Cervical cancer facts and risks

WOMEN often do their routine screens for breast cancer, but what they often overlook is another common cancer that affects women — cervical cancer.

Cervical cancer is the leading gynaecological cancer in Jamaica and almost all cervical cancers are linked to a common infection in the cervix called human papilloma virus (HPV).

Dr Daryl Daley, obstetrician-gynaecologist (ObGyn) at Gynae Associates, told

All Woman that of the more than 100 subtypes of HPV, many are benign, but some are linked to cancer of the cervix — mostly HPV 16 and 18 (high risk).

Dr Daley explained that the cervix is the lower part of the uterus that connects to the vagina, and stated that HPV is sexually transmitted and affects the cells of the cervix.

“Cervical cancer begins in the outer layer of the cervix. This outer layer is called the cervical epithelium. After many years, this HPV infection affects the genetic make-up of the cells and allows the cells to undergo cancerous changes. The cancer can then spread to nearby tissues and organs, namely the vagina, the rectum, the bladder and within the pelvis.”

However, he pointed out that HPV usually has no symptoms in males or females, resulting in cervical cancer being a slow progress, but noted that most women naturally clear the infection with their immune systems. However, some persist, resulting in the development of cancer.

Those at risk include:

1. Women with high risk HPV (16 and 18)

2. Women older than 30

3. Women who smoke

4. Women who have a suppressed immune system (HIV/diabetes)

5. Women who had an early onset of sexual intercourse

6. Women who use the pill

7. Women of lower socio-economic status

8. Women who have multiple sexual partners

9. Women who gave birth early in their reproductive years (teenage pregnancy)

For the warning signs and symptoms of cancer, Dr Daley said women should look for:

1. Abnormal vaginal bleeding

2. Spotting and/or foul smelling discharge

3. Bleeding after sex.

But he said in advanced cancer there may be pain, problem urinating, loss of appetite, weight loss and leg swelling.

Dr Daley said precancerous cells are identified with a Pap smear, which involves using a brush and taking a sample of cells from the cervical os (opening of the cervix) and is relatively painless.

“This is then placed on a slide and sent to the laboratory for examination. If the slide shows evidence of precancerous cells, an instrument called a colposcope is used to magnify the cervix and to look for any obvious signs of cancer.

Dr Daley added that a biopsy (a small piece of the cervix) is then taken and sent to the laboratory to confirm either if the cells are precancerous or cancerous. HPV DNA testing is also used in conjunction with the Pap smear to identify high-risk HPV.

If the biopsy confirms precancerous cells, depending on how extensive these precancerous cells are, different treatment options are available.

These include:

1. Freezing or heating the surface of the cervix to destroy the abnormal cells

2. Surgically removing the top layer of the cervix with a laser or an electric wire.

If it is indeed cancer, Dr Daley said the stage of the cancer must first be determined by examining the patient and by using other imaging technologies such as an MRI (magnetic resonance imaging) to aid with the degree of spread internally.

He said cervical cancer has four stages — stage one is confined to the cervix and stage four has spread to the bladder or rectum or even has spread to outside of the pelvis.

The treatment of the cancer depends on the degree of spread and the woman’s fertility desire.

“If cancer is confined microscopically to the cervix (early stage one) and the woman desires to have children, then a cone shaped excision of the cervix can be done to remove the cancerous cells. However, if the cancer is more extensive, then a radical hysterectomy should be done,” Dr Daley said, explaining that this involves removing the uterus, cervix and upper part of the vagina and sometimes the surrounding lymph nodes.

“It is an extensive surgery. In the adequately chosen patients, in combination with chemotherapy and radiotherapy, the five-year survival of these patients is about 90 per cent.”

In order to prevent cervical cancer, Dr Daley said women should get regular Paps; women between age nine to 26 should get the HPV vaccine, which should be given to girls by the age of 12 (before the onset of sexual activity); be monogamous; practise safe sex and do not smoke.