It is recommended that women between 30 and 65 undergo co-testing with Human papillomavirus (HPV) and Pap smear testing every five years or Pap testing alone every three years.
HPV testing for women in their 20s is controversial but recommended if the Pap smear is abnormal in this age group.
It is also recommended that girls from age nine and above are immunised against Human Papillomavirus before they become sexually active. This single intervention is eradicating cases of cervical cancer in some countries.
Diagnosis of cervical cancer requires taking a sample of cervical tissue (called a biopsy) and analysing it under a microscope. Cervical biopsy is usually done by a gynaecologist or a nurse trained to do it and the sample is sent to a pathologist to examine it under a microscope for evidence of cell changes suggesting cancer or precancerous stages.
Another way of examining the cervix for abnormalities is by colposcopy. This examination, usually done by a gynaecologist, uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye to make abnormal cells stand out.
The colposcope magnifies the cervix by eight to 10 times, allowing easier identification of any abnormal-appearing tissue that may need biopsy.
I need to appreciate Telecel and the Ghana Medical Trust Fund for donating a colposcope to the Gynaecology Unit at Korle Bu.
Sometimes, a larger biopsy is needed to fully check for invasive cervical cancer. A cone biopsy is performed in the operating room, while under anesthesia where a small cone-shaped sample of the cervix is removed for examination.
Different terms have been used to refer to abnormal changes in the cells on the surface of the cervix.
These changes are now most often called squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia 1 (CIN 1).
Low-grade SIL: Means early, subtle changes in the size and shape of cells that form the surface of the cervix.
These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion.
These early changes in the cervix most often occur in women aged 25 and 35, but can appear in women of any age.
High-grade SIL or CIN 2 or carcinoma in-situ: Here, a large number of precancerous cells, which look very different from normal cells, are seen on the surface of the cervix.
They develop most often in women aged 30-40, but can occur at any age. Precancerous cells, even high-grade lesions, usually do not become cancerous and invade deeper layers of the cervix for many months or years.
If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer or invasive cervical cancer. Cervical cancer occurs most often in women aged 40 or older, although it is infrequently found in younger women.
If the biopsy results show invasive cancer, a series of tests is performed to examine the extent of spread, known as the stage of the disease.
These tests include a chest X-ray, which looks for spread to the lungs, a liver function test, a CT scan or an MRI scan for the extent of spread to other structures.
The choice of treatment for a precancerous lesion of the cervix depends on several factors. These factors include whether the lesion is low- or high-grade, whether a woman wants to have children in the future, her age and general health, and her preference.
If a woman has a low-grade lesion, she may not need further treatment, especially if the abnormal area was completely removed during biopsy. She should have regular Pap smears and pelvic exams.
When a precancerous lesion requires treatment, cryosurgery (freezing), cauterisation (burning, also called diathermy) or laser surgery may be used to destroy the abnormal area without harming nearby healthy tissue.
Abnormal tissue also can be removed by doing a conisation- an intensified biopsy of the cervix that removes a large cone-shaped section of the abnormal tissue, as well as a small amount of normal tissue, so an area of normal tissue remains in the cervix.
In some cases, a woman may choose to have a hysterectomy – total removal of the cervix and womb for precancerous changes, particularly if abnormal cells are found inside the opening of the cervix. This surgery is more likely to be done if a woman does not plan to have children in the future.
The most widely used treatments for cervical cancer are surgery and radiation therapy. Chemotherapy or biological therapy is sometimes used.
If a biopsy demonstrates that cancerous cells have invaded through a layer called the basement membrane, which separates the surface layers of the cervix from other underlying layers, surgery is usually required.
Radiation therapy (also called radiotherapy) is used to treat cervical cancer at some stages. Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing.
Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is sometimes used in combination with radiation therapy in high-risk patients or may be used alone when the cancer has spread to other parts of the body.
Just one drug or a combination of drugs may be given. Chemotherapy regimens are constantly changing and a woman should discuss the best treatment options with her gynaecologist. Targeted biological treatments may also be used with chemotherapy.
In all these, though, the best way for prevention and treatment of cervical cancer is to vaccinate early, diagnose early when it occurs and treat. The earlier it is picked, before it spreads, the better the outlook.
Let us all then continue to spread the news about the need for regular screening for cervical cancer. “Let us play our part to contribute to protecting her and preventing cervical cancer now”.
The writer is a member of the Paediatric Society of Ghana and the Director of Medical Affairs of the Korle Bu Teaching Hospital.
Source:
www.graphic.com.gh