Are you having abnormal bleeding?

How to recognize cervical cancer

It happened several years ago during one of my night duties as a resident doctor at Laguna Doctor’s Hospital. The images of that scene are still vivid in my mind. A woman clutching a blanket between her thighs was brought into the emergency room. The cloth was all soaked in blood. She was bleeding profusely. Cervical cancer was the cause of her suffering. That’s how dreadful this disease is.

In the Philippines women usually do not go for cervical screening as part of their routine medical check-ups. Most see a doctor only when they already have symptoms, which is indicative of advanced stage. This can be attributed to economic factors and the apparent lack of awareness campaign on cervical cancer in the country. Lack of knowledge about cervical cancer can lead to late diagnosis and death.

Facts and data  on cervical cancer:

• According to WHO cancer of the cervix uteri is the second most common cancer among women worldwide, with an estimated 529,409 new cases and 274,883 deaths in 2008.
• The disease is the second or third most common cancer among women (cervical cancer and colorectal cancer are virtually tied for second place after breast cancer).
• About 86% of the cases occur in developing countries, representing 13% of female cancers.
• In Asia Pacific, about 266,000 cases of cervical cancer are diagnosed each year, with 140,000 women dying from the disease. It is the second most common female cancer in the region – where a woman dies of cervical cancer every 4 minutes.
• Each year, approximately 12,000 women in the United States get cervical cancer. In 2010 4210 was the reported death from it.
• Cervical cancer ranks as the 2nd most frequent cancer among women in the Philippines, and the 2nd most frequent cancer among women between 15 and 44 years of age.

What is cervical cancer?

The cervix is the lower, narrow end of the uterus. The cervix connects the vagina (birth canal) to the upper part of the uterus. The uterus (or womb) is where a baby grows when a woman is pregnant.

Cervical cancer is an abnormal growth that forms in tissues of the cervix. It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).  All women are at risk for cervical cancer.

Joey Albert, a cervical cancer survivor

Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately. A classic example of a cervical cancer survivor is Joey Albert, a famous Filipina pop and jazz singer in the 80's.

What are the causes and risk factors of cervical cancer?

Human Papilloma Virus (HPV)

HPV is the main cause of cervical cancer. Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.

Cigarette smoking

The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer.

Oral contraceptives

The pill may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than 5 years.

What are its symptoms?

Early cervical cancer usually has no symptoms. In most instances signs do appear when the cancer is more advanced. This does vary from woman to woman. You need to report to your doctor immediately if you experience any of the following:

• Abnormal bleeding. Women with cervical cancer may experience abnormal vaginal bleeding. This can be heavy or light bleeding during the month. 
• Unusual heavy discharge. An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick, or contain mucus.
• Pelvic pain. Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe. 
• Pain during urination. Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder. 
• Bleeding between regular menstrual periods, after sexual intercourse, douching, or pelvic exam. Bleeding after sexual intercourse, douching, or pelvic exam can be cervical cancer symptoms. This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.

How is cervical cancer detected?

The Pap smear is the most common screening test. Because of the Pap smear test, the number of cervical cancer cases has dropped over the past twenty years.

The American Cancer Society recommends the following guidelines for early detection:

• All women should begin cervical cancer screening about three years after they start having sexual (vaginal) intercourse. A woman who waits until she is over 18 to have sex should start screening no later than age 21. A regular Pap test should be done every year. If the newer liquid-based Pap-teast is done, testing can be done every two years.
• Beginning at age 30, women who have had three normal Pap test results in a row may be tested every 2 to 3 years. Some women should continue getting tested yearly, such as those who were exposed to DES before birth and those with weakened immune system (with HIV infection, organ transplant, chemotherapy and chronic steroid use.)

How to reduce the risk of cervical cancer

1.   Get a regular Pap smear. The Pap smear can be the greatest defenses for cervical cancer. The Pap smear can detect cervical changes early before they turn into cancer

2.   Limit the amount of sexual partners you have. Studies have shown women who have many sexual partners increase their risk for cervical cancer. They also are increasing their risk of developing HPV, a known cause for cervical cancer. 

3.   Quit smoking or avoid secondhand smoke.Smoking cigarettes increases your risk of developing many cancers, including cervical cancer. Smoking combined with an HPV infection can actually accelerate cervical dysplasia. Your best bet is to kick the habit.

4.   If you are sexually active, use a condom. Having unprotected sex puts you at risk for HIV and other STD's which can increase your risk factor for developing cervical cancer. 

5.   Follow up on abnormal Pap smears. If you have had an abnormal Pap smear, it is important to follow up with regular Pap smears or colposcopies, whatever your doctor has decided for you. If you have been treated for cervical dysplasia, you still need to follow up with Pap smears or colposcopies. Dysplasia can return and when undetected, can turn into cervical cancer. 

6.   Get the HPV vaccine. If you are under 27, you may be eligible to receive the HPV vaccine, which prevents high risk strains of HPV in women. The HPV vaccine, Gardasil, was approved by the US FDA to give to young girls as young as 9. The vaccine is most effective when given to young women before they become sex. The available brands of this vaccine in the Philippines at present are Cervarix and Gardasil. 

7.   Eat healthy and watch your weight. Women who eat less fruit and vegetables may be at increased risk for cervical cancer. Overweight women are more likely to develop this cancer.

References:


1.    Cervical Cancer Statistics. Centers for Disease Control and Prevention 
2.    Who Gets Cervical Cancer? Centers for Disease Control and Prevention 
3.    Cervical cancer. National Cancer Institute 
4.    Philippines Human Papillomavirus and Related Cancers, Fact Sheet 2010 (Sep 15,    2010). WHO/ICO Information Centre on HPV and Cervical Cancer. 
5.    Human Papillomavirus and Related Cancers in World. Summary Report 2010. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre) 
6.    Cervical Cancer Overview.Emedicinehealth. 
7.    Vaccine Protects Against Virus Linked to Half of All Cervical Cancers. National Cancer Institute 
8.    Cervical Cancer Symptoms. Lisa Fayed, About.com Guide. 
9.    Cervical cancer vaccine: Who needs it, how it works. Mayo Clinic.