Cancer of the cervix, also known as cervical cancer, is one of the leading cancers in women in many countries including Anguilla. Despite the many advances in preventing and treating this cancer many women continue to die each year from this largely preventable cancer.
What is cancer of the cervix?
This is a leading cancer in women that develops in a woman’s cervix (mouth of the womb). Often this cancer has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding which can occur after sex, in between periods or after menopause.
It is possible for women of all ages to develop cancer of the cervix, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25. Cervical screening has led to a decreased incidence of women getting cancer of the cervix, and most cases in Anguilla now occur in women who have never had a Pap smear in their lives or who fail to get follow-up care following cervical cancer screening.
What causes cancer of the cervix?
Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells resulting in a mass (tumour). Cancer cells invade nearby tissues and can break off from a tumour to spread (metastasize) elsewhere in the body.
It is not clear what causes cervical cancer, but it is certain that the human papilloma virus (HPV) plays a role.
Clinical studies have revealed that almost all cases of cervical cancer are associated with the human papilloma virus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman.
There are more than 100 different types of HPV, many of which are harmless. Some types of HPV can cause abnormal changes to the cells of the cervix which can eventually lead to cervical cancer.
Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection do not have any symptoms, so many women would not realise they have the infection.
However, it is important to be aware that these infections are relatively common and most women who have them do not develop cervical cancer.
Using condoms during sex offers some protection against HPV, but it cannot always prevent infection because the virus is also spread through skin-to-skin contact of the wider genital area.
Risk factors for getting cancer of the cervix
Various studies have revealed a few risk factors for women getting cancer of the cervix. It should be pointed out that women without these factors can still develop the cancer. Risk factors for cervical cancer 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 weak 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.
Diagnosing cervical cancer
Many women are referred to their gynaecologist if their doctor suspects cancer of the cervix. Your doctor might refer a patient if he or she notices a growth on the cervix during an examination.
Your gynecologist will carry out a biopsy to confirm the diagnosis. If the results of the biopsy suggest you have cervical cancer, and there is a risk that the cancer may have spread, you will probably need to have some further tests to assess how widespread the cancer is. Once all the tests and investigations have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread.
Treating cervical cancer
Treatment depends on a number of factors including the stage of the cancer at diagnosis. If cervical cancer is diagnosed at an early stage, it is usually possible to treat it using surgery.
Radiotherapy is an alternative to surgery for some women with early stage cervical cancer. In some cases, it is used in combination with surgery.
More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.
Prognosis
The earlier cancer of the cervix is detected, the better the prognosis.
As symptoms of cervical cancer are very few in its early stages, it is important for women to have regular screening for cervical cancer so that pre- cancerous lesions can be detected and treated before they go on to cancer.
Preventing cervical cancer
Many countries have successfully developed programmes that have led to reduce incidence of cancer of the cervix. There are many things women can do to prevent cervical cancer and include the following:
Cervical screening
Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage.
Screening depends on a number of factors. Discuss these with your gynaecologist, but women from age 21/25 years should start cervical screening even if they had HPV vaccine. The frequency of screening varies. If you have been treated for abnormal cervical cell changes, you should have screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is.
Cervical cancer vaccination
Anguilla will shortly introduce a vaccination programme for cancer of the cervix for young girls. This vaccine can significantly reduce the risk of cervical cancer. (Next week’s article will discuss this in more detail.)
Avoid smoking
You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body, which can develop into cancer.
Practice safe sex.
Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.
Conclusion
Cancer of the cervix is largely a preventable cancer, but women in Anguilla still die from it. Our cervical screening programme has reduced the incidence and with the introduction of HPV vaccination this would greatly help to further decrease the incidence of this dreaded cancer, on the island, which continues to affect our mothers, grandmothers, sisters and friends. If you are a woman over the age of 21/25 and never had a Pap smear, do so as soon as possible as cervical screening has been proven to help prevent cancer of the cervix. If you have any abnormal symptoms suggestive of this cancer, see your healthcare provider. The earlier the diagnosis is made and treatment started, the better the prognosis.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
