CERVICAL CANCER.

The causes, symptoms, prevention and treatment. By Dr. Adepiti Clement; Head of Department of ObstetricsHD and Gynecology, Ondo State Specialist Hospital, Akure.

What is cervical cancer and how common is it?

As the name implies, cervical cancer is the cancer of the cervix. Cancer, you may want to know, is an abnormal growth in any part of the body which has gone out of control of the normal body growth regulatory mechanisms.

Worldwide, 500,000 new cases of cervical cancer are reported yearly and about 80% of these new cases are seen in developing countries. Also on yearly basis about 280,000 women die from the disease and about 85% of these deaths occur also in the developing world. Plainly speaking, this means that a woman dies every 2mins from the disease worldwide.

The pertinent question to ask from the foregoing is why the disparity between the developed and developing countries in the incidence and mortality of this disease? The simple answer is that in the developed nations, there is a systematic cervical cancer screening programme that aims to detect and treat cervical pre-cancer lesions before they cause cancer.

WHO IS AT RISK of CERVICAL CANCER?

Every woman who has had sex before is at risk because this cancer is otherwise known as cancer of sex.

HOW DOES SEX CAUSE CERVICAL CANCER?

Not that sex causes the cancer. However, a particular virus called the Human Papilloma Virus (HPV) which is transmitted during sexual intercourse causes some changes in the cervix that may eventually lead to cervical cancer.

WHAT ARE THE SYMPTOMS PECULIAR TO THIS DISEASE?

At the earliest stages of the disease, there may be no symptoms. As the disease advances, there may be abnormal vaginal bleeding. This may be in form of intermenstrual or postcoital bleeding.

A woman may also have foul smelling vaginal discharge. She may begin to lose weight and if the cancer begins to spread it could affect the bladder, the kidney and the lungs. Eventually the affected woman may die from renal failure, consequences of blood loss or sepsis.

WHAT ARE THE RISK FACTORS FOR CERVICAL CANCER?

Any woman who has had sex is at risk of cervical cancer. Women with multiple sexual partners, those with partners who have multiple sexual partners, women who started having sex early in life say before the age of 16 years, those who are grand-multiparous, those who have used birth control pills for more than 5years and women who smoke cigarette are all at risk of cervical cancer.

Also, women who are HIV positive or who have a compromised immunity due to other diseases are also at higher risk.

PREVENTION OF CERVICAL CANCER

A woman can reduce her chances of having cervical cancer through the following;

* Every woman should be sexually responsible by avoiding multiple sexual partners.

* Avoid smoking cigarette

* Any woman who has had sex, even if it was just once is at risk, thus all women should go for screening regularly. At least every three years from the age of 30years till she is 60years.
Basically, the prevention of cervical cancer can be classified into three categories:

- Primary
- Secondary
- Tertiary

The primary prevention involves community education about the risk factors, vaccination of all sexually naive girls particularly those between 9-13-years with the HPV vaccine.

The secondary prevention entails that every woman who has ever had sex should avail herself of regular cervical cancer screening for detection and treatment of cervical pre-cancer and the early stages of the disease.

Finally, the tertiary prevention has to do with the treatment of women who has the advanced disease. Most things that could be done in this circumstance include Radiotherapy as a form of palliative treatment, blood transfusion and spiritual support all as part of end of life care.

The vaccines for cervical cancer are readily available in Nigeria. They are not for free. Infact the cost is about N12, 000 per dose and a woman will need three doses to be fully vaccinated.

Most developing nations who have started programmatic vaccination today have the vaccine supplied free of charge from GAVI fund. GAVI is the agency involved in the provision of free vaccines for childhood immunization.

Nigeria has not been able to receive cervical cancer vaccine because GAVI is not satisfied with our management of the childhood immunization. Their argument is that if we cannot achieve adequate coverage for the childhood immunization, why should they add anything extra?

SCREENING CENTERS IN NIGERIA where any woman can go for cervical cancer screening.

Unfortunately, Nigeria does not have any systematic screening program for our women. Screening services are not widely available. The type of screening available in Nigeria at the moment could best be described as opportunistic screening.

These women come to the hospital to do other things and in the course of that learn about cervical cancer and get screened or maybe they stumble on the information and avail themselves the opportunity.

The standard screening test is the Paps smear otherwise called cervical cytology. This is available in almost all the Teaching Hospitals, the Federal Medical Centres and some State Specialist Hospitals across Nigeria.

Any screening that does not provide coverage for at least 80% of the at-risk population cannot impact significantly on the incidence and mortality of the disease. As a matter of necessity, cervical cancer screening must be widely available. The only best way to do this is to make it a component of the national primary health care programme so that universal access could be guaranteed.

The relevant authorities should step up to this challenge in the interest of preventing needless deaths.

Fortunately our centre has a functional gynaecological oncology unit where we offer screening and treatment for cervical precancerous lesions and early stage diseases. However, most women that present with the disease come at very advanced stages.

This also has to do with our culture, ignorance and poverty. It may interest you to know that women do not discuss issues that have to do with private part in this part of the world and also when things happen they are first ascribed to spiritual attacks. They will rather go to churches and herbalists and eventually when the present themselves in the hospital the disease is too advanced.

All advanced cervical cancers are not amenable to surgery so, what is left is to refer such patient for radiotherapy.

Between January and September this year (2014), we have seen 35 advanced cases of cervical cancer and have referred them for radiotherapy after the initial palliative care. However, a considerable number of them have died already.

Can a woman have a child after cervical cancer treatment?

After treatment, the woman cannot have a child anymore except if the cancer is detected much earlier and the affected area is removed then she may still be able to carry pregnancies and have children but when it is advanced, we should be talking about how long she has to live not children any more.

How readily available is the radiotherapy services in Nigeria?

Unfortunately we have about five centers which provide such services in Nigeria and the most unfortunate thing is that only one or two of them are functioning. This is an irony, as South Africa has over 50 radiotherapy centres. So, you can imagine the pains women who are referred to these few centres go through for them to get treatment. Most of them die while waiting for their turn.

I advocate the integration of cervical cancer screening into our national primary health care programme and compulsory screening for all at-risk women. It is also important to at least ensure a Radiotherapy centre per state as radiotherapy is used in all cases of advanced cancers.

At the moment, there is no systematic cervical cancer programme, all women should be encouraged to have their screening regularly.
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