The cervix is the opening and bottom part of the uterus between the vagina (birth canal) and the uterus (womb). Cervical cancer is a fairly common form of cancer that occurs in women, especially of reproductive age.
The cells of the cervix are very much like skin cells. When they are exposed to toxins, viruses and bacteria they may cause abnormal changes (cervical dysplasia).
There are two types of cervical cancer
Squamous Cell Carcinoma: starts in the flat or scale-like cells that line the cervix. This type of cancer is sexually-transmitted by the human papilloma virus.
Adenocarcinoma: starts on the surface of a gland in glandular cells that line the cervix.
Why Is Cancer Of The Cervix So Important?
- 400,000 new cases are identified each year.
- 80% of the new cases occur in the developing countries
- At least 200,000 women die of cancer of the cervix world wide
- Now, cancer of the cervix is the 3rd common cancer world wide
- In Korle-Bu teaching Hospital in Ghana, a study in mid 1990s showed the commonest female genital tract cancer to be cancer of the cervix. It accounts for 58% of all female genital tract cancer.
Who Gets Cancer Of The Cervix?
Although cancer of the cervix is reported in all ages, even at birth, it is not common before the age of 40 years. There after the risk rises progressively to reach a maximum at 55-59 years and then diminishes. It is essentially a sexually transmitted disease.
Human papilloma virus
What Factors Increase The Chance Of A Woman Getting Cervical Cancer?
- Unprotected Sex
- Having a sexually-transmitted viral infection
- Multiple sexual partners
- Becoming sexually active before the age of 18
- A previous history of cancer of the cervix or dysplasia
- Sexually transmitted disease – Human papilloma virus infection; Herpes simplex virus infection.
- High parity
- Being the daughter of a woman who took DES (diethylstilbestrol) during pregnancy. This drug is used in the management of miscarriages.
- Immunosuppression –HIV infection, Steroid use.
- The use of hormonal contraceptives
- Social class.
Signs & Symptoms
This is usually asymptomatic (diagnosed on routine screening or assessment during antenatal care, family planning etc.). However, the manifestations may include:
- Abnormal vaginal bleeding
- In between regular menstrual periods
- After sexual intercourse
- Post menopausal bleeding
- Increased vaginal discharge
- Lower abdominal pain
- Pain during sexual intercourse
- Weight loss
- Urinary symptoms e.g. dysuria, frequency, incontinence
- Rectal pain
- Frequency of micturition
- Urinary incontinence
- Rectal pain
- Oedema of legs
- Loss of weight
- Low back pain
Natural History Of Cancer Of The Cervix
- It starts as high-grade dysplasia, which may progress to cancer of the cervix over a period of up to 10 years.
- Tobacco use may influence whether a woman with dysplasia is likely to develop cancer of the cervix
Stages of Cervical Cancer
Stage 0: Carcinoma insitu. This first stage of cancer is the last and most serious stage of dysplasia
Stage 1. The tumor is in the uterus and cervix only
Stage 2. The tumor has spread to the upper vagina. The cancer has spread to the upper vagina. The cancer has spread beyond the uterus, but not to the pelvic walls or lower third of the vagina.
Stage 3. The tumor has invaded the side wall of the pelvis, and lower third of the vagina. Blockage of the uterus from the tumor may cause urine to backup and swell the kidneys (hydronephrosis)
Stage 4. The tumor has spread to the rectum or bladder. In the latter part of this stage, it has also spread to distant organs such as the lungs.
Is Cancer Of The Cervix Preventable?
The cervix is uniquely placed for screening as a means of preventing cancer of the cervix
It is easily accessible.
Cells are constantly being shed from it. These cells can be viewed under microscope to identify early pre-cancerous changes (dysplasia).
There is a long period of about 10 years between when precursor (pre-cancerous) lesion appears and when cancer occurs.
A pap smear (named after its inventor Dr. George Papanicolou), also known, as cervical smear is a cytological test designed to detect abnormal cervical cells.
THE PROCEDURE: The procedure involves scrapping cells from the cervix and then fixing them on a glass slide. The slides are then sent to a cytology laboratory and evaluated by a trained cytologist.
- Surgery (Weatheim’s Hysterectomy) – This procedure involves the removal of the uterus and appendages, the upper half of vagina, the broad ligament together with their cellular tissue as well as the lymph nodes around the iliac vessels and on the lateral pelvic walls