Cervical cancer is a malignancy of the cervix, which is the lowest part of the womb where it opens to the outside.
It is the second most popular cancer of women in sub saharan africa and within the top 5 in the world. Unforunately 80 percent of cancer deaths from cervical cancers are in low income societies. They saddest fact is that most of these deaths are preventable because the cause of cervical cancer can be prevented and early stages can also be completely cured.
Causes: The commonest cause is prolonged infection of the cervix by the human papiloma virus subtype which can cause cellular mutaions(changes) in the outer lining of the cervix. This makes most cases of cervical cancer preventable since there are vaccines that can prevent this infection from taking root. Unfortunately most people in low income areas of the world cannot afford it, and many who can have no awareness of it’s existence or importance.
Since HPV is sexually transmitted, risk factors of HPV and Cervical Neoplasm are, early sexual exposure, multiple sexual partners, partner with multiple sexual partners, unprotected sex etc.
At every encounter we stand the risk of givng or receiving HPV.
What happensnext? After prolonged exposure to mitogen, the cells begin to change into abnormal forms, this is known as dysplasia and may lead to a premalignant (before cancer) condition known as Cervical intraepithelial Neoplasms which simply means abnormal cells are present within the lining of the cervix. This is classified based on progression into the basal layer as CIN 1 to 3 (note that at this stage it is not cervical cancer snd csn still be treated successfuly)
CIN 1 affects about one-third of the thickness of the epithelium, these are less likely to become cervical cancer but may progress to CIN2
CIN 2 affects about one-third to two-thirds of the epithelial layer, with a 5% chance of becoming cervical cancer
CiN 3 affects more than two-thirds of the epithelium and stands at about 12% risk of progression.
Carcinoma insitu is when the neoplasm has extended to the whole epitelium.
How do you know if you have CIN?
Regular screening of the cervix through a pap smear is a simple and painless way to do determine this, once in 3 year from age 21 to 30 and 5years upto 60. HPV DNA test can also be done but is not as readily available especially in resource poor countries. Visual examination through culposcopy with acetic acid is a cheaper means of assessing the cervix, this may be followed by a biopsy if found positive.
What do you do if these come back as positive?
Depending on the degree, many treatment protocols exist, With low grade disease (CIN 1), a more conservative approach is recommended as many resolve spontaneously, also, in younger women the same applies.
However in more advanced disease, removal of the layers is a good method of achieving a cure, this can be done by freezing(cryotherapy), burning with heat -loop excision electrosurgical procedure(LEEP), Cutting of the layer – cold knife conization(CKC). However the screen and treat protocols are adopted in low income areas to prevent delays, patient loss to follow up and reduce the number of hospital visits. This means examination, treatment and confirmatory biopsies are done at the same clinical visit if any suspicious pathology is detected.
In summary we have more than enough opportunity to prevent the onset of Cervical cancer in our women and also the progression if the precancerous disease is discovered early. You should be encouraged to do your regular checks. When last did you do yours?