Cancer of the cervix still causes much suffering and death in women in Anguilla. This largely preventable cancer is one of the few cancers that have precancerous conditions that can be detected, and if treated successfully can prevent cervical cancer.
Precancerous cervical lesions
A precancerous cervical lesion, which is also called an intraepithelial lesion, is an abnormality in the cells of the cervix that could eventually develop into cervical cancer. The cervix is the lower part of the uterus. Both the uterus and the cervix are located in the pelvis and are close to the upper part of the vagina and the ovaries. In fact, the cervix connects the uterus and the vagina. The vagina leads to the outside of the body.
The surface of the cervix is made up of two different types of cells, squamous epithelial cells (the lining cells of the outer part of the cervix, or ectocervix), and columnar epithelial cells (the lining cells of the inner part of the cervix, or endocervix).
A Pap smear also called a Pap test can detect precancerous and cancerous conditions by collecting cells from the surface of the cervix. Sometimes these cells appear abnormal, or atypical, when looked at under a microscope, but they are not completely cancerous. These are called premalignant or precancerous cells, which means they might turn into cancer if not found and treated early enough. These precancerous lesions are commonly called cervical intraepithelial neoplasia (CIN).
What are the main types of precancerous cervical lesions?
The most common types of precancerous cervical lesions include:
• Atypical squamous cells. These indicate that there are some abnormalities in the squamous cells of the cervix. This abnormality might be due to a human papillomavirus (HPV) infection, another infection, or possibly precancerous cells of another cause. Your gynaecologist may recommend further testing to determine what the abnormalities mean. In some cases, this may simply mean a repeat Pap test in a few months. A Pap test with this kind of finding may be reported as “atypical squamous cells of uncertain significance,” abbreviated as ASCUS.
• Squamous intraepithelial lesion (SIL). This lesion means that you have changes on your cervix that may be precancerous. SIL lesions are classified as either low-grade (LSIL) or high-grade (HSIL), with high-grade lesions being more likely to progress to cervical cancer.
• Atypical glandular cells. These signal a possible precancerous lesion in the upper area of your cervix or inside the uterus.
Testing and further screening
The Pap smear is not used to diagnose a condition – it is only a screening test. If you doctor has indicated that you have a precancerous lesion further testing and screening might be indicated. Recommended tests depend on a number of factors including your age, menopausal status, Pap test results, and whether you are pregnant. Follow-up testing may include one or more of the following:
• Repeat Pap test. Some women just need another Pap test within a few months to see if the abnormality is still present.
• HPV testing. Since many abnormalities are caused by an HPV infection, your doctor may recommend that your cervical cells be tested for HPV. Some types of HPV infection clear on their own, and may not go on to precancerous changes or cancer, but others, if not cleared by the body, are more likely to cause cancer.
• Colposcopy. This test allows your gynaecologist to get a better look at your cervix through a magnifying device. This can be done in the doctor’s office.
• Cervical biopsy. This involves removing a small sample of cervical tissue and sending it to a lab for further testing.
If this testing determines that you do, in fact, have a precancerous cervical lesion, there are a number of treatments that can help reduce the chances that the lesion will develop into cervical cancer.
Treatment options for a precancerous cervical lesion
There are a number of treatment options available for treating precancerous cervical lesions. These include: Loop electrosurgical excision procedure (LEEP). freezing (cryotherapy), laser treatment, and conization of the cervix. Women should be reassured that treating precancerous lesions of the cervix can almost always prevent them from getting cancer of the cervix.
Follow up
Once you have been treated you should continue to visit your gynaecologist for regular checkups and appropriate screening/testing. Timing of these follow up visits will vary so it is important to discuss this with your gynaecologist.
Conclusion
Cancer of the cervix is largely a preventable cancer. In most cases it is caused by the human papilloma visus (HPV). Precancerous lesions of the cervix can be detected by various tests including the Pap smear. These lesions can be successfully treated and in most cases cervical cancer can be prevented. Women, today, should not die from cervical cancer. One of the best ways to prevent cervical cancer is to have regular Pap tests – and if you are a young girl having the HPV vaccine.
Ask Your Dr 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 with over thirty-eight years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
