01/10/2023
Cervical cancer is a type of cancer that originates in the cells of the cervix, which is the lower part of the uterus (womb) that connects to the va**na. It typically develops slowly over many years, starting with pre-cancerous changes in the cervical tissue. If left untreated, these abnormal cells can progress to invasive cervical cancer.
Or
Cervical cancer is the type of cancer of the cervix in which there's abnormal growth of cells of the cervix caused by Human papilloma virus (HPV) characterized by painful coitus, abnormal va**na discharge
Historical Development of Cervical Cancer:
Cervical cancer has been recognized for centuries, but our understanding of its causes and treatments has evolved significantly over time.
In the early 20th century, the link between cervical cancer and human papillomavirus (HPV) was discovered, which is a key risk factor for the disease.
The introduction of the Pap smear test in the mid-20th century revolutionized early detection by allowing the identification of pre-cancerous changes in cervical cells.
Later, the development of HPV vaccines has provided a preventive measure against the virus, reducing the risk of cervical cancer.
Cervical cancer is typically staged according to the International Federation of Gynecology and Obstetrics (FIGO) system, which includes the following stages:
1. Stage 0 (Cervical Carcinoma in Situ):
Also called carcinoma in situ (CIS) or pre-cancerous stage.
Abnormal cells are confined to the surface of the cervix and have not invaded deeper tissues.
2. Stage I:
Cancer is confined to the cervix.
Stage IA indicates a very small tumor, while stage IB indicates larger tumors that may or may not be visible without a microscope.
3. Stage II:
Cancer has spread beyond the cervix but has not reached the pelvic wall or the lower third of the va**na.
Stage IIA involves the upper part of the va**na, while stage IIB extends into the tissues around the cervix.
4. Stage III:
Cancer has spread to the pelvic wall or lower third of the va**na.
Stage IIIA involves the lower third of the va**na, while stage IIIB extends into the pelvic wall or causes kidney problems.
5. Stage IV:
Cancer has spread to other parts of the body, such as the bladder, re**um, or distant organs.
Stage IVA involves nearby organs, and stage IVB indicates distant metastasis.
Cause: Cervical cancer is primarily caused by persistent infection with high-risk strains of the human papillomavirus (HPV).
Predisposing factors:
HPV Infection: Infection with high-risk HPV strains is the leading cause of cervical cancer.
Smoking: Smoking to***co increases the risk of cervical cancer.
Weakened Immune System: Conditions that weaken the immune system, such as HIV, make the body less capable of fighting off HPV infection.
Early S*xual Activity: Starting sexual activity at a young age may increase the risk of HPV exposure.
Multiple S*xual Partners: Having multiple sexual partners can increase the risk of HPV transmission.
Oral Contraceptive Use: Long-term use of certain oral contraceptives has been linked to a slightly higher risk.
Family History: A family history of cervical cancer can increase the risk.
Poor Socioeconomic Status: Limited access to healthcare and regular screenings can contribute to a higher risk.
Dietary Factors: A diet low in fruits and vegetables may increase susceptibility.
Cervical Infections: Certain sexually transmitted infections, like chlamydia, can damage the cervix and increase the risk.
The cardinal signs and symptoms of cervical cancer can include:
Abnormal Vaginal Bleeding: Often the first sign, it can occur between periods, after in*******se, or post-menopause, and is due to the presence of cancerous tissue in the cervix.
Pelvic Pain or Pain During S*x: As the cancer progresses, it can cause discomfort or pain, especially during sexual in*******se.
Vaginal Discharge: Unusual va**nal discharge that may be bloody, foul-smelling, or contain mucus can be a sign.
Painful Urination: Advanced cervical cancer may cause urinary symptoms due to its proximity to the bladder.
Back Pain or Swelling in the Legs: If the cancer spreads to nearby tissues or lymph nodes, it can lead to back pain or leg swelling.
Fatigue: General weakness and tiredness can result from the body's response to cancer.
Weight Loss: Unexplained weight loss may occur as cancer progresses.
Changes in Bowel Habits: In advanced stages, cervical cancer can affect the re**um, causing constipation or diarrhea.
Kidney Failure: In rare cases, cervical cancer can obstruct the ureters, leading to kidney problems.
Bone Pain: If the cancer spreads to the bones, it can cause bone pain and fractures.
It's important to note that these symptoms can be caused by various conditions, and their presence does not necessarily indicate cervical cancer. If you or someone you know experiences these symptoms, it's essential to seek medical evaluation and testing for an accurate diagnosis. Early detection and treatment can significantly improve outcomes for cervical cancer.
Medical management
Aims:
1. Diagnosis and staging of cervical cancer.
2. Treatment to eliminate or control cancer.
3. Supportive care and symptom management.
History Taking: This will reveal duration of signs and symptoms, predisposing factors. Gather information about the patient's medical history, including risk factors, prior screenings, and symptoms.
Physical Examination
Inspection: Assess the cervix for abnormalities, such as lesions or growths.
Palpation: Examine the pelvis and surrounding areas for signs of metastasis or lymph node involvement.
Laboratory Investigations:
Pap smear or HPV test.
Biopsy for histological diagnosis.
Blood tests such as full blood count to assess overall health.
Imaging and Scans:
- CT scan, MRI, or PET scan to determine the extent of the cancer.
- Chest X-ray to check for lung metastases.
The choice of treatment for cervical cancer depends on its stage and may include surgery, radiation therapy, chemotherapy, or a combination of these approaches.Treatment drugs may include chemotherapy agents like cisplatin, paclitaxel, or topotecan. Early detection through regular screenings like Pap smears and HPV vaccination can significantly improve outcomes and reduce the risk of advanced stage.
Complications:
Ureteral Obstruction: Blockage of the ureters affecting kidney function.
Metastasis: Spread of cancer to other parts of the body.
Pelvic Kidney: Kidney problems due to pressure on the ureters.
Lymphedema: Swelling due to lymph node removal or damage.
Bowel Obstruction: Blockage of the intestines due to tumor growth.
Ureteral Obstruction: Blockage of the ureters affecting kidney function.
Prevention Measures:
HPV Vaccination: Vaccinate young individuals to prevent HPV infection, a major cause of cervical cancer. HPV vaccination for both males and females (source CDC and WHO from current data)
Regular Pap Smears: Routine screenings for early detection and intervention.
Safe S*x Practices: Encourage the use of condoms to reduce HPV transmission.
Smoking Cessation: Promote quitting smoking, as it's a significant risk factor. Smoking cessation, as smoking increases the risk.
Healthy Diet and Lifestyle: Encourage a healthy lifestyle with a balanced diet and regular exercise.
Limiting the number of sexual partners.
Education about the risks and prevention of cervical cancer.
Early treatment of cervical dysplasia.
Use of barrier methods (condoms) during sexual activity.
Maintaining a healthy lifestyle with a balanced diet and regular exercise.
Reducing stress, as chronic stress may weaken the immune system.
Regular pelvic examinations by a healthcare provider.
Genetic counseling for those with a family history.
Proper management of precancerous lesions.
Avoiding immunosuppressive drugs when possible.
Cervical cancer awareness campaigns.
Support groups and counseling for individuals with a history of cervical cancer.
Ministry of Health Zambia
