CERVICAL CANCER - A SEXUALLY TRANSMITTED DISEASE !!!.

World wide cervical cancer is the second most common and the 5th deadliest cancer in women. Approximately 80% of cervical cancer now occurs in developing countries such as Nigeria.
Cervical cancer is common among female sex workers. It is rare in Nuns, except for those who had been sexually active before entering the convent. Cervical cancer is more common in the second wives of men whose first wife died from cervical cancer. Cervical cancer is rare in Jewish women.

SIGNS & SYMPTOMS

The early stages of cervical cancer may be symptomless. Vaginal bleeding, contact bleeding or rarely a vaginal mass may indicate the presence of malignancy. Moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, spread may be present in the abdomen, lining or elsewhere.
Symptoms of advanced cervical cancer may include loss of appetite, weight loss, fatique, pelvic pain, back pain, leg pain, swollen legs, heavy bleeding from the vaginal, bone fracture and rarely leakage of urine in faeces from vaginal.

CAUSES

Infection with some type of Human Papilloma Virus (HPV) is the greatest risk factor for cervical cancer; followed by smoking. Other risk factors include HIV infection. Not all the causes of cervical cancer are known, however and several other combining factors have been implicated.
Human Papilloma Virus (HPV) is the cause of 70% of cervical cancer globally. Women who have many sexual partners or who have sex with men who have had many other partners have a greater risk of the 150 -200 types of HPV known, 15 are classified as high risk types. Types 16 and 18 generally acknowledged to cause about 70% of cervical cancer.
Genital warts are caused by various strains of HPV. The general view is that a patient must have been infected with HPV to develop cervical cancer and is hence viewed as a sexually transmitted disease. Use of condom significantly reduce but does not always prevent transmission. HPV can be transmitted by skin to skin contact with the infected area.

DIAGNOSIS.

Whilst Pap smear is an effective screening test, confirmation of the diagnosis of cancer or precancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using diluted acetic acid solution to highlight the abnormal cells on the surface of the cervix. Colposcopic impression, the estimate of disease severity based on visual inspection forms part of diagnosis. Further diagnostic and treatment procedure are loop electrical excision procedure (LEEP) and conisation

PRECANCEROUS LEISONS

Cervical intra epithelial neoplasia (CIN) the precursor to cervical cancer is often diagnosed on examination of cervical biopsy by a pathologist through a cervical smear or Pap smear.
Squamons cell carcinoma (80-85%) is the cervical cancer with the most incidence. The incidence of Aden carcinoma (15%) is on the increase in recent decades especially among women.

PREVENTION

The widespread introduction of cervical screening by Pap smear for cervical cancer has been credited with dramatically reducing the incidence and mortality of cervical cancer in the developed countries.
Cervical smear test every 3- 5 years with incidence by up to 80%. Abnormal result may suggest the presence of precancerous changes allowing examination and possible prevention treatment. If precancerous disease or cervical cancer is detected early, it can be monitored or treated relatively non- invasively with little impairment of infertility.

VACCINATION

There are 2 HPV vaccines which reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93%. HPV vaccines are typically given to women age 9 to 26 as the vaccine is only effective if given before the infection occurs. The vaccines have been shown to be effective for at least 4 to 6 years. The case for a booster dose is strong. The high cost of this vaccine has been a cause of concern. Many countries have considered programmes to fund HPV vaccination and Nigeria should not be an exception.

CONDOMS

Condoms are thought to offer some protection against cervical cancer. Evidence of whether it offers protection against HPV is mixed, but they may protect against genital warts, and the precursor to cervical cancer. They also protect against other STDs such as HIV and Chlamydia which are associated with greater risk of developing cervical cancer.
Condoms may be useful in treating potentially precancer changes in cervix. Semen increases risk of precancer CIN3 and the use of condoms help to cause this changes regress and help clear HPV.

TREATMENT

Treatment of cervical cancer varies world wide, largely due to a large variance in the disease burden in developed and developing nations, access to surgeons skilled in radical pelvic surgery and emergence of fertility sparing therapy in developed countries. Because cervical cancers are radiosensitive, radiation may be urgent in all stages where surgical options do not exist. Micro invase (stage 1A) is best treated by hysterectomy. A combination of surgery, radiation and Chemotherapy can be used depending on stages of cancer and expertise available.