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Early-detection key to cervical cancer

Dr Romayne Edwards

Sunday, June 01, 2014    

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CERVICAL cancer, also known as cancer of the neck of the womb, is an abnormal growth of the cells of the lower part of the uterus. It is the third most common cancer diagnosed in women globally and it is among the leading causes of death in women in the developing world. Approximately 20 per 100,000 women are diagnosed yearly in Jamaica, of which approximately 250 will result in death, making it the second most common diagnosed cancer in Jamaican women.

Cervical cancer is linked directly to the Human Papilloma Virus (HPV) as it is involved in 9.9 out of every 10 cases diagnosed. This virus has many types and many strains are spread by sexual transmission. Most infections will cause no symptoms but sometimes it can affect the skin and mucous membranes. Some strains cause warts on the cervix, vulva, vagina, penis, oropharynx (throat -- especially due to oral sex), and anus.

While most HPV infections are transient and do not cause disease, persistent infections with certain "high risk" strains such as HPV 16 and 18 are directly linked to cancers of the throat, penis, vulva, anus, and cervix.

HPV vaccines are relatively new and with time should impact the incidence of cervical cancer. It currently provides protection against HPV types 16 and 18 which account for about 70 per cent of all cervical cancers and against strains that cause genital warts. It is best recommended for girls who have not yet had sexual intercourse and for males and females ages 9 to 26 to prevent other lower genital tract and anal cancers.

RISKS

People at risk for cervical cancer include those who smoke cigarettes, are of older age, obese, lower educational attainment and poor women who did not seek to do health screening tests. Women who became sexually active at an early age and had many sexual partners, had several children and were on long-term combination oral contraceptive pills were at increased risk of developing cervical cancer according to current research data.

Condom use offers protection against HPV infection and is thought to be protective. Other supplements, such as vitamins or antioxidants, have had mixed results regarding the prevention of cervical cancer.

Cervical cancer often starts with early changes in the cells termed pre-malignant lesions. These abnormal changes can most times be detected early by the Papanicolou Smear. This has reduced the incidence and mortality of cervical cancer in developed countries like the USA. It is a useful screening tool that allows changes in the cervix to be picked up and procedures done to remove these cells before they become cancerous. It is recommended as an annual screening for women, especially once sexually active.

SIGNS AND SYMPTOMS

The signs and symptoms of cervical cancer are varied. Initially there may be no symptoms. Irregular vaginal bleeding, contact bleeding, such as during a vaginal examination or during sex, abnormal mass on the cervix, pain during sexual intercourse, and persistent abnormal vaginal discharge are some of the early clues. In the late stages it additionally causes signs of distant spread and constitutional symptoms such as lack of appetite, night sweats, tiredness, weight loss, leg swelling, pains in the back, pelvis and leg, heavy odorous vaginal bleeding, and the presence of fistulas - communication of the tumor with the rectum and bladder so that urine and faeces leak from the vagina. It may spread to the ovaries, abdomen (liver), lungs and bone causing fractures.

TREATMENT

After diagnosis the gynaecologist will proceed to staging and treatment using invasive and noninvasive tests and radiological interventions such as Computed Tomography/Positron Emission Tomography Scans and Magnetic Resonance Imaging. The patient, family and the team of physicians will then based on the stage of cancer decide on surgery, chemotherapy and or radiation as further treatment.

Dr Romayne Edwards is a

consultant emergency

physician at the University

Hospital of the West Indies

and an associate lecturer at

the University of the West

Indies.

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