January has been designated as cervical cancer month. As we come to the end of the month let us take some few minutes to educate ourselves of this disease.
Overview
Cervical cancer is a type of cancer that occurs in the cells of the cervix. The cervix is the lower part of the uterus that connects to the vagina. Cervical cancer is the fourth most common cancer among women globally. Most common gynaecologic cancer in Ghana with an estimated 3151 new cases and 2119 deaths in 2018.
Cervical cancer usually develops gradually in the cells (squamous or/and columnar) of the cervix. This starts as a precancerous condition called dysplasia. Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix.
Almost all cervical cancers are caused by Human papillomavirus (HPV). HPV is a common virus that is sexually transmitted. There are different types (strains) of HPV of which some leads to cervical cancer, others can cause genital warts and some do not cause any problems at all. In about 80 percent of cases the body is able to get rid of it but unfortunately in about 20 percent the virus will persist and cause changes in the cells overtime to cause cervical cancer.
Risk Factors of Cervical Cancer
A woman’s sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include:
- Many sexual partners: The greater your number of sexual partners and the greater your partner’s number of sexual partners, the greater your chance of acquiring HPV.
- Early sexual activity: Having sex at an early age increases your risk of HPV.
- Other sexually transmitted infections (STIs): Having other STIs such as chlamydia, gonorrhoea, syphilis and HIV/AIDS increases your risk of HPV.
- A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
- Smoking: Smoking is associated with squamous cell cervical cancer.
To reduce your risk of cervical cancer:
- Ask your doctor about the HPV vaccine: Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
- Have routine Pap tests: Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
- Practice safe sex: Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections, such as using a condom every time you have sex and limiting the number of sexual partners you have.
- Don’t smoke: If you don’t smoke, don’t start. If you do smoke, talk to your doctor about strategies to help you quit.
Signs and Symptoms
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include:
- Abnormal vaginal bleeding between periods, after intercourse, or after menopause
- Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling
- Periods that become heavier and last longer than usual
Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: Fatigue, Back pain, Bone pain or fractures, leaking of urine or faeces from the vagina, Leg pain, Loss of appetite, Pelvic pain, Swelling of one (single) leg and Weight loss
Diagnosis
Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Thus, your doctor identifies these abnormalities using special tests and tools.
Screening
Screening tests can help detect precancerous cells that may one day develop into cervical cancer. Most guidelines suggest beginning screening for precancerous changes at age 21.
Screening tests include:
Pap test: This can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer. During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities.
Visual Inspection using Acetic Acid (VIA): Involves inserting a vaginal speculum and swabbing the cervix with 3% to 5% of acetic acid solution (ordinary table vinegar) before a cervical examination..
HPV DNA test: This test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer. HPV DNA test is done depending on your age or after a woman had an abnormal pap smear result. I t may also be used as a first test.
Colposcopy Examination.
If your doctor suspects cervical cancer, he/she is likely to start a thorough examination of the cervix using a special magnifying instrument (colposcope) to check for abnormal cells in the cervix. The doctor is likely to take a sample of the cervical cells (biopsy) for laboratory testing. The tissue is obtained by using:
Punch biopsy– which involves using a sharp tool to pinch off small samples of cervical tissue or Endocervical curettage– which uses a small, spoon-shaped instrument (curette) or a thin brush to scrape a tissue sample from the cervix. In cases where punch biopsy / endocervical curettage is worrisome, your doctor may perform one of the following tests:
Electrical wire loop- which uses a thin, low-voltage electrified wire to obtain a small tissue sample. This is generally done under local anaesthesia.
Cone biopsy (conization)- which is a procedure that allows your doctor to obtain deeper layers of cervical cells for laboratory testing. A cone biopsy may be done in a hospital under general anaesthesia.
Treatment
Treatment of cervical cancer may be surgery, chemotherapy, radiotherapy or a combination of the three. Cervical cancer treatment depends on several factors such as:
- The stage of the cancer
- The size and shape of the tumour
- The woman’s age and general health
- Her desire to have children in the future
Cervical cancer is preventable and curable when seen early. It can be prevented by
- Avoiding being exposed to HPV.
- Not having sex at Early age.
- By not having multiple partners
- By not having partners with high risk behaviors
- by using Condoms (” rubbers”) provide some protection against HPV.
- By not smoking.
- By Getting vaccinated.
- By getting Screened for premalignant lesions
BY WORTHY BR DR ADU APPIAH-KUBI
ASSISTANT SUPREME PHYSICIAN