An overview of cervical cancer

[PHP Nepal Vol 3 Issue 2 Feb 2013] | Cervical cancer is the second most common cancer in the world. It was responsible for 2, 75,000 deaths, about 88% of which occurred in developing countries in 2008, says International Agency for Research on Cancer (IARC). Nepal Cervical Cancer Prevention Situation Analysis, 2008 estimated that there were about 10,020 new cases of invasive cervical cancer and about 26,000- 45,000 pre-cancerous lesion. In addition, World Health Organization (2010) ranked cervical cancer as the most frequent cancer among women age 15 to 44 years of age in Nepal.

Cervical cancer starts in the squamous cells on the surface of the cervix. The development of cervical cancer is very slow process. It starts with a precancerous condition called dysplasia and can be detected by pap smear test. Most of the cervical cancers are caused by Human Papilloma Virus (HPV). 

There is probably no one single cause of cervical cancer or pre cancer, but epidemiological evidence points to a sexually transmitted agent or agents. It is associated with sexual activities that include sex at an early age, frequency of the sex, and number of sexual partners. In addition, poor economic status, not getting HPV vaccine, drug (diethylstilbestrol) intake during pregnancy, and weaken immune system also causes cervical cancer.

Cigarette smoking is an independent risk factor. Some content of cigarette smoke, which can be detected in cervical mucus, may act as co-carcinogenic agent. The polycyclic aromatic hydrocarbons in cigarette smoke form damaging adducts with DNA. These have been demonstrated in cervical tissue at higher level in current smokers.  

The morbidity and mortality rates of cervix cancer are very high, so early detection and treatment is the only solution to it. Most of the time, early cervical cancer has no symptoms.  However, symptoms that may include: abnormal vaginal bleeding between periods, after intercourse, or after menopause, continuous vaginal discharge, periods become heavier and last longer than usual. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread to other organs.

Primary prevention of cervical cancer is thus possible by abstinence from sex which will prevent the infection by HPV. Early immunization of female adolescents with a vaccine is also effective against HPV.  

Secondary prevention of cervical cancer is also possible through periodic screening of sexually active females by pap-smear. It can diagnose early forms such as in-situ malignancy which can thus be treated before changing into invasive cancer. Pap-smear screening can significantly help reduce cervical cancer rates.    

Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Pap smears screen test (a cotton swab is used to take exfoliates of cervical cells for observation under the microscope, it is not the final diagnostic test) for precancer and cancer is found to be useful. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy.  Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination. 

The treatment of cervical cancer depends on the stage of the cancer, size and shape of the tumor, woman’s age and general health. Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix.  Treatment for more advanced cases is mainly by radiotherapy and chemotherapy. Mitomycin C, carboplatin is first line choice of drugs. Sometimes radiation and chemotherapy are used before or after surgery.

Takkella Nagamma is a Senior Grade Lecturer in Department of Biochemistry at Melaka Manipal Medical College (Manipal Campus), Manipal, Karnataka, India. 

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