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World Cancer Day

The 2019 World Cancer Day was marked on Tuesday, February 4. Kindly enlighten the public about cervical cancer, one of the deadly cancers among women?

Zeenat B.

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Let me provide a simple anatomy to help readers understand the problem better. The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The foetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix).

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The two main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). These two cell types meet at a place called the transformation zone. Most cervical cancers start in the transformation zone.

Cervical cancer usually develops very slowly. It starts as a precancerous growth. This precancerous condition can be detected by a Pap smear and is 100 per cent treatable. Almost all cervical cancers are caused by Human Papilloma Virus (HPV). It is a common virus that is spread through sexual intercourse.

Risk factors include

1. Exposure to sex at an early age.

2. Keeping multiple sexual partners.

3. Poor economic status (may not be able to afford regular Pap smear).

4. Sexual partners who have multiple partners or who participate in high-risk sexual activities such as sex without protection.

5. Weakened immune system.

Symptoms

Note: Most of the time, early cervical cancer has no symptoms.

Symptoms may include:

1. Abnormal vaginal bleeding between periods, after intercourse, or after menopause.

2. Any bleeding after menopause.

3. Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling.

4. Periods become heavier and last longer than usual.

Symptoms of advanced cervical cancer may include

1. Back pain and leg pain

2. Bone fractures

3. Fatigue and weight loss

4. Heavy bleeding from the vagina

5. Leaking of urine or faeces from the vagina

6. Loss of appetite

7. Single swollen leg

Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions.

1. Pap smears screen for pre-cancers and cancer, but do not make a final diagnosis.

2. If abnormal changes are found, the cervix is usually examined under magnification.

3. Endocervical curettage (ECC) to examine the opening of the cervix

4. Cone biopsy

Treatment

1. Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix so that a woman can still have children.

2. A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women with advanced cancer.

Prevention

1. It is very important to ensure prevention of cervical cancer through provision of vaccine to female children, practicing safe sex (using condoms) also reduces risk of HPV and other sexually transmitted diseases (STDs).

2. Limiting sexual partners, as well getting regular Pap smear can help detect precancerous changes which can be treated before they turn into cervical cancer.

3. Pap smear effectively spots such changes, but it must be done regularly. Annual pelvic examination, including a Pap smear, should start when a woman becomes sexually active, or by the age of 20 in a non-sexually active women.


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