Cervical cancer

"Cervical cancer is one of the most common cancers among women worldwide. The incidence of death and disability from this cancer are very high. The need is therefore for the prevention and control of cervical cancer at an early stage."- World Health Organisation

“Ahhhh…..god…Nayana, please help……..”

*Thud*

Nayana had just turned off her headphone when she heard something fall and turned around to see what it was. Kirti, her sister-in-law, was lying on the floor, clutching her abdomen and crying in pain.

“Crap…." she ran to her. "What happened…..” she tried to help Kirti to her feet . Kirti yelped in pain unable to stand.

“Ok, relax,  I’ll call for help..” No one was at home and panicking she dialed for the family doctor. Luckily he lived just a few blocks away.

“How did you fall down?”

“Ahhh…I….ahh..no…”

 “Don’t bother answering, relax, keep breathing…yea, good girl….keep breathing… Here comes the doc."

After examining her, Dr. Prasad had a worried look on his face.

“I think she needs to see her gynaecologist right away. I have given her a jab for the pain now, but the sooner you take her to the hospital the better.”

“What’s wrong doc?” Nayana had a worried look on her face.

“Lot of things could be wrong, but I don’t want to speculate without a proper probe. Just take her, ok?”

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“Kirti, how long have you been having this pain?” asked Dr.Roopa, Kirti’s gynaecologist.

“ For some time now, doctor, must be around a couple of years, but I usually had dull aches lasting four to five minutes, which would go off on its own. Never this sharp.”

“Any abnormality in your monthly cycles or anything else you can think of?”

“No, but now a days there’s a lot of pain during urination.”

“Why did you wait so long to come and see me?”

“I was taking painkillers, it subdued the pain and I didn’t think it was serious.”

“Why do you have to self-medicate? Anyway, have you ever got a Pap smear test done before.”

“No”

“Well, I’ll do a pelvic examination first. Don’t panic, I am using a Colposcope to have a look at your cervix. It may cause you a little discomfort. We’ll get a Pap smear test done too. Are you on any medications?”

“No. What’s wrong with me doctor.”

“Let’s find out. Now lie down and I want you to relax.”

“Ahhhh….it hurts terribly doctor….” Kirti was screaming again. “Oh my god, what’s all this blood?”

“The examination must have caused irritation in the cervix. It’s ok. I’ll ask the nurse to  help you.”

Dr.Roopa looked worried too as she left Kirti in the examination room to change and sat down on her chair.

“Doc…is everything ok?” Nayana had a huge question mark on her face.

“Nayana, does anyone in your sister-in-law’s family have a history of cervical cancer or any other cancer?”

“I think her grandmother died of cancer. I am not sure what cancer it was. But why do you ask?”

“You are more predisposed to cancer if you have a genetic history.”

“What? Kirti has cancer?”

 “I am not saying she has. Her symptoms look like that. And it seems pretty bad too. Even the pelvic examination was painful for her. And she bled during the check up. The irritation of the cervix can cause bleeding if the cervix is not healthy. These can be cervical cancer symptoms.  Painful urination is another symptom. But I am surprised that she did not come to me sooner. Symptoms usually occur in advanced stages. I am also surprised that she has never got a Pap test done.”

“What is a Pap test Doctor?”

 “A Pap test, also known as a Pap smear or a cervical smear, is a simple tool used to screen for cervical cancer. Pap tests are important because they can find cervical cancer or abnormal cells that can lead to cervical cancer.” she explained.

“Ideally,” she continued, “Once a woman is in her productive age, a Pap test should be done every three years, unless your doctor says otherwise. Cervical cancer symptoms often go unnoticed because they mimic so many other ailments. Many women pass these symptoms off as PMS or ovulation pains. The bottom line is that you should not ignore your symptoms or wait for them to go away on their own. Self-diagnosing through information found on the internet is not recommended, either.”


“I can’t believe she has cancer.” Nayana was reduced to tears.

“I have taken a cervical smear sample and sent to the lab, we can expect the results in two weeks. Don’t draw your own conclusions. Let’s wait and hope it is nothing.”

Kirti had been listening to ever word and now they hung heavy on her head like Damocles sword. She buried her face in her hands and sobbed.

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“Why me?” she sobbed harder on the way back home as Nayana struggled for words of encouragement.

“Come now, cheer up yaar, the results have not yet come. It will be nothing, trust me, you’ll be fine.”

As they broke the news to their family, everyone was shocked. Most of all, Jai, Kirti’s husband.

He tried to think of something cheerful to say.

“You’ll be fine, love, we are all with you"

                                                                     ***************            

Two weeks seemed like a hundred years and when the call finally came, Kirti could not muster courage to pick up the call. She passed her phone to Nayana. Nayana spoke to the doctor.

"Yes doc, we’ll see you immediately.”

“What did she say?”

“Let’s go to the hospital Kirti.”

“It’s positive isn’t it?”

“Yes.”

“I’ll take her to the hospital Nayana” said Jai putting a comforting hand on Kirti’s shoulders.

“Sure Bhaiya, come along. She needs all the support she can get.”

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“Jai, the tests are positive for cervical cancer. I want her to get some more tests done.”

She wrote down on her prescription pad.
Chest X ray
CT scan
Lymphangiogram
Ultrasound

 "How did she get the cancer? I though it affects women with multiple partners."

"Human papilloma virus (HPV) infection is a sexually transmitted virus that causes cervical cancer. The reasons could be many.

1. Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual. Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer. There is also a link between becoming sexually active at a young age and a higher risk of cervical cancer.

2. If a woman develops cervical cancer it does not mean she had several sexual partners, or became sexually active earlier than most other females. It is just a risk factor. Women who only ever had one sexual partner can develop cervical cancer.

3. Smoking increases the risk of developing many cancers, including cervical cancer.

4. People with weakened immune systems, such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications have a higher risk of developing cervical cancer. 

5. A woman who experiences a high level of stress over a sustained period of time may be undermining her ability to fight off HPV and be at increased risk of developing cervical cancer.

6. Women who gave birth before the age of 17 are significantly more likely to develop cervical cancer compared to women who had their first baby when they were aged 25 or over.

7. Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared to women who never had children.

8. Long-term use of the contraceptive pill slightly raises a woman's risk.

9. Women who become infected with chlamydia, gonorrhea or syphillis have a higher risk of developing cervical cancer..

10. Women in deprived areas have significantly higher rates of cervical cancer, compared to women who live in other areas. Higher rates are also found in women of working age in manual jobs, compared to women in non-manual jobs .

 “How bad is it doc?” asked Jai,beads of perspiration starting to form on his forehead.

“When caught early, it is curable. Even with advanced stages included, the overall chance of surviving at least five years, with likelihood of a full cure, is still better than 70%. Only when the cancer spreads to distant organs does prognosis for five-year survival dip below 20%. Recurrent cervical cancer carries an even lower chance of survival.”

“What are Kirti’s chances?”

“These tests will help us find out how bad it is. Whether the cancer has spread to other parts, like her lymph, pelvis and other parts of her body.”

“Is it in its early stages?” he asked.

“Cervical cancer is a slow-progressing disease. It can take years before cervical pre-cancer develops into cervical cancer. Of course, it can happen sooner in some women, but for most it takes several years. If she had been getting regular Pap smears, then any cervical abnormalities would have been detected.

Pain is not an early cervical cancer symptom. Therefore, she should not have waited to feel pain before seeing a doctor. It looks advanced to me.”

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The results of the tests were not encouraging either. Dr.Roopa’s eyes conveyed that all was not well as she read the report. Taking a deep breath and placing an understanding hand around Kirti, she announced, “Stage IIIB”

“What does that mean doctor?”

 “Stage IIIB means her cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters ,that is, the tubes that connect the kidneys to the bladder. She has pain on urination because the cancer has spread to her bladder. In stage IIIB, cancer cells may also have spread to the lymph nodes in the pelvis.”

“What next?” Jai was shattered that someone as delicate as Kirti, would have to suffer so much.

“We’ll discuss our options with an oncologist, whether he would recommend surgery or radiation.”

“She’s just 32, doctor, how could this happen to her?” Jai could not bear to think all this was happening to her.

“Cervical cancer can affect any woman. That is why screenings are extremely important because they can help doctors find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer, and treatment is more likely to be effective if cancer is found early.

In fact, if your doctor thinks you are at risk, she may even ask you taken vaccination for its prevention. But the problem is women somehow seem to ignore their health. Your doctor can tell you when you should begin having Pap tests, how often you should have them, and when you can stop having them. This is especially important for women who have a higher-than-average risk of cervical cancer.”

“Doctor, I will bring the entire women folk in our house, my mother, sister and bhabhi to you, I am sure none of them has ever got a pap smear test or vaccination done. I don't want anyone suffering like this again."

"I wish all men thought like you. Had you known about the screening earlier, Kirti could have been spared this trauma. ”
                                     

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(If you are a woman in your productive age, get a Pap smear test done soon, and if you a man, you know what to do!)