Cancer, also known as malignant tumor or malignant neoplasm, is a group of disease involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous but all cancer is tumors. Tumors are solid neoplasm.
Cervical cancer occurs when abnormal cells on the cervix grow out of control. It is one of the most of the common cancers among women, worldwide.
CAUSES OF CERVICAL CANCER
Most cervical cancer is caused by Human papilloma virus, or HPV infection, and there are many serotypes of this virus. However, not all serotypes cause cervical cancer. Some of them are implicated in genital wart. Particularly, HPV sero16 and sero 18 have been implicated in the causation of over 70% cervical cancers.
HVP is only a necessary factor in the causation of cervical cancer. This means that other factors must be presented, in addition to HVP infection, for malignant to occur.
- Female Sex
- Age: Two peaks in the age specific incidence of cancer of the cervix:
- Women aged 30-34 (20 per 100,000)
- Women aged 80 -84 (13 per 100,000)
- Early Coitarche
- Other STIs, eg Chlamydia, Gonorrhea
- Intercourse with an uncircumcised sexual partner
- Non-vaccination against the virus
- Drugs such as Diethylstilboestrol
- Long-term use of oral contraceptive pills
- Long-term use of intra-uterine contraceptive devices
- Multiple full-term pregnancies
- Family history of cancer of the cervix
- Other diets low in vegetables, use of vaginal douches.
SYMPTOMS AND SIGNS
- Abnormal vaginal discharge, e.g foul-smelling, bloody vaginal discharge
- Post-menopausal bleeding
- Prolonged menstrual bleeding
- Bleeding after douching or following a pelvic examination
- Pelvic Pain
- Pain during coitus (dyspareunia)
- Abnormal vaginal bleeding
- Other symptoms relating to spread to adjacent or distal organs e.g urinary symptoms, bowel symptoms, etc
SCREENING FOR CANCER OF THE CERVIX
Screening for cancer of the cervix is a way of preventing cervical cancer from developing, and diagnosing the disease at an early pre-cancerous stage.
- Pap smear (sensitivity 72%; specificity 94%)
- Liquid-based cytology (sensitivity 61%; specificity 82%)
- HPV typing (sensitivity 88%; specificity 73%)
- Pelvic examination
- Visual inspection
Who should be screened?
- Female between ages 20-30 years
- Female between the age of 31-65 years
Frequency of Screening
- Females within ages 21-29 years, who have never had an abnormal pap smear should be screened every 3years, regardless of HVP vaccination.
- Screening for females between ages 30-65years is co-testing (cervical cytology plus HVP testing), every 5 years of Pap smear every 3 years.
Note: every abnormal screening result must be followed by a definitive diagnostic investigation. An abnormal Pap smear is NEVER diagnostic of cervical cancer.
DIAGNOSIS OF CANCER OF THE CERVIX
Diagnosis of cervical cancer follows the following order:
- Detailed history taking
- Physical examination
This should focus on the presence of symptoms and high risk factor, among other things.
- HVP Typing
- Colposcopy: the cervix and uterus
- Computer tomography (CT) scan
- Magnetic resonance (MR) imaging
- Position emission tomography (PET) scan
- Cystoscopy: the urinary bladder
- Protoscopy or proctosigmoidoscopy: the rectum or sigmoid colon
- Laparoscopy: the abdominal cavity
- Generally, systemic treatment of cancer of the cervix is employed for advanced stages of the cancer. For some stages of the disease the preferred treatment is radiation and chemo given together (called concurrent chemoradiation) . The chemo helps the radiation work well. Options for concurrent chemoradiaton include:
- Cisplatin given weekly during radiation (this drug is given intravenously about 4 hours before the radiation appointment).
- Cisplatin plus 5 fluorouracil (5-FU) given every 4 weeks during radiation.
Drugs used in cervical cancer management include the following:
A commonly used combination therapy is Carboplatin and paclitaxel.
Common side Effects of Chemotherapy
- Nausea and vomiting
- Mouth sores
- Bone marrow suppression with pancytopenia leading to anaemia, infections, and bleeding.
- Other less common side effects include menstrual changes, neuropathy, and increased risk of leukemias.
Following an abnormal screening and a definitive diagnosis of cervical intra-epithelial neoplasia (CIN), the abnormal cells could be removed or destroyed using one of several procedures:
- Removal or destruction of just part of the cervix affected (CIN) could be achieving by Laser ablation or Cryothrapy. These procedures allow the normal cells to grow back in their place.
- Removal of the whole area containing the abnormal cells, that could become pre-cancerous or develop into cancer of the cervix, can be achieved by Loop Electric Excision of the Transformation Zone (LLETZ) and cervical Conization (cone biopsy) an Hysterectomy.