CERVICAL cancer is simply a malignancy of the cervix. The cervix is the lowest part of the uterus otherwise loosely termed the mouth of the uterus. Malignancy or cancer simply means a growth that has capacity to invade local tissues and/or spread to distant organs.
What happens when there is cancer is that your body cells become rebellious to the commands of your higher centers. Millions of body cells die and new ones are produced on a daily basis. But when there is cancer now these (cancer) cells “refuse” to die at the apportioned time and they now live longer than they should and this now results in the malignant growths we call cancer. So if this process happens on the cervix we call it cancer of the cervix.
Cervical cancer is the commonest cancer in women in developing countries. It is also the leading cause of cancer deaths in women in the developing world. In the first world it’s the fourth commonest cancer in women. You will get to understand these disparities in prevalence between the developed and the developing countries when we talk about the risk factors and prevention of cervical cancer.
About 90% of cervical cancer cases are caused by an infection with the virus Human Papilloma Virus (HPV). HPV is a sexually transmitted infection that causes genital warts. So if you have had genital warts before or your partner has had genital warts, your chances of developing cervical cancer are increased. As such we encourage anyone who has had genital warts to start going for cervical cancer screening early.
The other risk factors for cervical cancer include smoking, immunosuppression eg patients with HIV that is not well managed, oral contraceptives, early sexual debut, multiparty (having given birth to plenty of Children) , having multiple sexual partners or a partner with multiple sexual partners.
Immunosuppressed patient like poorly managed HIV patients will also present with cervical cancer at an early age and also with a very aggressive cancer. We say cancer of the cervix mainly affect the elderly women aged above 50 years.
But with unmanaged HIV you can get a young lady in her twenties developing cancer of the cervix. In my experience the youngest person I saw with cervical cancer was 21 years of age and she was HIV positive not taking her medication and the variant of the cancer was quite virulent that she didn’t survive for more than a year from the time of diagnosis. So if you are HIV positive please make sure you take your medications well to minimize your chances of developing cervical cancer.
Early sexual debut simply means having your first sexual intercourse at an early age. By early age we mean before full sexual maturation of the cervix. Normally this happens from 16 to 18 years on average. There is a part of the cervix called the squamo-columnar junction which when bruised during sexual intercourse will lead to the development of cervical cancer later in life. So young girls please desist from partaking in sexual activities before the age of 18 to minimize your chances of developing cervical cancer later in life.
Women who have given birth to a lot of children are also at a higher risk of developing cervical cancer compared to those that have only given birth to one or two children.
Having multiple sexual partners increases your chances of contracting HPV and hence increases your chances of developing cervical cancer. Likewise a partner with multiple sexual partners also increases your chances of contracting HPV and subsequently your chances of developing cervical cancer. So it is not enough to just have one partner you are faithful to, but you need to have one you are faithful to and who is also faithful to you.
If you look at all these risk factors you will understand why cancer of the cervix is more prevalent in developing countries than developed countries. Most of the risk factors are somehow poverty related. HPV is more prevalent in the developed world because of the low number of women that are vaccinated against HPV in this part of the world.
That is why our government is pushing for HPV vaccinations in school girls. We encourage parents and guardians to allow their girl children to be vaccinated against HPV as this will go a long way to reduce the prevalence of cervical cancer in the next generations in our country. More women in the developed world are multiparous compared to the first world hence a higher prevalence of cervical cancer in the developing world.
Screening and early detection of cervical cancer is one of the most important measures to reduce the mortality rate of this invasive cancer. Every woman from the age of 20 to 30years should start going for cervical cancer screening. And screening should be done every 3 to 5 years depending on your risk level. If for example you have had genital warts before you should start screening early and you should also get screened more frequently.
Two main screening tests are available namely the Pap smear and the VIAC. Screening is very simple and can be done by nurses at most local clinics. Developed countries are more thorough with the screening of cervical cancer compared to developing countries hence the higher prevalence of cervical cancer in developing countries. So please ladies go and get screened, do not wait for symptoms of cervical cancer to go and get screened.
The symptoms of cervical cancer include intermenstrual bleeding (bleeding in between your periods), post coital bleeding (bleeding after sexual intercourse), contact bleeding (bleeding when the cervix is contacted even by a finger), a foul smelling discharge which is not remitting to standard antibiotic therapy. Rarely can you feel a lump on the cervix whilst bathing. Please note early cervical cancer has no symptoms. That’s why we say screening should commence before any symptom is suspected because once the symptoms come chances are we are already late for treatment.
The treatment of cervical cancer can be by surgery and radiotherapy or a combination of the two depending on the stage of the cancer. Early stages are easier to manage and have a better prognosis (outcome) compared to late stages. As such we encourage women to start going for screening at an early age to help us make the diagnosis early and to manage it in an easier and better way. By Josephat Chiripanyanga
Remember a healthy you, a healthy me to a healthy world.
Josephat Chiripanyanga is a Harare based medical doctor.