national HPV vaccination, cervical screening, and treatment services, and social and economic determinants.

Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV.

Countries worldwide are accelerating efforts to eliminate cervical cancer, guided by the global 90–70–90 targets: 90% of girls fully vaccinated with the HPV vaccine by age 15, 70% of women screened by ages 35 and 45, and 90% of women with pre-cancer or invasive cancer receiving appropriate treatment.

17 November is observed as World Cervical Cancer Elimination Day.

General symptoms

• Burning in the vagina
• Minimal burning, which is not recurrent and not persistent, once in a while, do not worry, but if it is recurrent and persistent, you should seek medical attention.
• Itching in the vagina
• These symptoms are commonly seen with infections and non-cancer causes, but one should not neglect these symptoms and should seek expert opinion
• Low back or abdominal pain
• Again, this symptom is seen with intestinal spine causes, but can be present in cervical cancer.
• Though seen in the advanced stage, cancer can also occur as an initial symptom.
• Frequent and urgent urination
• Passing urine multiple times (7-8 times) and not being able to hold the urine; these symptoms are usually seen in urinary infections, diabetes, pregnancy, and neurological conditions, but can be seen in cervical cancer.
• Should consult your doctor
• Bloating
• Usually seen with late cancer stages, but should not be neglected, as it can present early.
• Fatigue
• Unusual tiredness, consult the expert.
• Swelling in the legs
• Usually due to nutritional deficiencies and in advanced cervical cancer.

Specific symptoms

• Vaginal spotting or bleeding

Bleeding after sex

Postmenopausal bleeding

Bleeding after the periods are over (intermenstrual bleeding)

Premenstrual spotting

Heavy periods or longer periods

• Vaginal discharge

Foul-smelling discharge

Copious discharge

Discharge mixed with blood

Discharge that is recurrent and not cured by routine medications

Discharge after menopause

• Pain

Pain after intercourse

Pain in the pelvic region

Dull aching lower back pain

All these symptoms are commonly seen with non-cancer causes.

Every woman should be educated about this and should not cause panic. She should be aware of her body and should be aware of what is normal for her.

So a minimal vaginal discharge, non-foul smelling and asymptomatic, before menses can be normal for many women but if there is a change in color, odor, quantity, she should report to the hospital.

What is normal for one woman can be abnormal for another. Hence, the importance of knowing your body.

Cervical cancer is asymptomatic in early stages, so screening becomes very important. Pap smear is a very important screening test for cervical cancer in the early stages. Safe sex practices are vital for the prevention of cervical cancer.