Cervical Cancer; A challenge?
Cervical carcinoma becomes the third most common cause of female morbidity in Pakistan and the second most common cancer around the globe in females below the age of 50. A shocking revelation indeed!
The females most affected reside in developing countries such as Pakistan where women make 49% of the entire population. Although the detection of risk factors, early screening and treatment could reduce morbidity and mortality. However, women in Pakistan tend to approach healthcare facilities at the advanced stage of cancer due to deluged socio-economic and cultural factors such as scarcity of awareness, stigmatization, aversion to male doctors, lack of screening centres, expensive treatment and exposure to risk factors.
Risk factors
Factors typically associated with increased risk of cervical cancer include early marriages, Low socioeconomic status, use of contraceptives, uncircumcised partners and HIV infection. However early unprotected sex accompanying Human Papilloma Virus HPV infection (a sexually transmitted infection) type 16 and 18 was seen to be crucial in developing cancer. Female smoking has also been identified as a factor in changing the epithelial lining of the cervix called dysplasia.
Types
1. Squamous cell carcinoma: the commonest cause, accounts for 80% of cases.
2. Adenocarcinoma: 15%.
3. Adenosquamous carcinoma: 3–5%
4. Neuroendocrine Carcinoma
5. Small cell Carcinoma
Clinical Features
Most cases remain asymptomatic and women often come with the advanced age of the disease.
Early-onset:
- Abnormal vaginal bleeding(most common)
- Mal-odorous vaginal discharge
- Post-coital spotting
- Ulcers in the cervix
Late-onset: Advanced disease
- Pain
- Bladder dysfunction
- Rectal dysfunction
- Rectal fistulas
Screening and Prevention
Cytologic screening has significantly reduced mortality from cervical cancer because most cancers grow from precancerous lesions over the course of years. These lesions shed abnormal cells that can be detected on cytologic examination. But in developing countries like Pakistan screening is not widely practised so the cancer ratio continues to rise.
Pap smear is a screening test for cervical cancer, where cells are scraped off from transformation zone of cervix and smeared onto a slide.
Cervical cancer vaccination with Gardasil or Cervarix can prevent cervical cancers caused by HPV type 16 and 18 and protect against low grade and precancerous lesions caused by these types. Cervical cancer vaccination is now recommended for all men and women of childbearing age as men play role in the spread of HPV and the toll that HPV-related anal and oropharyngeal cancers take in men. The vaccine offers protection for up to 10 years.
Hope
The challenge is to bring awareness amongst our people of not just cervical cancer but into letting them know that there are changes, hope in early detection, diagnostics, advanced treatment options in addition research is changing things because survivorship actually matters.
