Damini looked at the clock with shock. It was half past eight. She had overslept again. Cursing her body for not cooperating with her, she tried to drag herself up quickly so she could face the mountain of chores lined up for her that day. Her son’s wedding was now, only a few weeks away. She can’t be complaining and staying in bed with so much left to do. She rushed to take a shower and to her embarrassment, found that the white discharge which had begun a few months ago, hadn’t ceased yet. Recently, she had also seen that it was slightly streaked with blood. She made a mental note to drink tender coconut sometime in the evening if she could go out. It must be the heat of the summer, she thought. But the sight of blood had intrigued her. She wondered about the possibility that her period might have come back. Hadn’t it been almost four years since her menopause? It had stopped around her 52^nd birthday. All was well until the white discharge had begun. Thinking about it made her feel tired. She sat down on the sofa after making breakfast and lunch for the family and waved them off as they hurried out of home, each busy with their own pursuits, busy to even ask if she had eaten anything. Damini winced and shifted slightly on the sofa to a more comfortable posture so that the pain in her abdomen seemed to lessen slightly. She watched her old frail self stare back at her from the mirror mounted on the wall. She looked tired and there were hollows under her cheek bones. Has she lost weight? So it seemed, considering how the blouse of her saree was uncomfortably loose now. Anyone would lose weight if they had to walk up and down two floors a hundred times every day, she thought. Her grown up kids weren’t helping much with the chores and her husband wasn’t supportive either. Should she tell him, perhaps, about the pain in the abdomen? She knew what would be his reaction, “For once will you stop complaining? Pain here, pain there..It must be something to do with the hormones..you know what they say..the peri menopausal hormonal changes.” Yes, that’s what he would say. It had been a while since he listened about it on a health program on the television after which he had attributed all of Damini’s health concerns to the hormones, in spite of the menopause happening four years ago. She can’t be resting now, Damini thought guiltily, not with the wedding around the corner. She hoisted herself up gingerly from the sofa and started climbing the stairs. She needed to get the clothes back inside, it looked like it would rain any moment. She remembered getting up from the sofa, but couldn’t take another step. She felt dizzy, as if being engulfed in a black cloud. She clutched the door nearby to stop herself from falling. After a minute or two, she came back to her senses and the cloudy sensation had cleared. But fear was gripping its place. She dialed her friend Hema’s number, one person whom she was sure would not brush her worries away as ridiculous. Damini was lying on the hard white bed, her head turned to the window. The smell of disinfectant wafted through the air. It had been two days since that fateful day when she had almost fainted. The clothes would still be on the rails battling sun and rain, Damini thought sadly. Her friend Hema had insisted that she take Damini to hospital immediately. They visited the nearest multispeciality hospital and the doctor who had examined her had suggested a battery of tests and scans. Her husband hadn’t been very happy about Damini going on her own to the hospital, or about the number of tests, but he at least hadn’t objected, so he can say “I told you so” when all the tests came back normal. But fate had other plans. It would be robbing him of that glorious moment. The tests had shown that she was battling stage 4 cervical carcinoma. The cancer had already found its way to her lungs and liver. Damini had ignored the warning signs for too long. The doctor was talking to her family now, and they all looked grave as he was discussing the limited options that are available at this stage. She had wanted to see the cherry blossoms of Japan, the tulip fields of the Netherlands, she had hoped she could start her small business after the wedding of her youngest. There was so much left to do, she can’t be resting like this. “Ask the doctor when we should come next”, she told her husband and walked out, her head held high with a steely resolve. The cancer can steal her physical strength, but it cannot touch the strength of her mind, not when there was so much left to do, with so little time.

What do the experts say?

1. What are the warning signs of cervical cancer that Damini had ignored? White vaginal discharge, spotting, post-menopausal bleeding, easy fatiguability, abdominal pain, weight loss 2. When could the disease have started? Probably six months ago Damini would have had an easily curable cancer 3. If Damini had got herself screened for cancer six months ago, could she have had a better survival chance? Definitely. Most common uterine cancer is Cancer of the cervix which can easily be detected by screening for early cancer changes and carries very good survival chances if treated early. 4. What are the treatment options available for early and late cancers? Uterine cancer treatment involves a multi modality therapy- Surgery, Chemotherapy and Radiation and will be individualised based on the stage of cancer. 5. After treatment, is a normal life possible? Yes. After cancer treatment, the chances of recurrence depends on the stage of the cancer. The patient needs to have regular follow ups for every 3 months in the initial two years and then once in 6 months. 6. Is uterine cancer preventable? Human Papilloma Viral infection is the most common cause of Cervical cancer and it is preventable with a vaccine which can be given after ten years of age. Regular screening with a simple pap smear test and HPV DNA testing from the age of 21 can detect cancer at its earliest.