Cervical cancer is a disease caused by the
abnormal growth and division of cells that make up the
cervix (the portion of the uterus attached to the top of the
vagina). Ninety percent of the cervical cancers arise from
the flattened or squamous cells covering the cervix. Most of
the remaining 10% arise from the glandular, mucous-secreting
cells of the cervical canal leading into the uterus.
What are the causes?
The development of cervical cancer is gradual
and begins as a pre-cancerous condition called dysplasia. In
this form it is 100% treatable, usually without the need for
a hysterectomy (surgical removal of the uterus). Dysplasia,
depending on its severity, can resolve without treatment,
particularly in young women. However, it often progresses to
actual cancer called ‘carcinoma in situ’ (CIS) if it has not
spread, or ‘microinvasive’ if it has spread only a few
millimeters into the surrounding tissue but not into the
lymph channels or blood vessels.
The risk factors for cervical
cancer are:
Infection with the virus that causes
genital warts (human papilloma virus or HPV) may increase
the risk of developing dysplasia and subsequent cancer.
Fortunately, not all women who have had HPV infection or
genital warts develop cervical cancer. Other factors, such
as smoking, may increase the risk of developing cervical
cancer in those who have had HPV
Early age at first sexual intercourse
Multiple sexual partners or partners
who have multiple partners
There is a small increased risk of
abnormal Pap smears among women who take birth control
pills. It is because such women are more sexually active,
are less likely to use condoms, and have more frequent Pap
smears in order to be prescribed the birth control pill
Women whose immune systems are weakened
- such as those with HIV infection or women who have
received organ transplants and are taking drugs to
suppress the immune system - may be at a higher risk
Infections with genital herpes or
chronic chlamydia infections, both sexually transmitted
diseases, may increase risk
What are the symptoms?
Most often, cervical cancer in its earliest
and most treatable stages does not cause any symptoms. When
there are symptoms, the most common are:
Persistent vaginal discharge, which may
be pale, watery, pink, brown, blood streaked, or dark and
foul-smelling
Abnormal vaginal bleeding, especially
between menstrual periods, after intercourse or douching,
and after menopause, which gradually becomes heavier and
longer
Symptoms of advanced
cervical cancer may include:
Loss of appetite, weight loss, fatigue
Pelvic, back, or leg pain
Leaking of urine or faeces from the
vagina
Bone fracture
How is the diagnosis made?
Invasive cervical cancer often appears as an
irregular fleshy growth, often firm or hard, that tends to
bleed easily. But even on pelvic examination by a doctor,
pre-cancers and even early cancers of the cervix are often
not visible to the naked eye. Special tests are necessary to
diagnose cervical pre-cancers and cancers:
Pap smears screen for cervical
pre-cancers and cancers. The Pap smear test consists of
cells wiped or brushed off the cervix and placed on a
microscope slide. This is usually done at the time of a
pelvic examination, though not every pelvic exam includes
a Pap smear.
Colposcopy is an examination of the
cervix under magnification in order to locate an
abnormality of the cervix
Biopsy, colposcopy, or sometimes the
use of LASER (a loop electrode) or other instrument allows
a diagnosis to be made
When cervical cancer is found,
additional tests - such as X-rays, using an instrument to
look into the bladder (cystoscopy), and rectum and colon
(colonoscopy) - are used to determine how far the cancer
has spread and what stage the disease is in
What is the treatment?
Treatment of cervical cancer
depends on the type of cancer, the stage, the size and shape
of the tumour, the age and general health of the woman, and
her desire for future childbearing.
In its earliest stages, the disease is curable by removing
or destroying the pre-cancerous or cancerous tissue. This
can often be done in various ways without removing the
uterus or damaging the cervix so that a woman is still
capable of having children.
In other cases, a removal of the uterus (hysterectomy) is
performed, with or without removal of the ovaries. In more
advanced disease, a radical hysterectomy may be performed
which removes the uterus and much of the surrounding
tissues, including internal lymph nodes. In the most extreme
surgery, called a pelvic exenteration, all of the organs of
the pelvis, including the urinary bladder and rectum, are
removed.
Radiation or chemotherapy may be used to treat cancer that
has spread beyond the pelvis, or has recurred. A variety of
chemotherapeutic drugs, or combinations of them, are used.
Sometimes radiation and chemotherapy are used before or
after surgery.
What is the prevention?
There are two ways to prevent
cervical cancer - the first is to prevent infections with
HPV, the second is to get regular Pap smears that will
detect pre-cancerous conditions and HPV. Both of these can
be treated and the progression to cervical cancer be
arrested.
Precancers are completely curable when followed up properly.
To reduce the chances of cervical cancer, girls less than 18
years of age should avoid sexual activity or always use
condoms. HPV infection causes genital warts. These may be
barely visible or several inches across. If a woman sees
warts on her partner's genitals, she should avoid
intercourse. To further reduce the risk of cervical cancer,
women should limit the number of their sexual partners,
avoid sexually promiscuous partners, and discontinue any
tobacco use. Condoms may help prevent the transmission of
HPV.
Annual pelvic examinations,
including a pap smear, should begin when a woman becomes
sexually active, or by the age of 20 in a non-sexually
active woman. All abnormal findings should be followed up
with colposcopy and biopsy.
Treatment For Cervical Dysplasia
Lack of education makes
silent HPV virus a real threat
Acupuncture to alleviating
the pain of cervical cancer
Exercise
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