The cervix is part of a woman’s reproductive system. It is the lower, narrow part of the uterus. The uterus is a hollow, pear shaped organ in the lower abdomen. The cervix connects the uterus to the vagina. The vagina leads to the outside of the body.
The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina as the woman’s menstrual period. The cervix also produces mucus. During pregnancy the cervix is tightly closed to help keep the baby in the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.
Understanding cancer
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old they die and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them or old cells do not die when they should. These extra cells can form a mass of tissue called a growth or a tumour. Tumours may be benign or malignant.
Benign tumours are not cancer and do not spread.
– Polyps, cysts and genital warts are some examples of benign growths on the cervix.
Malignant tumours are cancer.
– Cancers may be life-threatening.
– Cancers can often be removed, but sometimes they grow back.
– Cells from cancers can invade and damage nearby tissues and organs.
– Cells from cancers can spread (metastasize) to other parts of the body.
– Cancers can spread by breaking away from the original tumours and entering the bloodstream or lymphatic channels.
Cancer of the cervix has two significant stages.
1. Pre-invasive
2. Invasive
Invasive cancer of the cervix
Invasive cancer of the cervix is considered a preventable cancer because it has a long pre-invasive state which is easily treated, and effective screening to diagnose this pre-invasive state is available in the form of Pap smears, which are discussed in detail later in this article.
What is pre-invasive cancer of the cervix?
The cervix is one of the few organs where changes can be identified that have the appearance of cancer but are limited to the outermost lining. These changes are called Pre-invasive changes. If these changes are not treated they have the potential to progress to invasive cancer over a variable period of time. If these changes are recognized and treated in a timely fashion they may never progress to cancer.
The cervix is also one of the few organs that is easily accessible and can be seen at a simple gynaecological exam.
The cells from the surface of the cervix are shed (exfoliate) regularly and can be sampled and studied by performing a simple test called a Pap smear.
The Pap smear can find changes in the cervix before cancer develops. It can also find early cancer in its most invisible stage.
Risk factors
The major risk factors associated with cancer of the cervix are:
(a) Young age at first sexual intercourse – less than 16 years.
(b) Multiple sexual partners
(c) Cigarette smoking
(d) Large number of children
(e)Young age at first childbirth
Many of these are linked to sexual activity and exposure to sexually transmitted diseases.
The Human Papilloma virus (which causes a type of genital wart) has been detected in 99% of women with the commoner type (squamous cell) of cervical cancer. The other viruses that are also implicated in the causation of cancer of the cervix are the Herpes virus and HIV.
Symptoms and signs of cancer of the cervix
Pre-invasive cancer and early stage Invasive cancer of the cervix may have no symptoms and do not cause pain. It is important not to wait to feel pain before seeing a doctor.
When the disease gets worse, women may notice one or more of these symptoms.
– Abnormal vaginal bleeding
– Bleeding that occurs between regular menstrual periods
– Bleeding after sexual intercourse douching or a pelvic exam
– Menstrual periods that last longer and are heavier than before
-Bleeding after meno-pause
– Pelvic pain
– Pain during sexual intercourse
Although the above symptoms are not exclusive to cancer of the cervix, any of the above should alert a woman to an existing problem and she must seek advice.
Screening for cancer of the cervix – the Pap test
Testing for cervical changes before there are symptoms is very important. This helps the doctor find abnormal cells before cancer develops (Pre-invasive stage). Finding and treating abnormal cells can prevent most invasive cervical cancers and screening will also help to find early invasive cancers, when treatment is most likely to be effective.
It is recommended that women help reduce their risks of cervical cancer by having a regular Pap test (also called a Pap smear). The test is not painful and is done in a doctor’s office and is read in a laboratory.
Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.
– Women should start having the Pap test three years after they start having sexual intercourse, or when they reach 21 years of age (whichever comes first).
– Once a Pap test is normal, it should be repeated at 1 to 3 years intervals.
– It is important for women to continue having regular Pap tests until the age of 70 years.
– Women who have had a total hysterectomy to remove the uterus and cervix do not need cervical cancer screening. However, if the surgery was for pre-cancerous cells or cancer, the woman should continue screening with Pap tests.
It is suggested that a patient:
– Does not douche for 48 hrs before a Pap test.
– Does not have sexual intercourse for 48 hrs before the test.
– Does not use vaginal medications for 48 hrs before the test.
Having discussed early diagnosis and risk factors, prevention of cancer of the cervix and treatment will be discussed in this column next week.
