Cervical cancer occurs when the cells of the cervix grow abnormally and invade other tissues and organs of the body. When it is invasive, this cancer affects the deeper tissues of the cervix and may spread to other parts (metastasis), most notably to the lungs, liver, bladder, vagina, and rectum.
Cervical cancer is slow progressing and so its progression through precancerous changes provides opportunities for prevention, early detection, and treatment.
∙ According to the World Health Organization, cervical cancer is the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers.
∙ In Sub-Saharan Africa, cervical cancer accounts for 22.5% of all cancer cases in women, and the majority of women who develop cervical cancer live in rural areas.
Cervical cancer begins with abnormal changes in the cervical tissue and the risk of developing these abnormal changes is associated with infection with human papillomavirus (HPV). More than 99% of cervical cancers occur in women who have been previously infected with HPV. HPV is a group of viruses and there are more than 100 different types. About 15 types of HPV are considered high-risk for cervical cancer. The two types known to have the highest risk are HPV 16 and HPV 18, which cause about 7 out of every 10 cervical cancers. High-risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.
Other factors that increase the risk of developing cervical cancer are early sexual contact, multiple sexual partners and taking oral contraceptives (birth control pills) especially for longer than five years, because they already lead to greater exposure to HPV.
Cigarette smoking is another risk factor for the development of cervical cancer because the harmful chemicals in cigarette smoke interact with cells in the cervix, causing pre-cancerous that may progress to cancer over time.
EARLY DETECTION AND PREVENTION THROUGH SCREENING AND HPV VACCINATION:
– Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN), or less commonly, cervical glandular intraepithelial neoplasia (CGIN)
– CIN and CGIN are pre-cancerous conditions, that may not pose an immediate threat to a person’s health, but they can potentially develop into cancer in the future.
The purpose of screening is to detect precancerous changes; women who are found to have abnormalities on screening need follow-up, diagnosis and treatment, in order to prevent the development of cancer or to treat cancer at an early stage.
Cervical screening makes it possible to find and treat cervical cancer in the early stages. Cervical cancer screening can involve testing for HPV, the Pap smear test, liquid-based cytology and visual inspection with acetic acid (VIA). For the liquid-based cytology (LBC), a speculum is placed inside the vagina and the doctor scrapes the cervix with a small brush, which collects cervical cells for lab testing. A similar process is also used for the Pap smear test.
At Lakeshore Cancer Center (LCC), we offer the LBC for cervical cancer screening in the clinical facility and VIA at outreach screening events. The sample collection process can be a very uncomfortable experience for many women, especially those who are psychologically unprepared for such an invasion of privacy and also for women who feel slight pain and/or discomfort with the insertion of the speculum. According to Nurse Uche, head of oncology nurses here at LCC, it is important to explain the process carefully to each patient beforehand making sure to detail every single step, in order to make the sample collection process a more comfortable one. In addition, introducing relaxation techniques such as breathing exercises, can make a world of difference.
Between ages 21 and 29, it is recommended that women get a Pap smear or LBC at least every three years, especially if they are sexually active.
For women aged 30 to 65 years, the American Cancer Society (ACS) recommends that a Pap smear test or LBC combined with an HPV DNA test be done every 5 years or the pap smear test alone every 3 years.
Women older than 65 years who have had regular screening with normal and clear results in the last 10 years can stop screening. However for women whose tests have shown a serious pre-cancer within the last 20 years, such as severe cervical intraepithelial neoplasia (CIN), screening should continue until 20 years after the date when the pre-cancerous conditions were discovered.
Women with a higher risk of developing cervical cancer – this includes women with suppressed immune system due to HIV or women who have received organ transplants, should undergo screening more often than others.
Avoidance of HPV infection is important in the prevention of precancerous and cancerous changes in the cervix.
- There are now vaccines available to protect women and men from HPV and thus reduce the risk of developing cervical cancer in women. Lakeshore Cancer Center (LCC) administers HPV vaccines to guard against cervical cancer.
- The Advisory Committee on Immunization Practices (ACIP) recommends that routine HPV vaccination be initiated for both males and females between the ages of 9-26 years. It is important to ask your healthcare provider about your eligibility for the HPV vaccine before taking it.
It is important for women to screen for cervical cancer regularly, contact us at Lakeshore Cancer Center for cervical screening, HPV testing and vaccination and other inquiries.
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Ntekim A. Cervical Cancer in Sub Sahara Africa, Topics on Cervical Cancer With an Advocacy for Prevention. Intech, 2012.