We had an overview of Cervical Cancer last time and will dig more into this disease that is ravaging our Women. You may view the first part of this article here. Please share and comment

Today, we’ll dwell more on the practical aspect of Cervical Cancer – what you can do about it, and that will be prevention. I have stuck more to the standards and treated it to our environment (finding out what can actually work for us here in Africa).

Before the prevention, let’s look at

 Differential Diagnosis.

Some diseases look like cervical cancer, let’s briefly find out what they are

  1. Cervicitis. Inflammation of the cervix (yes, same area as that for the cancer). Usually bacterial and has discharge and bleeding (after sex and in between menstruation).
  2. Vaginitis. Inflammation of the Vagina – tube leading from the outside to the cervix. About same symptoms as vaginal discharge, very little or no bleeding and there could be itching.
  3. Pelvic Inflammatory Disease. About same with discharge and possibly bleeding but there is also lower abdominal pain.
  4. Endometrial Cancer. Cancer of the Uterus (womb) occurs mostly in women above 50. Usually has bleeding from the Vagina.

Your Doctor will help you further differentiate, but honestly, you don’t have to get to that stage with regular screening which we will discuss.

 

Prevention.

This is my favourite because people don’t have to suffer  by frequent visits to the Hospital and expenditure of time, money and energy on treatment.

Prevention can be:

  • General, and
  • Specific

General deals with:

  • Healthy lifestyle (rest, exercise, hygiene, diet, social interaction)
  • Good Health Policies.
  • Avoiding multiple sex partners
  • Use of Condom

We won’t dwell on the General Measures to prevent Cervical Cancer but on the Specific.

Specific Prevention deals with Screening.

The two widely recommended ways to screen for Cervical Cancer are:

  • Pap smear
  • HPV (human papilloma virus) test.

There are others but the above are mainly used for screening and are the recommended ones because they have been found to detect the disease early and prevent death from the disease. So, we will consider them.

  1. The Pap (Papanicolaou) Test

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under the microscope to find cancer and pre-cancer.

How the Pap test is done

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under the microscope to find cancer and pre-cancer.

The health care professional first places a speculum inside the vagina. The speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly. Next, using a small spatula, a sample of cells and mucus is lightly scraped from the exocervix. A small brush or a cotton-tipped swab is then inserted into the opening of the cervix to take a sample from the endocervix. If your cervix has been removed (because you had a trachelectomy or hysterectomy) as a part of the treatment for a cervical cancer or pre-cancer, the cells will be sampled from the upper part of the vagina (known as the vaginal cuff). The samples are then prepared so that they can be looked at under a microscope in the lab.

 

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Although the Pap test has been more successful than any other screening test in preventing a cancer, it’s not perfect. One of the limitations of the Pap test is that the results need to be examined by the human eye, so an accurate analysis of the hundreds of thousands of cells in each sample is not always possible. Engineers, scientists, and doctors are working together to improve this test. Because some abnormalities may be missed (even when samples are looked at in the best labs), it’s not a good idea to have this test less often than guidelines recommend.

Making your Pap tests more accurate

You can do several things to make your Pap test as accurate as possible:

  1. Try not to schedule an appointment for a time during your menstrual period. The best time is at least 5 days after your menstrual period stops.
  2. Don’t use tampons, birth-control foams or jellies, other vaginal creams, moisturizers, or lubricants, or vaginal medicines for 2 to 3 days before the Pap test.
  3. Don’t have vaginal sex for 2 days before the Pap test.

A pelvic exam is not the same as a Pap test

Many people confuse pelvic exams with Pap tests. The pelvic exam is part of a woman’s routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries and may do tests for sexually transmitted disease. Pelvic exams may help find other types of cancers and reproductive problems. Pap tests are often done during pelvic exams after the speculum is placed. Sometimes a pelvic exam is done without having a Pap test, but a Pap test is needed to find early cervical cancer or pre-cancers. Ask your doctor if you had a Pap test with your pelvic exam.

How Pap test results are reported

The most widely used system for describing Pap test results is the Bethesda System (TBS). There are 3 main categories, some of which have sub-categories:

  1. Negative for intraepithelial lesion or malignancy
  2. Epithelial cell abnormalities
  3. Other malignant neoplasms.

You may need further testing if your Pap test showed any of the abnormalities .

‘1’ above means normal. So, when the result is given to you, please look out for the above and still ask your Doctor to interpret it for you

  1. The HPV Test

The most important risk factor for developing cervical cancer is infection with HPV. Doctors can now test for the HPV (high-risk or carcinogenic types) that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells. The test can be done at the same time as the Pap test, with the same swab or a second swab. You won’t notice a difference in your exam if you have both tests.

The HPV test is most often used in 2 situations:

  1. The HPV gene test can be used in combination with the Pap test to screen for cervical cancer. The American Cancer Society recommends this combination for women 30 and older. The HPV DNA test is not recommended to screen for cervical cancer in women under 30. That is because women in their 20s who are sexually active are much more likely (than older women) to have an HPV infection that will go away on its own. For these younger women, results of this test are not as significant and may be more confusing.
  2. The HPV DNA test can also be used in women who have slightly abnormal Pap test results (ASC-US) to find out if they might need more testing or treatment.

 

Here is a summary of the recommendation :

 

Cervic

 

Screening is very important in the prevention of Cervical Cancer.

Another specific prevention is Immunization

Vaccination (immunization) has come in as another way to prevent Cervical Cancer. The three main vaccines used are:

  1. Cervarix from GSK, also called HPV2 (16 and 18 HPV subtypes)
  2. Gardasil from Merck, also called HPV4 (6, 11, 16 and 18)
  3. Gardasil 9, also from Merck, HPV9 (6, 11, 16, 18, 31, 33, 45, 52, and 58)

 

The U.S. Advisory Committee on Immunization Practices (ACIP) has issued the following recommendations for HPV vaccination:

  1. Routine vaccination of girls 11-12 years of age with three doses of HPV2, HPV4, or HPV9
  2. Routine vaccination with HPV4 or HPV9 for boys 11-12 years of age
  3. Previously unvaccinated females and males aged 13-26 years
  4. Children as young as 9 years may be vaccinated, particularly if there is a history of sexual abuse or assault
  5. Any man who has sex with a man and individuals with compromised immune systems (including people with HIV infection/AIDS), through age 26, if they were not fully vaccinated when they were younger.

 

Please check with your local listing for places to do a pap smear.

Cervical Cancer remains one of the most easily preventable Cancer in the World. We can take screening and a healthy lifestyle seriously to overcome the scourge.

 

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