Cervical cancer | The most preventable cancer in women

Human papillomavirus (HPV) is the primary cause of 99.7% of all cervical cancers in Kenya and 70% in the world(statistics of year 2013). 

This makes it highly preventable.

Cervical cancer is the second highest common cancer in women in the world.

Prevention,

 By staying away from Human papilloma virus one can eliminate about 99.7% chances of getting the cancer.

Below are some of the methods of preventing cervical cancerr.

  •   Promote abstinence or  delayed  sexual debut for  adolescents.
  •  Promote faithfulness  to one  partner for those in relationships
  •  Promote Condom use: Allows faster HPV clearance,  increases regression of cervical  lesions, reduces the risk of genital warts as well as pre-cancer and cancer, protects  against other STIs that are cofactors for cervical cancer, and protects against HIV which facilitates high risk HPV infection and progression into high grade squamous intraepithelial lesion.
  •   Promote HPV  Vaccination.
  •   Promote  male  circumcision. Circumcision prevents HIV infection by about 60%.

HPV Vaccination(primary prevention)


At present, two types of HPV vaccines are available: One  type that protects against the high risk HPV types 16 and 18 as well as low risk types 6 and 11 that are responsible for genital warts and another type which protects against HPV types 16 and18. 
 

Both vaccines are licensed for use in Kenya. 

The vaccines should be given to even to the girls of age 9-13 years and to women of 26 years. At least women should get this vaccine in their lifetime.

Secondary prevention.

Cancer has a long period(latency) of up to 10years before it is full blown(precancerous period).

Secondary prevention aims at preventing the precancer to becoming invasive cancer.

Screening and Early Diagnosis.

The methods below are used to screening of cervical cancer.

  • Visual    inspection with acetic acid    (VIA)
  • Visual    inspection  with  Lugol’s  iodine    (VILI)
  • Cytology    using    conventional    and    liquid    based    Pap    smear
  • HPV    testing

Early sexual exposure, multiple sexual partners  and previous abnormal screening results  are at high risk of cervical abnormalies.

Screening cycle

Screening should be done after every 5 years and more frequent for those with HIV or those with abnormal test results whose screening should be done yearly.

Screenining should be stopped when patient is 65 years.

Screening for HIV positive women

All HIV positive women above 18 years shold be screened for cervical cancer after every six months in the first year and then yearly.

Screening during Pregnancy and Puerperium(period of about one month after giving birth)

It is recommended that screening should be done for the first 20 weeks of pregnancy.

No treament should be given to non-invasive cervical cancer inless there is evidence of spread.

Patients should return 6-12 weeks after giving birth.

Screenning will be handled as follows for Visual inspection with acetic(VIA) acid orLugols Iodine (VILI).

Negative cases shoul wait fo five years for another test.

Positive cases should be treated vappropriately.

Those found suspicious should be tested further using biopsy and colposcopy.

Methods of Treatment of Precancerous Cervical Lesions

Cyopathy

This method involves freezing abnormal tissues with a probe cooled by liquid nitrous oxide or carbon dioxide.

It has an overall effectiveness rate of 80-90% in women with suitable lesions. It is simple, safe, and major complications are uncommon.

It is also inexpensive; does not require electricity, and is practical for low-resource settings.

It has been safely performed by nurses and other non-physicians in low level facilities and even primary care level in Kenya and elsewhere.

Common Symptoms and Signs of Invasive Cervical Cancer.

Early    

  •  Vaginal    discharge, sometimes    foul    smelling
  •  Irregular    vaginal    bleeding
  • Post coital bleeding(bleeding after sex) in women of  any age
  • Post  menopausal bleeding  (especially that which does   not respond to appropriate treatment)

Late  

  •  Urinary frequency and urgency
  •  Backache
  •  Lower  abdominal pain  

Very late    

  •  Severe  back pain
  •   Weight  loss
  •  Oliguria(low urine volume)    (due to ureteric obstruction or renal(kidney) failure)
  •  Urinary/fecal incontinence
  •  Edema of  lower    limbs
  •  Dyspnoea(shorness of breath)  (due to  anemia, metastasis or  pleural effusion)

Management 

Treatment options depend on stage of the cancer and include radiotherapy, surgery, or chemotherapy or a combination of any.

The cancer managerial team shoul decide what is the best treament for the patient.

In pregnancy, the treatment is individualized on basis of risk benefit ratio.

Outcome of cervical cancer

The outcome of cervical cancer depends on early diagnosis and treatment.

If diagnosis and treatment is done in early stages recovery rate is between 95-98%.

In very late stages the recovery rate is 5-10%.

 

 

 

 

 

 

 

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Dr Mathu

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