The basics of cervical cancer
Dr Cattleya Gaspar highlights the basics of cervical cancer with importance on HPV vaccines and regular Pap smears.
You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies
Cervical cancer is the fourth most common cancer among women globally and the second most common cancer among women in South Africa.1,2 However, itās one of the most preventable forms of cancer.
As a South African female, itās therefore pertinent to educate yourself about this disease. Empower yourself by getting to know your risk factors, which screening methods are available and how to prevent this illness.
How does cervical cancer develop?
The uterus (womb) is made up of several parts; the lowest part, being the cervix is found within the vagina. Exposed to certain carcinogens (substances capable of causing cancer), the cells within the cervix become abnormal and start to multiply, forming a cervical mass (tumour). Cervical tumours begin to grow locally and may invade surrounding structures. In slower growing tumours, growth may occur over several months. In more aggressive tumours, growth is more rapid and you may experience symptoms within weeks. If left undiagnosed and untreated, the abnormal tumour cells will spread to the lymph nodes nearby and eventually spread to different parts of the body, such as the liver, lung and even the bone.
What are the risk factors?
In most cases, the human papillomavirus (HPV) is the virus that causes cervical cancer. This virus alters (changes) the DNA within a normal cervical cell, thereby changing a normal cell into an abnormal cancer cell.
HPV is usually transmitted sexually. Therefore, risk factors are:
- Unprotected sexual intercourse,
- Intercourse at a young age,
- Having multiple sexual partners, or having a partner who has had multiple sexual partners,
- A history of other sexually transmitted diseases, including HIV.
Other risk factors may also include other forms of immunosuppression, smoking, high exposure to oestrogen (hormone) and obesity.
Prevention
The HPV vaccine prevents an HPV infection and thus reduces the risk of developing HPV-related cervical cancer. Generally, these vaccines are indicated for girls aged 9 ā 14 years. However, should you have multiple risk factors, this vaccine can be recommended at any age. Prevention is better than cure.
Currently, there are two HPV vaccines that are available in South Africa.
Common symptoms
- Abnormal vaginal bleeding,
- Vaginal bleeding and pain after intercourse,
- Post-menopausal bleeding,
- Pelvic pain, with increased urinary frequency and an abnormal vaginal discharge.
In advanced cases of cervical cancer, you may present with swelling of the lower limbs, deep venous thrombosis, severe lower backpain, weight loss, jaundice and even kidney failure.
Screening
Regular Pap smears decrease the incidence and mortality of cervical carcinoma by at least 80%.1Ā The earlier the detection of cancer cells or HPV infections, the sooner effective management can commence. A Pap smear is a five-to-ten-minute procedure that can be performed by your healthcare provider. Although it may be an uncomfortable procedure, itās potentially life-saving and well worth the brief discomfort.
During the procedure, an instrument called a speculum is inserted into the vagina to visualise the cervix. A trained nurse or doctor then takes a small brush or spatula and removes cells from the cervix. Those cells are sent off for testing. Both pre-cancerous and cancerous lesions can be can detected and subsequently managed.
There are various guidelines available regarding when a woman needs to go for a Pap smear. Making the decision on when to go for a Pap smear should be based on your overall risk. In general, women should have a Pap smear within three years of their first sexual debut. Once again, Pap smears should be repeated according to your risk. A healthcare provider will be able to provide guidance. HIV positive women are advised to have a Pap smear at diagnosis.
Management
Once you have been diagnosed with cervical cancer, you should be referred to a gynaecological oncologist or a clinical and radiation oncologist for an examination, workup and for staging investigations. Treatment options would then depend on the stage of the disease. In general, earlier stages of the disease are usually managed surgically (fertility-sparing surgery or a hysterectomy) with or without chemo-radiation.
Patients whoare diagnosed with more advanced stages benefit from chemo-radiation alone. Irrespective of the stage ofthe illness, you need to be treated holistically. Although medical treatment is important, itās also vital that your psychological and social needs are attended to. Finding an oncologist who you are comfortable with is crucial when it comes to cancer care. Cervical cancer is a common, yet preventable cancer. Knowing the risks of developing this illness, preventative measures that can be taken and screening methods that can be adhered too will go a long way in avoiding this dreaded illness.
MEET THE EXPERT – Dr Cattleya Gaspar
Dr Cattleya Gaspar is a radiation oncologist and practices at the Groenkloof Radiation Oncology and Mƻelmed Radiation Oncology Centres. Her special areas of interest include gynaecological-, gastro-intestinal-, genito-urinary- and breast cancers.
References
- Handbook of Evidence-Based Radiation Oncology 3rd Edition, Kindle Edition by Eric K. Hansen, Mack Roach III. Chapter 17: Breast Cancer.
- https://cansa.org.za/cervical-cancer/
- Western Cape Government – https://www.westerncape.gov.za/service/cervical-cancer-screening | https://www.westerncape.gov.za/general-publication/cervical-cancer#:~:text=Statistics%20on%20HPV,associated%20deaths%20in%20South%20Africa.
- HPV centre https://hpvcentre.net/statistics/reports/ZAF_FS.pdf
Header image by Freepik
