CANCER of the cervix recognized as Cervical Cancer is the number two killer among women in Malaysia and is the third highest widespread types of cancer after breast cancer and colorectal cancer. In fact, latest statistics divulge an average, a total of 16 new cases of cervical cancer were reported among 100,000 women in this country.
Cervical cancer is caused by the transmission of persistent infection with an extremely common and contagious virus - the human pappillomavirus (HPV), the same virus that causes genital warts.
It is estimated that up to 50 to 80 per cent of women will acquire a genital HPV infection in their lifetime, and up to 50 per cent of these infections will be potentially cancer-causing. The threat starts from sexual debut, when women begin having sex.
What is Cervical Cancer?
CERVICAL cancer is a disease in which malignant cancer cells form in the cervix. The cervix is the lowest, narrow end of the uterus and is sometimes called the neck of the womb. It leads to the vagina which leads to the exterior. The cervix holds the developing baby in the uterus during pregnancy. In cervical cancer, the cells in the cervix behave abnormally. They keep growing and turn into a lump or tumour. If untreated, they can spread to other parts of the body through the blood lymph system. Cervical cancer doesn't happen overnight. It goes through a process and takes many years to develop. Although not all pre-cancers will develop into cancer, it must be treated because 15 to 30 per cent of the cases may develop into cancer. Before it develops, early changes take place in the cells on the surface of the cervix. This is called the pre-cancerous stage.
What is Papillomavirus?
THE Human Papillomavirus (HPV) is a common virus and forms a group of more than 100 related viruses. They are called papillomaviruses because certain types may cause warts, or papillomas, which are benign (non-cancerous) tumours. All types of HPV infection is a pervasive condition that affects and can be transmitted between men and women.
Most HPV infections are comparatively harmless and will clear up on their own through the body's natural immune response within one to two years. Of these about 30 infect the genital areas of women and men. Infection with high-risk types of HPV can lead to cervical cancer and other cancers of the genital area. Although HPV is not the sole cause of cervical cancer, there is no cervical cancer without HPV.
HPV types 16 and 18 account for nearly 70 per cent of cases of cervical cancer while HPV types 6 and 11 cause approximately 90 per cent of genital warts.
These four types of HPV also account for 35 to 50 per cent of all low grade cervical, vaginal and vulva lesions.
SIGNS and SYMPTOMS
* Discomfort or bleeding during sexual intercourse.
* Bleeding between periods.
* Vaginal discharge after menopause.
* Unusual foul bloody mucus vaginal discharge
* Pelvic pain and excessive tiredness.
* Swollen legs and backache.
ALTHOUGH the exact cause is unknown, there are definite factors which place some women at a slightly higher risk.
* Giving birth to many kids.
* Having many sexual partners.
* Having sexual intercourse at an adolescent age.
* Smoking cigarettes.
* Using oral contraceptive pills in the long term
* Bacterial infection such as syphilis, gonorhoea, Chlamydia or HIV.
* Lack of immune resistance (Ineffective immune system).
PRECAUTION and PREVENTION
You can reduce the risk of suffering from cervical cancer by preventing HPV infection. HPV is a sexually transmitted disease . HPV is spread through sexual contact therefore, the use of condoms can reduce the risk of HPV.
Reduce HPV with
1. Having sex with one partner.
2. Avoid sexual activity at a young age.
3. Do not smoke.
4. Immunised against HPV infection
VACCINES against HPV
Today there are vaccines that can prevent some strains of HPV that cause cervical cancer. Girls as young as 13 years are encouraged to take this vaccine. In fact, the younger the vaccine the higher her immune response. This makes the vaccine more effective. It can prevent up to 70 percent of HPV infection and more effective if given before girls become sexually active. It is also recommended for all women up to age 46 years.
There are currently two types of HPV vaccines available locally: Gardasil by Merck, Sharp & Dohme (The quadrivalent vaccine against HPV high-risk genotype 16 and 18 and low-risk Type 6 and Type 11 for warts) has been available in Malaysia since October 2006 and Cervarix by GlaxoSmithKlines (The bivalent vaccine against HPV high-risk genotype 16 and 18), both of which stay effective for up to about eight years. However, both vaccines offer some cross-protection for Type 31 and Type 45 high-risk genotypes.
At present, the Cervical Cancer Vaccination Programme by the Ministry of Health is giving the immunisation jab for free to all girls in Form 1 and girls currently aged 13. Under its programme, girls between 14 and 19 years who did not qualify for the school programme could receive two doses of the vaccine at RM466 and the third dose free.
Other countries that have national funding of HPV vaccines include Canada, the United States, Australia and New Zealand. In Australia, girls between 9 and 26 years are given HPV vaccine free of charge.
A course of HPV vaccine consists of three doses on the upper arm administered over six month period. The first injection takes place on the date set in school or at clinics. The second jab is a month later, and the third is six months after the first. Not completing the course makes the vaccine ineffective and a waste of funds.
If a large proportion of males are also vaccinated, herd immunity will develop. There will be less HPV infections, and the risk of women getting infected will also be reduced. Immunising them would not only prevent transmission of the virus but would also keep them protected from genital warts.
CERVICAL CANCER SCREENING
Screening is the way how cancer is diagnosed. Women are luckier than men as the two most common cancers in women can be easily detected by a simple test - a mammogram for breast cancer and a pap smear for cervical cancer.
Having the vaccine does not mean a woman can skip regular pap smear tests. The pap smear test picks up any changes in the cells. It is what we call early detection. The vaccination just stops the agent that starts the changes from taking place.
Women should have a pap smear test at least once every three years, beginning about three years after they start to have sexual intercourse. It is safe to wait three years, because cervical cancer usually develops slowly.
Treatment depends on the level of the cancer and how far it spreads. If still at an early stage, womb removal surgery is suggested and a major surgery will be done if the cancer has spread to nearby organs. Other treatment, includes radiation and chemotherapy. The usual treatments offered by hospitals are:
Pre-invasive stage (Stage 0 to carcinoma in situ)
When the cancer has affected only the outer layer of the lining of the cervix, treatment may include:
- Laser surgery, which uses a laser beam to destroy abnormal cells.
- Cryosurgery, which destroys cancerous and pre-cancerous lesions by freezing them.
- Loop electrosurgical excision procedure, which uses a thin wire loop (through which an electrical current is passed) to cut away an area of abnormal cells from the cervix.
- Conisation surgery, which removes a cone-shaped piece of tissue from the cervix.
Invasive stage (Stages 1-4)
When the cancer has penetrated into the cervix and possibly to other tissues and organs, treatment may include:
- Radiation using high-energy rays to shrink tumours by destroying the cancer cells' ability to reproduce.
- Chemotherapy uses anti-cancer drugs which reach all areas of the body to kill cancer cells, including those that have spread to distant organs.
- Hysterectomy can be performed in two ways, depending on the extent of the cancer:
1) Simple hysterectomy which removes the cancer, the cervix and the uterus.
2) Radical hysterectomy which removes the cervix, uterus, part of the vagina and lymph nodes in the area.
Above all, education and awareness is the best and cheaper way to deal with the disease. Parent should educate their children to regulate sexual behaviour with knowledge and moral values . They also need to know the fact that;
* HPV is the main cause of cervical cancer;
* HPV is a sexually transmitted disease;
* practise abstinence to avoid HPV infection from sexual contact;
* pap smear tests can detect early stages of cervical cancer;
* cervical cancer, if detected at an early stage, is curable;
* the vaccine is not a vaccine against cervical cancer but a vaccine against HPV, which may cause cervical cancer;
* there are 18 types of HPVs linked to cervical cancer but the vaccine protects against only six types;
* there are thousands of cases of serious side effects that are linked to these vaccines;
* you can still get cervical cancer after taking this HPV vaccine; and,
* those who take the vaccination still have to take their yearly pap smear tests for cervical cancer.