A jab in time can keep cervical cancer at bay

By Smriti Daniel

Worldwide the news is grim. Cervical cancer is on the rise in third world countries. “In Sri Lanka, the incidence of cervical cancer is only second to breast cancer in women,” said Dr. Nalinda Rodrigo, Consultant Obstetrician and Gynaecologist.

A study published this month by a team from the University of Washington in Seattle in the British journal ‘The Lancet’ concluded that last year an estimated two million women around the world developed breast cancer or cancer of the cervix (the neck of the womb). Of these 600,000 had their lives claimed by the disease. In the 187 countries included in the study, women younger than 50 in developing countries accounted for 34 percent of global cervical cancer deaths.

The real tragedy lies in the fact that cervical cancer is preventable. It is caused by a virus known as the human papillomaviruses (HPV). More than 70 strains of HPV have been identified. Among these, only a few are known to cause cervical cancer. Others cause benign or harmless lesions. A vaccine to protect against these most dangerous HPV strains is available in Sri Lanka explains Dr. Rodrigo. In addition, when diagnosed early, the cancer is very treatable, with the possibility of a long, healthy life afterward. This week he tells us about diagnosing and treating the disease and why he believes mothers should have their daughters vaccinated early on.

Known as the ‘neck of the uterus’ the cervix is the lower, narrow portion of the uterus which connects the uterus to the upper part of the vagina. Cancer of the cervix often begins in the lining of the cervix. It forms slowly, with a few cells beginning to shift from normal into a pre-cancerous stage and finally into full blown cancer. The precancerous condition is called dysplasia. This precancerous condition can be detected by a simple, timely pap smear and is entirely treatable. (It’s one of the reasons gynaecologists recommend regular pelvic examinations. These should start when a woman becomes sexually active, or by the age of 20.) Upon examining the smear, if abnormal changes are found, your doctor might order a colposcopy which is a direct magnified inspection of the surface of the vagina.

Cervical cancer can spread to the bladder, intestines, lungs, and liver. During this time, many women remain blissfully ignorant as symptoms might not manifest until the cancer goes into advanced stages. Cervical cancer comes in two main types, namely squamous cell carcinomas and adenocarcinomas. The former is more common and begins in the squamous (flattened) epithelial cells that line the cervix. The second arises in the gland cells that make vaginal mucus. Rarer is when the cancer combines features of both – then it is called mixed carcinoma.

HPV, which causes cervical cancer, spreads through sexual contact. Most women are able to fight off the infection, but a weakened immune system can leave you vulnerable. When worldwide data is examined, increased incidence of cervical cancer has been found among women who smoke, have multiple sexual partners or belong to certain ethnic groups.

Protecting against the infection can be as simple as using condoms during sex. Incidentally, the infection can cause genital warts. If a possible partner has these warts on their genitalia, abstaining from sexual intercourse or using protection at the very least is recommended. Most women will not notice any symptoms in the early stages of cervical cancer. However, some will complain of abnormal vaginal bleeding and continuous vaginal discharge and even heavier flow during periods. In the later stages, symptoms can get more worrying: severe back pain, fatigue, bone fractures, heavy bleeding from the vagina, pelvic pain and a single swollen leg have all been reported.

A vaccine for girls and young women protects against the four types of HPV that cause most cervical cancers. Studies have shown that the vaccine appears to prevent early-stage cervical cancer and precancerous lesions. Ensuring more young women are vaccinated might be key in dampening the surge in cervical cancer. However, treating the cancer depends on several factors, including which stage it is in and the woman’s age and general health.

Whether or not she wants to have children in the future is also a factor that must be considered. In its early stages, cervical cancer is treated by a simple surgical removal of precancerous or cancerous tissue. This can be done in such a way as to allow a woman to still be able to bear children. Chemotherapy and more serious surgery might be employed to cope with the cancer in its more advanced stages.

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