India is considered a hub for cervical cancer. According to the Globocan 2020 statistics, there were 678,383 newly diagnosed cases of cancer among women, with 18.3% of them being cervical cancer cases. It is estimated that by the year 2025, 38.69 per 100,000 cases will be diagnosed with cervical cancer worldwide, and 42.82 per 100,000 cases in India.
Risk Factors
The risk factors for cervical cancer include women aged 50 years and above, Human Papilloma Virus (HPV) infection, cigarette smoking, a weakened immune system (HIV/AIDS, immunosuppressant drugs, organ transplant), long-term use of contraceptive pills, chlamydia (a sexually transmitted infection), sexual activity at a young age (before 16 years), multiple sexual partners, having a sexual partner with multiple previous partners, and multiple childbirths.
Symptoms
Clinically, the symptoms of cervical cancer include heavy periods, vaginal bleeding between periods, post-coital bleeding, post-menopausal bleeding, asymptomatic anaemia, foul-smelling vaginal discharge, pelvic and lower back pain, pain during sexual activity (dyspareunia), Diarrhea, anorexia, unexplained weight loss, and lower extremity swelling due to the occlusion of pelvic lymphatics. The common sites of metastasis are the lungs, liver, bones, and brain.
Diagnostic Tests
Various diagnostic tests are conducted to diagnose cervical cancer, including the Pap test, HPV test, colposcopy, cervical biopsy, cystoscopy, proctoscopy, and PET scan.
Management
Cervical cancer can be managed through various treatment options, including surgery (such as total hysterectomy, bilateral salpingo-oophorectomy, inguinal lymph node dissection, and trachelectomy), radiation therapy, chemotherapy, chemo-radiation, immunotherapy, and hormone replacement therapy.
Role of Physiotherapy
The diagnosis of cervical cancer affects women both physically and psychologically. The treatments patients undergo can lead to numerous complications, most of which can be recognized and addressed by a Physiotherapist. Peri-operative counselling is a crucial aspect of physiotherapy for cervical cancer patients. Many women have concerns about their body image and functions during and after cancer treatment. Additionally, the importance of exercise needs to be clearly explained to patients before starting a rehabilitation program.
Immediate post-operative care involves preventing post-operative chest infections, deep vein thrombosis (DVT), and encouraging early ambulation. Exercise also plays a significant role in alleviating problems such as urinary incontinence, pelvic floor muscle weakness, vaginal dryness, sexual dysfunction, fatigue, reduced physical functioning, lower extremity lymphedema, neurological complications (such as lumbar plexopathy and peripheral neuropathy), and psychological complications (including anxiety, depression, and post-traumatic stress disorder).
In terms of palliative care, the primary goals are to prevent complications related to cancer and its treatments and to provide the best possible quality of life. Symptom management is the primary treatment strategy, complemented by relaxation techniques, pain management methods (e.g., the use of TENS, massage, heat, and cold therapy), appropriate positioning, the use of assistive devices for mobility, and environmental modifications.
India offers two globally licensed vaccines: GardasilTM (administered at 0, 2, and 6 months) and CervarixTM (administered at 0, 1, and 6 months). The recommended age for initiating vaccination is 9–12 years, with catch-up vaccination allowed up to the age of 26 years.