Women in Anguilla continue to die from cancer of the cervix also called cervical cancer. Today, screening tools have significantly reduce the impact of cancer of the cervix but, sadly, many women do not have access to these screening tools – and in some instances the diagnosis is often made in the late stages of the disease when the chances of cure are diminished.
What is cancer of the cervix?
Cancer of the cervix, or cervical cancer, begins on the surface of the cervix. There are two main types of cancer of the cervix — squamous cell carcinomas, and adenocarcinomas. About 80% to 90% are squamous cell carcinomas, while 10%-20% are adenocarcinomas. The cervix is the lower part of the womb (uterus). The uterus has two parts — the upper part (body) where a baby grows, and the lower part (cervix). The cervix connects the body of the uterus to the vagina (birth canal). Nearly all cervical cancers are caused by an infection from certain types of human papillomavirus (HPV).
Cancer of the cervix can often be prevented by women attending cervical screening which aims to find and treat changes to cells before they turn into cancer.
Cervical cancer usually grows very slowly. How serious it is depends on how big it is, if it has spread, and the general health of the individual.
What are some signs and symptoms of cancer of the cervix?
Precancerous cells in the cervix do not usually cause symptoms. In most cases symptoms of cervical cancer occur when the cancer has progressed to the point that it is difficult to treat.
Early stages of cervical cancer do not involve pain or other symptoms. The first identifiable symptoms of the disease are likely to include:
• Watery or bloody vaginal discharge which may be heavy and can have a foul odour.
• Vaginal bleeding after intercourse or exercise, between menstrual periods; or after menopause.
• Menstrual periods that may be heavier and last longer than normal.
If the cancer has spread to nearby tissues, symptoms may include:
• Difficult or painful urination, sometimes with blood in urine.
• Diarrhoea, or pain or bleeding from the rectum upon defecation.
• Fatigue, loss of weight and appetite.
• A general feeling of illness.
• Dull backache or swelling in the legs.
If abnormal bleeding, vaginal discharge, or any other symptoms last more than two weeks without explanation, you should have a complete gynecological examination that includes a Pap smear. It is important to get any symptoms of cervical cancer checked as soon as possible.
How is cancer of the cervix diagnosed?
Following a detailed history and examination most cases of cervical can be detected. For an accurate diagnosis, your gynaecologist will visually examine the cervix and take a tissue sample of any apparent abnormality for biopsy.
If the biopsy confirms cancer, further tests will determine whether the disease has spread (metastasized). These tests might include liver and kidney function studies; blood and urine tests – and X-rays of the bladder, rectum, bowels, and abdominal cavity. This process is called staging.
How is cervical cancer treated?
Treatment usually involves a team of doctors. Recommended treatment for cervical cancer is based on many factors including the stage of the disease, the age of the patient, the general health of the woman, and the woman’s desire for future childbearing. The three main treatments for cervical cancer are radiation, chemotherapy and surgery. Some people may have a combination of treatments. Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis (Stage IV) or cancer that has recurred.
Prognosis
In women with invasive cervical cancer that is caught at the earliest stage, the 5-year relative survival rate is over 90%. The overall 5-year relative survival rate for cervical cancer is about 68%. The rate takes into account all stages of the cancer combined. The earlier the cancer is detected the better the prognosis.
Can cervical cancer be prevented?
Women can take some measures to prevent cervical cancer. Receiving regular gynecological exams, and getting Pap tests, are the most important steps that women can take toward the prevention of cervical cancer. Unfortunately, many women in Anguilla are still not having regular Pap smears. Most experts now recommend the following:
• All women should begin cervical cancer screening when they are 21 years old, regardless of sexual history. The frequency of screening should be discussed with your doctor. More frequent screening may be needed if any abnormal cells are found or if HPV is present.
• Beginning at age 30, women who have had 3 normal Pap test results in a row should be screened every 5 years with both a Pap smear test AND a screening test for – high risk type – HPV infection. Another acceptable option is to be screened every 3 years with only the Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use, should continue to be screened annually.
• Women 65-70 years of age, or older, who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 20 years should stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Women who have had a total hysterectomy (removal of the uterus and cervix) should also stop having cervical cancer screening, unless they have a history of cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.
It is important to remember that a diagnostic Pap test may be done earlier if a woman is having new problems, such as unusual bleeding.
Also, women being followed for an abnormal Pap test, or who have been treated for an abnormal Pap test, will have a different scheduled follow-up than what is noted above.
What is the cervical cancer vaccine?
A vaccine to prevent cancer of the cervix is available in several countries including Anguilla. The vaccine is approved for girls and women ages 9 to 26 – and protects against the development of cervical cancer. The vaccine, which also protects against genital warts (and also has been approved for boys for this purpose), works by triggering the body’s immune system to attack certain human papillomavirus (HPV) types, which have been linked to many cases of cervical cancer. It is best to get the vaccine before the start of sexual activity.
Conclusion
Cancer of the cervix or cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. This cancer often has precancerous conditions which can be detected by screening tests, and can help prevent cervical cancer. Symptoms of cervical cancer often occur in the late stages of the disease. Most cases of cervical cancer can be treated with the survival rate highest in the early stages of the disease. The advent of frequent cervical screening test, and the use of cervical cancer vaccine, have markedly decreased the incidence of cervical cancer, but the disease is still prevalent in Anguilla and many other countries.
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 is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
