Cervical cancer, also known as cancer of the cervix, is now considered a preventative cancer, but women in Anguilla continue to get this cancer and have many complications. Improved medical care and widespread use of the Pap smear has led to drastic declines in the incidence of this cancer worldwide.
What is cervical cancer?
Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus (womb). Most cases of cervical cancer are caused by a virus. In most women, when the cancer is found early and managed by a qualified health team, cervical cancer is highly curable.
What are some of the symptoms of cervical cancer?
In the early stages many women with cervical cancer might not have any symptoms at all. 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. About 40 types can infect the genital areas, and some have high risk for cervical cancer. Most cases of 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.
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. 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.
Other risk factors for cervical cancer?
Any woman can develop cervical cancer even if she does not have any risk factors. We now know that, in addition to infection with HPV, there are other factors that can increase a woman’s chances of getting cervical cancer. These include the following:
• Smoking
• A woman having many children
• An individual who is HIV positive or has a weakened immune system
How can cervical cancer detected?
Early Detection
Getting a Pap test is one way of detecting precancerous lesions that can go on to develop into cervical cancer. This painless test should be done as early as age 21 or even earlier in at risk women. The frequency and interval of having Pap test will vary, but talk to your health care provider on when and how often to have your Pap test. Skipping tests raises your risk for invasive cervical cancer. An abnormal Pap test does not mean you have cancer. Some doctors continue to tell patients that an abnormal Pap test is the same as cervical cancer.
What does an Abnormal Pap test mean?
If test results show a minor abnormality, you may need a repeat Pap test. Your doctor may schedule a colposcopy — an exam with a lighted magnifying device — or biopsy to get a better look at any changes in the cervical tissue. If abnormal cells are precancerous, they can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.
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.
How do you know if you have cervical cancer?
A cervical biopsy and examination in the lab is one way to accurately diagnose cervical cancer. 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
Once a diagnosis of cervical cancer is known your doctor will determine the stage of the cancer as this will influence treatment and prognosis.
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. And the most severe stage is 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
There are many treatment options for cervical cancer.
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.
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.
Survival rates for cervical cancer
The success of treatment for cervical cancer will depend on many factors, but most significantly on how early the cancer is detected. In the early stages success rates are as high as 93 per cent and in late stages as poor as 15 per cent.
Support for individuals with cervical cancer
Individuals with cervical cancer, in addition to their medical treatment, need a lot of support both spiritually, emotionally and psychologically. Family members, relatives and friends should be there to lend support at all times, but especially during times of treatment. The side effects of therapy can be tremendous and brutal to the individual.
Cervical cancer and vaccines
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Cervarix and Gardasil vaccines 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.
Conclusion
Cervical cancer is a preventable cancer. The use of the Pap test has been a success story. This test has helped to drastically reduce the number of cases of cervical cancer worldwide. As cervical cancer has few symptoms in its early stages, frequent medical check-ups are warranted. Fortunately, with early detection of cervical cancer and effective means of treatment, the prognosis for treatment for cervical cancer is excellent.
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 thirty years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
