Cervical Cancer Informative diagram

Insights on Cervical Cancer

Cervical Cancer Informative diagram

WHAT IS CERVICAL CANCER?

The cervix connects the vagina to the body of the uterus (commonly called the Womb, which is where babies develop in the bodies of pregnant women). Cervical cancers result from uncontrolled growth of the cells in the cervix of a woman. (For more about cervical cancers).

It begins with the formation of precancerous cells in the cervix which if not automatically cleared by the body’s own immune system or timely medical treatment, could further develop into cervical cancer.

Worldwide, cervical cancer is both the fourth-most common cause of cancer and the fourth-most common cause of death from cancer in women. About 14,000 new cases of Human Papilloma Virus (HPV, which is a precursor to cervical cancer) is diagnosed in women every year in Nigeria, and WHO estimates ranked it as the second leading cause of female cancer in Nigeria and most common in women aged 15 to 44 years in Nigeria (Read More). An oncologist reports about 9,000 deaths resulting from cervical cancers yearly in Nigeria (Source). With these type of statistics, it is imperative that more public enlightenment aimed at prevention and regular screening be encouraged for women within the risk age, given that cervical cancer is so easily preventable.

TYPES OF CERVICAL CANCERS

  • The precancerous cells are of several types: cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL) and dysplasia.
  • There are many types of cervical cancers, but the two most common are: Squamous cell carcinomas and adenocarcinoma.
  • Most Cervical cancers occur in women between the age of twenty years and fifty years.

WHAT CAN CAUSE CERVICAL CANCER?

The major risk/causal factor of cervical cancer is getting infected with Human Papilloma Virus (HPV) which causes warts (papilloma). The high-risk types of HPV can lead to cancers including cervical cancers, and exposure to HPV is directly as a result of sexual activity which includes unprotected sex with multiple partners, underage sex, and  sex with high-risk male partners. Other factors include:

  • Genetics (family history) sometimes determine susceptibility to developing cancers including cervical cancers.
  • Age: women within the ages of 21 and 65 years are at risk for cervical cancer.
  • Diets lacking in adequate fruits and vegetables increases the chances of developing cervical cancer.
  • Bad habit such as smoking, which reduces the body’s immune system as well as introduce harmful chemicals into the body increases cervical cancer risk.
  • Obesity/excess body weight increases the chances of developing cervical cancer (as well as other cancer forms like colorectal cancers) .
  • The body’s immune system plays a vital role in fighting cancers, hence infections like HIV/AIDS, drugs- such as those administered to patients who have undergone organ transplant (to prevent rejection) or other conditions that weaken the body’s immune system increases the risk of developing cervical cancer.
  • Untreated or improperly treated Chlamydia infection could put some women at risk of developing cervical cancer.
  • Prolonged use of birth control pills (oral contraceptives) increases the chances of developing cervical cancers.
  • Underage pregnancy, particularly for women below seventeen years of age increases cervical cancer risk.

(the American Cancer Society has more resources for the causes, risk factors and prevention of cervical cancer)

SIGNS AND SYMPTOMS OF CERVICAL CANCER

Unfortunately, precancerous lesions and early onset cervical cancers do not exhibit any symptoms. Certain symptoms become common only after the cervical cancer has become invasive. Symptoms to watch out for includes:

  • All forms of vaginal bleeding and discharge that are out of tune with the norm are suspect.
  • Back pain, pelvic pain, as well as pain during intercourse could indicate cervical cancer.
  • Anaemia and urinary incontinence.

Consulting a medical professional and undergoing physical examination and screening would help diagnosis of causes for the abnormality.

Cervical Cancer Awareness Campaign at St. Dominics Catholic Church, Yaba
Cervical Cancer Awareness Talk during the Sisters week of Yaba Deanery at St. Dominic’s Catholic Church, Yaba,Lagos

 

HOW DO WE PREVENT CERVICAL CANCER?

To prevent infection with high-risk HPV which is a sexually transmitted disease: sexual abstinence (particularly for the underage); avoiding engaging in sexual intercourse with multiple partners; diligent use of adequate protection during intercourse, are some of the steps one can take.

  • Getting vaccinated against HPV with the HPV vaccine helps protect against HPV types that can cause the group of gynaecologic cancers such as cervical, vaginal and vulvar cancers. The vaccine in recommended doses can be given to both girls and boys within the age of puberty (12 years or even earlier) and 26 years of age.
  • Healthy diets, habits and lifestyle could reduce the risk of developing cervical cancer
  • Prevention of cervical cancer is optimized through regular screening. Screenings include pelvic examination, Pap smear/test and HPV test. Regular screenings (especially for women within 21-65 years age bracket) help detect changes in the cervix and the presence of precancerous growths or cancers before they become invasive. This enhances the success of treatment.

SCREENING AND DIAGNOSIS OF CERVICAL CANCER

Screening is mostly through Pap test and visual examination. An abnormal pap test leads to further confirmatory diagnostic testing such as colposcopy, endocervical scraping/curettage and cone biopsy/conization. For cancers that have passed the early stage, cystoscopy, proctoscopy and examination under anaesthesia are a few of the diagnostic methods.

Other comprehensive diagnostic imaging test are: Chest X-ray, Computed tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET) scan

STAGES OF CERVICAL CANCER

Three factors help classify the stages of cervical cancer known as TNM Staging System.

  1. The tumor extent (T) which indicates the size, depth and location of spread of the initial tumor within the cervix, uterus, vagina, bladder, rectum and pelvis.
  2. Nodes (N) which indicates if the nearby lymph nodes have become infected
  3. Metastasis (M) which indicates if the cancer has spread to distant organs and tissues of the body.

The TNM classes combined indicate the stages and sub-stages of cervical cancer with severity increasing from Stage 0 to Stage IV.

For more on early detection, diagnosis and staging of Cervical cancer

TREATMENT OF CERVICAL CANCER

There are different methods for treatment of cervical cancer, but the choice depends on the stage of the cancer and class. The options are:

  • Surgery (cryosurgery, laser surgery, trachelectomy, pelvic extenteration (urostomy & colostomy), hysterectomy (simple and radical) e.t.c.
  • Immunotherapy
  • Chemotherapy
  • Radiotherapy

The success of the various treatment methods mostly depend on the stage of the cancer in addition to the age of the patient, their general health and how well the cancer responds to treatment. Some form of early stage and early detected cervical cancers can be cured outright, while some  others can be managed with appropriate treatment. Regular monitoring of survivors by their doctors help prevent or detect very early incidence of re-occurrence.

Various researches conducted in Nigeria on cervical cancer revealed that illiteracy, polygamy, early girl-child marriages,inadequate family planning, low general awareness on cervical cancer, prevailing poverty, inadequate screening and treatment facilities in most states across Nigeria, worsen the incidences of cervical cancer cases (Cancer of the cervix…). Nigeria as the giant of Africa has no excuse not to be at the forefront in the fight against cancers, especially one as preventable as cervical cancer. That we are yet to make an impact in high-tech drug development researches should not deter us from implementing worthy blueprints to reduce the high incidence rate of cervical cancer. Thus more need to be done with respect to public awareness, provision of affordable screening facilities and vaccines, as well as putting in place policies that strengthen our medical and research facilities to play their part in combating the cancer menace.

Further reading on cervical cancer:

  1. Wikipedia: Cervical Cancer 
  2. Centers for Disease Control and Prevention (CDC) Inside Knowledge: Get the Facts About Gynecologic Cancers
  3. The American Cancer Society: Treating Cervical Cancer (General treatment information)
  4. The American Cancer Society: After Treatment, Living as a Cancer Survivor  
  5. Detailed resources on cancer research in Nigeria can be gotten from http://www.cancerindex.org/Nigeria
  6. Cancer of the cervix in Zaria, Northern Nigeria –   http://ecancer.org/journal/5/full/219-cancer-of-the-cervix-in-zaria-northern-nigeria.php