Cervical cancer is the second most common cancer after breast cancer occurring in Sri Lankan women. It also has a high chance of cure if diagnosed early, when compared to other cancers. Incidentally the screening test for cervical cancer, commonly known as the Pap smear, remains the most successful screening test for cancer developed to date and is freely available in the government sector. Therefore it is unfortunate that many women forego this life-saving opportunity due to lack of knowledge on the subject. This week, Health Capsule consulted Dr. Jayantha Balawardane, Senior Consultant Oncologist, Radiotherapist and senior lecturer, Kotelawala Defence University hospital to get more information on cervical cancer.
How is cervical cancer diagnosed?
One doesn’t contact cancer as soon as one gets infected with HPV. There could be almost a 15-year gap from the time the woman gets infected to the point where she develops cancer. During this time, the cervix undergoes gradual malignant changes, which could be detected by the simple screening test known as the pap smear, where a few scraped-off cells from the cervix are examined under a microscope. Detection of these changes in the earlier stages is preferable because once it progresses to frank cancer, the treatment methods become more complex.
What are the treatment options available?
If the malignant changes are identified in the very early stages, only the tissues containing the lesions can be incised and removed in a procedure called cone biopsy. In this method, the childbearing ability of the woman is preserved. But if the cancer is somewhat spread through the cervix, the treatment option required is a surgery. In these cases, the uterus, ovaries and fallopian tubes, the upper part of the vagina as well as the supporting tissues of the uterus and pelvic lymph nodes are removed in a procedure called the Werthime’s hysterectomy. If the cancer are very advanced, chemotherapy and radiotherapy is given in place of surgery. Both external radiation and per vaginal internal radiation as well as chemotherapy are combined in this treatment method.
Due to modern advanced treatments, even patients in the advanced stages of cancer now have comparatively high chances of survival.
Who is at a higher risk of contacting this disease?
Women who begin their sexual lives early have a higher chance of getting cervical cancer. Women with multiple sexual partners, especially commercial sex workers, also have a higher incidence of the disease. Even though males do not display symptoms of HPV, they can contact HPV through sexual contact with an infected person and act as carriers of the virus and are known as high-risk males. Therefore, even if a woman has a single sexual partner throughout her life, if her male partner has had other sexual partners, there’s a chance of her contracting the infection through him, which may ultimately lead to cervical cancer. Research has also shown that women who smoke have a higher tendency to get cervical cancer when compared to non- smokers.
“When it comes to the prevention of cervical cancer, we should talk about three things. The first is having one faithful sexual partner. The second is vaccination for HPV. It covers 98% of HPV infections for a period of about 15 years. In developed countries, it is given to all teenage girls as part and parcel of the immunization schedule. In Sri Lanka it is readily available in the private sector at a small cost. The third is the use of barrier methods like condoms and refraining from practising unsafe sex. These methods might provide a certain amount of protection against HPV and other sexually transmitted diseases, though it is not 100 percent effective” he added.
Message to Sri Lankan women
Dr. Balawardane stresses on the need for every female who has been sexually active at some point in her life to get screened for cervical cancer. He also advises women who have post-coital bleeding to seek immediate medical care, because this is usually the first visible symptom of cervical cancer. Symptoms like unusual vaginal discharge, pelvic pain and irregular vaginal bleeding may also occur. Cervical cancer can be defeated through spreading awareness and timely diagnosis and treatment.
The Sri Lankan situation
“About five years back, most patients coming in for treatment for cervical cancer were in the last stages. Today, however, more and more cases are identified early because people are more informed and have access to improved screening facilities in the country, especially in the ‘Well Woman’ clinics. Unfortunately, the number of patients identified from rural areas are lower, because they are less educated and are reluctant to get screened.”
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