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.
According to
worldwide statistics, every two minutes, a woman dies of cervical cancer. An estimated 500,000 cancer cases reported
each year, with over 80 percent in developing countries. Globally more than
270,000 deaths occur each year from cervical cancer.
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.
THE CAUSES
ALTHOUGH the exact
cause is unknown, there are definite factors which place some women at a
slightly higher risk.
These are:
* 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
5. Vaccinations.
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
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.
