This Content Is Only For Subscribers
The month of January is recognised as cervical cancer awareness month. I will use this opportunity to discuss this condition. This current issue will be sensitizing the reader about the diagnosis of this conditions. Subsequent articles will focus of the management aspect of the disease.
Cervical cancer is growth of abnormal cells in the cervix, which is the lower end of the uterus and connects the uterus and the vagina. Cervical cancer is one of the most frequent cancers amongst women in Botswana and is the highest in the aged group of 15 to 44 years. In 2021 it was estimated that 374 women were diagnosed with cervical cancer with 207 demising form the disease.
The biggest risk factor for the development of cervical cancer is persistent infection with Human Papilloma Virus. Other risk factors include weak immune system, particularly in the setting of HIV infection. Women who have an early onset of sexual activity and those with multiple sexual partners are also at an increased risk. Cigarette smoking and passive smoking has been identified as a risk factor as well.
In the early stages cervical cancer is usually asymptomatic. This is often discovered during routine cervical cancer screening and highlights the importance of screening. When symptomatic the most common symptoms of cervical cancer are irregular or heavy vaginal bleeding. Some patients may have bleeding after sexual activity. Some patients may present with a vaginal discharge which can be watery and foul smelling. This can often be confused with vaginitis or cervicitis.
As the disease advances, they may be symptoms related to the spread of the cancer. These includes back pain, due to spread to the vertebral spine. They may also be pressure related. Some patients may have blood in the urine or blood when passing stools, due to infiltration into the bladder and rectum respectively.
A cervical examination should be done with a speculum in any woman who presents with symptoms suggestive of cervical cancer. If there are any obvious lesions, then a biopsy should be taken. A thorough pelvic examination and examination of the rectovaginal structures and the tumor should be done in order to stage the cancer. Staging is essential as it determines the severity of the disease as well as guides the required treatment.
Women without a visible lesion should undergo colposcopy and directed biopsy. Colposcopy is a diagnostic procedure in which a colposcope (a dissecting microscope with various magnification lenses) is used to provide an illuminated, magnified view of the cervix, vagina, and vulva The primary goal of colposcopy is to identify precancerous and cancerous lesions so that they may be treated early.
Pap smears are recommended in women of ages of 30 to 65. Botswana guidelines prioritise women of ages 30-49 as they are highest risk group. The goal of pap smear screening is to detect precancerous lesions and cancer early and offer appropriate treatment.
The Human Papilloma Virus vaccine has also been introduced into the Botswana vaccination schedule. It is given to girls aged 9-13 years and is meant to reduce the risk of developing cervical cancer that is due to the virus.
Cervical can be detected early and thus reducing its morbidity and mortality. The important thing is regular screening via pap smear an to be aware of symptoms suggestive of the disease.