 Hello, good morning all. I am Dr. Aditya Godse, consultant OBGYN department, Manipal Hospital, Old Airport Road. Hi, I am Dr. Pratima, consultant gynecological oncology, Manipal Hospitals, Old Airport Road, Bangalore. So we are having this discussion basically to create about awareness among the general people regarding cancer cervix. Now why is it essential to be aware about this particular cancer is because this can be picked up at a very early stage even at a pre-malignant stage. So one should be aware about the facilities or the test available for screening and also about some symptoms which may give a person a clue and do not ignore the symptoms. So to begin with, I would like to ask Dr. Pratima, what is cervix and what is cancer cervix? So cervical cancer is the cancer of the uterine cervix that is the mouth of the uterus. Okay, what are the risk factors one should keep in mind about what are the risk factors which result in cancer cervix? So we know that cancer cervix most of the time at least 90% of the time cancer cervix is caused by HPV that is human papilloma virus. So cancer cervix is basically divided into two that is HPV dependent and non-HPV dependent. So now we know that HPV dependent is most commonly caused causing cervical cancer that is about 90% of the time. So let us discuss more about the HPV dependent cervical cancer. So HPV as we all know it is a human papilloma virus it is a sexually transmitted infection. So every men or women in their lifetime at least 70 to 80% of men and women in their lifetime will come across this infection. Okay, they get infected with this infection but it does not mean that all women or men who get infected with this will develop into a cancer. But there are certain risk factors where this HPV virus persists that is like you know if somebody is having multiple sexual partners or if there is an early child marriage, if somebody is using oral contraceptive spills or they are exposure to smoking and alcohol or if the body humidity is low like if there are some immunosuppressants or if they are having other sexually transmitted infections like HIV or other sexually transmitted infections. So in such condition what happens is the virus stays for a long time and this persistence of virus could lead to some cellular changes in the cervix which further can lead to cancer cervix. But we have to remember most of the time like young women or young adults or like with a good immunity they are able to clear this HPV infection most of the time. But already as I mentioned these risk factors certain risk factors can predispose them to a cervical cancer later on. Adding to what Dr Pratima says I will just add what symptoms a person or a lady can come up to us in the OPD. One the lady can be absolutely asymptomatic or she can have profuse bleeding or she can have prolonged bleeding, bleeding post intercourse bleeding in between the periods or profuse foul smelling vaginal discharge. These are couple of symptoms which may point this to the clue that there is some cervical pathology may not necessarily be malignancy that's where we emphasize the screening. So not because these patients have these symptoms all women who started sexual activity of preferably even before after the age of 21 should be undergoing some form of screening method for cervical cancer. So Dr Pratima what are the screening methods for cervical cancer? So cervical cancer can have like you know we can as you already mentioned it is one of the most preventable and detectable and once if it is detected early it can be prevented and curable. So cervical cancer we have a screening test that is pap smear screening test and this screening pap smear or HPV DNA test. So in pap smear what happens is we usually like you know in both pap smear and HPV DNA testing the method is simple and it is safe just like in a COVID test how we use a swab through the on the through the nasal firings and we collect some cells and send it for the pathology. The same thing here women is positioned in a prone and without tummy position and the cervix is visualized through the cervix a brush is inserted and the cervical cells are scraped through this either a pap test or a HPV DNA test can be done. So through the pap smear test it will tell whether the cervix are there any changes in the cervix due to the HPV infection is the cervix cells are normal or there are any abnormal cells like you know pre malignant stage or there any cancer invasive cancer in that and in the HPV testing what we find is usually if there is a persistence or if there is an infection with HPV. So these are the tests which we do routinely for screening and every woman after the age of 25 to 30 years onwards up to the age of 65 to 70 years every 3 to 5 years they have to get this pap smear testing or HPV DNA testing in their lifetime. Just add to what Dr. Pratima said these tests are absolutely playlist there are no post there is no care post test the patient can go home immediately walking no doesn't take more than 5 minutes. So are you seeing any rise in the HPV infection because we get a lot of women asking for these but they are very petrified about the HPV and they want the HPV to be gone away completely from the body is it possible. Yeah yeah see what happens is most as we already know that HPV is most common like you know in the all age groups basically and especially in young adults most of the 60 to 70 percent of them are infected with HPV but like you know this infection can be enough through their immunity within 2 to 3 years of getting exposed to the HPV infection. So like you know patients whenever they come to us if we are doing HPV infection test yes at least 6 to 12 percent of the population whom we see who are HPV infected. So we've already discussed about the findings so what could be the preventive aspect is there a prevention towards HPV infection one regular screening second would be vaccination and thanks to the government of India which has introduced the HPV vaccine even in the children's immunization schedule. So we are now extending it from 9 to 14 years of age and also from 15 to 45 years of age so frankly there are no much side effects I would like to ask Dr. Pratimai if she's noted any side effects. If we see in Australia or in Australia the HPV vaccination was started in a national immunization program since 2006 onwards. So we have huge lengthy papers and studies which have shown like you know 10-12 years of follow-up they have seen that there are no significant adverse events. So these days lot of concerns are happening towards like infertility or premature ovarian failures and etc. So there are again certain Swedish and Danish studies and also there are certain studies which have been published in like you know pediatric and perinatal epidemiology journals. So that says that HPV like you know women who are if they have compared if they have seen that women who have been vaccinated had did not have any premature ovarian failure or infertility but yes if somebody is infected HPV as we all know it is a sexually transmitted infection and also they would be associated with other STIs. So we know that STIs itself will cause infertility like you know PID, general basics like thing they causes PID itself. So in such patients who have already been exposed and who already have other variants of STIs they could be having infertility but still they have seen that HPV vaccination could also prevent that infertility premature ovarian failure even in such patients who have been infected with HPV. So that is the benefit of HPV but there are no serious adverse events which have been seen. Minor like if we have any vaccines with any other vaccines just like flu, fever, redness, swelling or sometimes dizziness. So that is why most of the time after giving vaccination we ask the patient to lie down or to sit or we give a vaccine in a sitting position because most they feel dizziness is one of the most common thing otherwise not very much serious adverse events 97% of their side effects are very minor. To stress upon one even in spite of vaccination one should not forget the screening. The screening methods still continue as per the schedule there won't be any changes because one has been vaccinated about the pregnancy part if a person who has HPV DNA can definitely plan a pregnancy. So Dr. Pratima does it mean the person who has early cancer or pre-malignant they have to undergo removal of the uterus? So basically if a woman is desirous of pregnancy or if she is very young and then she has developed this cervical cancer so the treatment usually depends based on the what stage is the tumor what is the grade of tumor and what is the extent of the tumor. So if it is an early stage then definitely there are certain surgeries and certain advancements that is called fertility preserving technology fertility preserving surgeries. So even in early stage we have certain surgeries called we do cone biopsy cone isation or laser surgery that is called as leap which you call it as a laser or a leap surgeries and also we have something called as a trachelectomy or in some instances even some times the tumor is large even we can try with chemotherapy new adjuvant chemotherapy we can first give chemotherapy and see the disease like you know shrinks down and then we can do a surgery so there are a lot of advancement and technology in gyne oncology so we can do that and still preserve the fertility. So just to summarize that discussion cancer cervix is the most leading type of cancer in India and when it is more important rather to seek help early because this can be prevented and treated with lesser invasions please do take the HPV vaccine screen accordingly and screen adequately screen frequently do not ignore the symptoms and seek medical help as early as possible HPV DNA and Paxmeer are the most effective screening methods available so please do not ignore the screening methods do take your preventive vaccination and with this I would like to conclude thank you so much.