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Cervical Cancer

The 4th most common cancer among women worldwide

Statements issued by the World Health Organization’s International Agency for Research on Cancer showed an estimated 570,000 new cases of cervical cancer were diagnosed worldwide in 2018, making it the 4th most common cancer among women globally. 

Every year, more than 310,000 women die from cervical cancer and as a result of not receiving the HPV vaccine, which is highly effective in preventing the most common types of human papillomavirus (HPV).

HPV is responsible for cervical cancer that usually develops very slowly, which means that early detection makes treatment more effective as the disease is still in its early stages. Cervical cancer is the most common HPV-related disease, and almost all cases can be attributed to this virus.

Early detection guarantees cure by up to 96%, while neglecting symptoms and late detection increase the severity of the disease and the cure rate drops to only 5%. The problem here is that the symptoms appear in advanced stages, making the cure difficult. Global organizations, governments, and ministries of health encourage people to perform periodic examinations for early detection to reduce the spread of the disease.

Signs of advanced stages of cervical cancer are:

Heavy period, bleeding after menopause, or unusual vaginal bleeding which is the most common symptom associated with cervical cancer and usually happens between two menstrual cycles or after sexual intercourse.

Pelvic pain ranging from acute to moderate pain. If it’s a new symptom and not related to menstruation, the woman should therefore consult a doctor. Pain during sexual intercourse or urination is also a warning sign.

Watery, bloody vaginal discharge that have a foul odor.

Feelings of tiredness and lethargy are not among the first important symptoms, but are part of a long list of symptoms of health problems including cervical cancer.

Desire to urinate permanently is one of the symptoms associated with cervical cancer due to changes in the urethra.

HPV Infection

At first, it should be noted that there are more than one hundred types of HPV but not all of them are cancerous. HPV is a virus transmitted through genital contact. The appearance of warts in the genital area is an indication of inflammation as a result of getting the virus.  Genital warts vary significantly in size and shape. They may persist for a few weeks, sometimes even a few months, after having sexual intercourse with a person with HPV. That person may not be aware of the fact that they got infected and are responsible for spreading HPV. Some types of HPV may be the cause of cervical cancer. If the person is infected with one of them, it is possible to develop precancerous changes in cells and tissues without any symptoms.

Medical development succeeded in creating a vaccine that would protect against the most common types of the virus that cause 70% of cervical cancer cases. The vaccine has the potential to prevent most cases of vaginal and vulva cancer, as well as genital warts. HPV vaccination is recommended to girls and boys at age 11 or 12 years, and it is important to be vaccinated before having any sexual intercourse and being exposed to HPV. Once the virus makes its way in the body, the vaccine may be ineffective. If they are not fully vaccinated at age 11 or 12 years, the Centers for Disease Control and Prevention (CDC) recommends that it be given to girls and women at age 26 and to boys and men at age 21. The vaccine is injected in three doses over six months. The second dose is given one or two months after the first one and the third dose is given six months after the first one.

Pap Smear

It is one of the methods that help detect cervical cancer early. Every woman should periodically have a Pap smear as it is the most effective test for cervical cancer.

Approximately 80% of women get HPV at some time in their life. Therefore, women are required to perform periodic cervical cancer screening by Pap smear. This test along with the HPV vaccine is an effective means of prevention from and early detection of cervical infections that, if not detected in time, can turn into cancer.

The Pap smear looks for the DNA of HPV that is likely to cause cancer in cervical cells. Periodic examination is a necessity to prevent and detect the disease before it develops and reaches advanced stages. The Pap smear detects abnormal cervical cells which may eventually lead to cancer in the future. Thus, it contributes to halting the possible development of cancer and treating the patient fast in case cancer started developing.

As for the examination, the doctor slowly inserts the speculum into the vagina, and then scrapes a small sample of cervical cells. Most women feel a sensation of pressure during the procedure. The sample is sent to a laboratory where it is examined to look for abnormal cells. After the test, the woman may feel mild pain or a little cramping. Light vaginal bleeding can also occur directly after the examination. If abnormal cells are discovered, this does not mean the patient has cervical cancer, but simply that there are abnormal cervical cells, some of which may be precancerous and need more tests to determine their nature.

Depending on the test results, the doctor may recommend doing the Pap smear more often, or closely examining the cervical tissue through a procedure called colposcopy. In some cases, the doctor may also take a sample of the cervical tissue.

Diagnosis and Treatment

A woman with cervical cancer starts a new phase in her life where she needs to carry out further diagnostic tests to determine the stage and extent of the disease and the treatment plan.

The stages of cervical cancer are as follows:

Stage 0 means that the cancer is present only on the surface of the cervix.

Stage I means that the cancer is within the neck of the cervix.

Stage II means that the cancer has grown beyond the cervix and uterus but has not reached the walls of the pelvis or the lower part of the vagina.

Stage III means that the cancer has spread to the lower part of the vagina or the walls of the pelvis.

Stage IV means that the cancer has spread to nearby organs such as the bladder or rectum or to other parts of the body such as the lungs, liver, or bones.

The treatment depends on the extent and stage of the disease, taking into account the age of the patient and her general health condition. Hysterectomy is one of the treatment options in advanced stages and is adopted especially by post-reproductive women. On the other hand, if the woman is still fertile and wants to have children, a clear discussion with the medical team is required to determine the possibility of keeping the uterus.

Chemotherapy is also an option but consideration should be given to the damage that may happen to the ovary or other parts of the reproductive system causing difficulty in pregnancy or in the birth process. However, there is still a possibility that a woman may become pregnant after having chemotherapy by undergoing fertility treatments. Radiotherapy can also cause reproductive damage, and may sometimes be done in a way that somehow protects the reproductive system. This may be difficult however in the case of uterine cancer. Using hormones to fight cancer, rather than chemotherapy or radiotherapy, could be a more conservative approach, especially for women who want to maintain their fertility levels.

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