Cervical cancer, though preventable and curable, remains a significant global public health challenge. The World Health Organization (WHO) identifies it as the fourth most common cancer among women, causing over 300,000 deaths in 2018. The impact is most profound in low- and middle-income countries, where limited access to timely treatment compounds the burden. Initiatives, such as the WHO’s Cervical Cancer Elimination Initiative, aim to enhance treatment availability, accessibility, and affordability. 

This blog delves into the options, challenges, costs, and strategies related to cervical cancer treatment, contributing to the goal of eliminating it as a public health issue and enhancing affected women’s quality of life.

What Is Cervical Cancer?

Cervical cancer, formally referred to as carcinoma of the cervix, originates from alterations in the surface cells of the cervix. This transformation leads to the development of precancerous cells. While not all precancerous cells inevitably progress to cancer, it is imperative to detect and manage these aberrant cells proactively to prevent the onset of cervical cancer.

Diagnosis Of Cervical Cancer 

Cervical cancer diagnosis involves a gradual progression of normal cervical cells into irregular or abnormal forms. Routine screenings, notably Pap tests, are pivotal in identifying precancerous developments or irregularities. Abnormal results may necessitate additional assessments, such as HPV tests, to check for associated viral infections. 

If cancer is suspected, healthcare providers conduct cervical biopsies using techniques like punch biopsy or conization. Biopsy confirmation prompts further tests to determine the extent of the disease through liver and kidney function studies, blood and urine tests, and X-rays, collectively known as staging.

Treatment Options:

The approach to cervical cancer treatment is contingent on various factors, encompassing the cancer type and stage, potential side effects, and the patient’s preferences and overall health. Some common cervical cancer treatments are, 

• Immunotherapy
• Targeted therapy
• Chemotherapy
• Radiation therapy
• Surgery

Immunotherapy

Immunotherapy employs medications to activate the immune system, helping it recognize and eliminate cancer cells. By targeting signals used by cancer cells to evade immune detection, immunotherapy prevents them from deceiving the immune system. Some immunotherapy drugs, like monoclonal antibodies, work by inhibiting specific proteins in cancer cells, functioning as targeted therapy to hinder their growth. This dual action enhances the efficacy of immunotherapy in countering deceptive strategies employed by cancer cells.

The cost of immunotherapy for cervical cancer in India varies between Rs. 1,50,000 and Rs. 4,50,000 per session. The actual expenses may fluctuate based on factors like treatment frequency, specific drugs administered, overall treatment strategy, and the patient’s health condition. The necessary number of sessions hinges on the cancer’s severity. Patients with locally advanced or metastatic cervical cancer may qualify for immunotherapy. 

Targeted therapy

Targeted drug therapy for cervical cancer involves medications that specifically target proteins in cancer cells, inhibiting their growth or spread. These drugs, administered orally or through injections, differ in side effects from chemotherapy. Monoclonal antibodies, a subtype of targeted therapy, may also function as immunotherapy, boosting the immune system. 

Notably, Bevacizumab (Avastin), an angiogenesis inhibitor, is utilized in advanced cervical cancer cases, targeting the immune system protein VEGF. This approach offers diverse strategies for managing cervical cancer effectively.

In India, the cost of targeted therapy varies from Rs. 3,000 to Rs. 3,00,000 per month, depending on factors like the type and stage of cancer and the affected area. For advanced cases, the cost can be approximately Rs. 1,00,000 to Rs. 2,00,000 per month, making it significantly more affordable than in developed nations.

Chemotherapy

Chemotherapy, or chemo, involves the administration of anti-cancer drugs either through injection into a vein or orally. These drugs circulate in the bloodstream, reaching virtually all body areas, making chemotherapy effective for targeting cancer cells throughout the body. 

In certain stages, a combined approach of radiation and chemotherapy, known as concurrent chemoradiation, is preferred. This synergistic combination enhances the efficacy of radiation treatment by aiding in the destruction of cancer cells. Overall, chemotherapy proves beneficial in select situations, complementing other treatment modalities for comprehensive cervical cancer management.

Cervical cancer chemotherapy in India usually costs between Rs. 3,77,659 – Rs. 5,28,722, with the expenses influenced by factors like the treatment type, infrastructure, and quality of care.

Radiation Therapy

Cervical cancer treatment employs high-energy X-ray radiation tailored to the cancer stage. Early stages may undergo radiation alone or surgery followed by radiation, while advanced stages benefit from concurrent chemoradiation. In cases of spread or recurrence, radiation addresses cancer affecting other organs. 

The primary radiation types include external beam radiation, utilizing external X-rays, and brachytherapy, involving internal placement of radioactive sources for targeted treatment. This versatile approach optimizes effectiveness based on the specific stage of cervical cancer.

The cost of radiotherapy per session in India typically ranges from INR 60,000 to INR 3,00,000. It’s noteworthy that the expense in India is slightly higher compared to other regions, particularly for advanced and precise methods like IGRT and IMRT. Therefore, the overall cost is contingent upon the recommended radiation approach tailored to individual medical needs.

Surgery

Surgery involves the removal of the tumor and adjacent healthy tissue through an operation. For cervical cancer confined to the cervix, the following procedures are commonly employed:

1. Conization: This procedure, similar to a cone biopsy, removes all abnormal tissue. It is effective for micro-invasive cancer visible only under a microscope.
2. Loop Electrosurgical Excision Procedure (LEEP): This method utilizes an electrical current through a thin wire hook to extract tissue, suitable for micro-invasive cervical cancer removal.
3. Hysterectomy: This involves removing the uterus and cervix. A simple hysterectomy removes the uterus and cervix, while a radical hysterectomy includes the removal of the uterus, cervix, upper vagina, and surrounding tissue. The latter also involves an extensive pelvic lymph node dissection, which may be done through laparotomy (large abdominal cut) or laparoscopy (smaller cuts).
4. Bilateral Salpingo-Oophorectomy: If necessary, this surgery removes both fallopian tubes and ovaries concurrently with a hysterectomy.
5. Radical Trachelectomy: This procedure removes the cervix while preserving the uterus, often with pelvic lymph node dissection. It is an option for young patients aiming to maintain fertility.
6. Exenteration: Rarely recommended, this involves removing the uterus, vagina, lower colon, rectum, or bladder if cervical cancer spreads to these organs after radiation therapy. Typically reserved for cases where cancer recurs post-radiation therapy.

Alleviating Financial Burdens For Impoverished Cancer Patients

The scheme established in 2009, the Health Minister’s Cancer Patient Fund (HMCPF) under Rashtriya Arogya Nidhi (RAN) aims to provide financial aid to impoverished individuals below the poverty line afflicted with cancer. This assistance, capped at Rs. 2,00,000, is facilitated through revolving funds allocated to 27 Regional Cancer Centers (RCCs), each receiving up to Rs. 50 lakhs for patient support. The Institute/Hospitals manage the disbursement of funds to eligible cancer patients through the allocated revolving fund.

The scheme encompasses various treatments, including:

1. Radiation treatment, covering Radiotherapy, Gamma Knife Surgery, GRT, MRT, and Brachytherapy.
2. Anti-cancer chemotherapy, inclusive of supportive medication and hormonal therapy.
3. Bone Marrow Transplantation, both Allogeneic and Autologous.
4. Diagnostic Procedures, incorporating PET scans.
5. Surgery for operable malignant tumors.

The financial aspects of cervical cancer treatment have significant implications for patients, healthcare systems, and policymakers. Understanding these economic dimensions is crucial for developing accessible and sustainable care strategies.

WHO’s Cervical Cancer Elimination Initiative 

Affordability is a critical factor in the accessibility of cervical cancer treatment. The cost of treatment can be prohibitive, particularly in low-and middle-income countries, where resources are limited. The WHO’s Cervical Cancer Elimination Initiative seeks to improve the affordability of cervical cancer treatment by focusing on vaccination, screening, and treatment. 

Conclusion

By achieving the objectives outlined in the initiative, we have the potential to eliminate cervical cancer as a significant public health challenge, ultimately preserving numerous lives on a global scale. Through unwavering commitment to comprehensive awareness campaigns, preventive strategies, and supportive programs, we strive for a future where cervical cancer no longer poses a prevailing health issue, ensuring an elevated quality of life for affected women worldwide.

Last Updated
16 Jan 2024 | 01:00 PM (IST)