Despite many advances in the management of cervical cancer, this cancer still kills many women in Anguilla. This is unfortunate because it is largely preventable. Regular medical checkups and cervical screening have led to declining deaths from cervical cancer in many countries.
What Is Cervical Cancer?
Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus (womb). It is felt by many that a virus is the trigger for most cases of cervical cancer. When detectedearly, cervical cancer is usually curable if treated correctly.
What are the signs and symptoms of Cervical Cancer?
When cervical cells first become abnormal, there are rarely any warning signs. In the vast majority of cases the diagnosis is often made following a biopsy in a patient with no symptoms. As the cancer progresses, symptoms may include the following:
• Unusual vaginal discharge
• Vaginal bleeding between periods
• Bleeding after menopause
• Bleeding or pain during sex
What causes Cervical Cancer?
The human papillomavirus (HPV) is a large group of viruses. More than 40 types of this virus can infect the genital areas, and some have high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix. It is these changes that may lead to cancer. Worldwide, over 90% of cervical cancers are caused by an HPV infection.
Symptoms of HPV
HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It is important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms.
Who Is at Risk for HPV?
HPV is so common that most people who have ever had sex — both women and men — will get the virus at some point in life. As HPV can linger quietly, it is possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis, and to anal and oral cancers in both sexes.
How HPV Causes Cervical Cancer
If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer. Over time the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas.
Early Detection: Pap smear test
The Pap smear test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormal cells, often before cancer appears. At age 21, women should start having a Pap test. The frequency of testing will vary depending on your risks, therefore you should discuss this with your doctor.
Early Detection: HPV DNA Test
In some cases, doctors may offer the option of the HPV DNA test in addition to a Pap test. This test checks for the presence of high-risk forms of HPV. It may be used in combination with a Pap test to screen for cervical cancer in women over 30. It may also be recommended for a woman of any age after an abnormal Pap test result.
Diagnosing Cervical Cancer: Biopsy
A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells, and cancer cells. In most cases, a biopsy takes place in a doctor’s office with local anesthesia. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix, but this test may require general anesthesia.
Stages of Cervical Cancer
Doctors will stage cervical cancer so as to help in the management of this disease.
Stage 0 describes cancer cells found only on the surface of the cervix. More invasive cancers are separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the tumour has spread to the upper part of the vagina. A Stage III tumour extends to the lower part of the vagina and may block urine flow. In Stage IV, the tumour has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumours.
Treatment for Cervical Cancer
Treatment will depend on a number of factors, and the type of treatment often involves discussions with the affected individual and a number of health professionals. Treatment often includes surgery, radiation and chemotherapy.
Surgery
If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer.
Radiation
External radiation therapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the tumour. Women with cervical cancer are often treated with a combination of radiation and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting, and loose stools.
Chemotherapy
Chemotherapy uses drugs to reach cancer wherever it is in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting, and loss of appetite.
Coping With Cancer Treatments
Cancer treatments may make you tired or uninterested in food. It is important to take in enough calories to maintain a healthy weight. Check with a dietitian for tips on eating well during cancer treatment. Staying active is also important. Gentle exercise can increase your energy while reducing nausea and stress. Check with your doctor to find out which activities are appropriate for you.
Survival Rates for Cervical Cancer
The odds of surviving cervical cancer are tied to how early it is found. Depending on the stage, between 93% and 15% of women will survive for at least five years after diagnosis. Statistics do not predict how well any one individual will respond to treatment.
Vaccine to Help Prevent Cervical Cancer
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Both Cervarix and Gardasil require three doses over a six-month period. Studies suggest the vaccines are effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers. Gardasil also protects against two types of HPV that cause genital warts.
Who Should Get the HPV Vaccine?
The vaccines are only used to prevent, not treat, HPV infection. They are most effective if administered before an individual becomes sexually active. Talk to your gynaecologist if you have a daughter who is interested in having this vaccine.
Conclusion
Cervical cancer still kills women inAnguillatoday. Some women are having screening tests for this cancer, but many more are still not seeing their doctor for regular check-ups and screening. Prevention is important in our quest to decrease the number of cases of cervical cancer in Anguilla.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over twenty nine years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
