Cervical Cancer Unit

Cervical cancer is the 2nd most common gyneacological cancer after breast cancer. Worldwide there are around 550.000 cases with 288.000 fetal cases annually. This disease is essentially preventable. It evolves very slowly. This pathology is divided into 3 stages which are: low, intermediate, and high-grade lesions, after which is invasive cancer. From the initial low-grade lesion to high-grade lesion / invasive cancer, the length of time could be ≥ 10-15 years. This gives enough time to curb the disease before it gets into its invasive phase. Buea Regional Hospital Annex has embarked on a cervical screening exercise. In this scope, a free cervical cancer screening exercise was carried out on the 16th and 17th of October, 2020.

EPIDEMIOLOGY AGE AFFECTED

The Peak incidence is between ages 45 and 55. Fifteen (15) percent of women develop it before age 30. An increasing percentage of women are diagnosed before age 20 (perhaps due to early screening or changes in sexual patterns).

RACE PREVALENCE

More prevalent in African women than white women. The African mortality rate is two times greater than whites.

RISK FACTORS :  Mainly in the age group 45 to 55.

  • It is Rare in virgins.  Coitus increases the risk: (a) very early coitus; (b) multiple sexual partners.
  • Infection with the human papilloma virus (HPV); types 6, 11, 16, 18, 31, 33, 45, 52 and 58.
  • HIV infection.
  • Vaginal dysbiosis (bacterial vaginosis) in association with HPV infection.  More frequent in the lower social class groups.
  • Possibly hygienic factors may play a part.
  • Cigarette smoking shows an associated higher risk.

SYMPTOMS

The symptoms of cancer of the cervix only begin when the surface of the growth becomes ulcerated. The chief symptom is a watery discharge (often offensive) and blood-stained discharge or bleeding, particularly after coitus. Later, frank, sometimes severe, and continuous bleeding occurs, with the patient rapidly becoming anemic. As the disease is advancing, one could have: Irregular/prolonged vaginal bleeding/pink discharge, Post-coital bleeding (brownish discharge), Postvoid bleeding, Dysuria/hematuria, weight loss, loss of appetite, bloody, malodorous discharge, severe pain, due to spreading to sacral plexus and leg swelling (secondary to blockage of lymphatics).

DIAGNOSIS AND PREVENTION

  • VIA/VILI: visual inspection with 3-5% acetic acid/Lugol’s Iodine.
  • Pap smear: cytological analysis.  Colposcopy: visualization of the cervix with a magnifying device.
  • Biopsy: Pathological analysis.
  • Genotyping of HPV

METASTASIS OF CERVICAL CANCER.

  1. By direct extension: To the vagina, rectum, bladder, endometrium, and the Intra-abdominal cavity.
  2. Distant spread: To the breast, Lungs, bones, and liver.

SURGICAL TREATMENT

The choice of treatment depends on many factors: the age, the general condition of the patient, and the extent and type of the lesion. The following could be used for early-stage: Laser or cryotherapy (endocervix); loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (ectocervix); total abdominal hysterectomy (TAH; if completed childbearing), conization or cryotherapy (if the patient wants to retain uterus). A Wertheim’s radical abdominal hysterectomy is the treatment of choice removing the uterus, tubes, ovaries, broad ligaments and parametrium, the upper half or two-thirds of the vagina, and the regional lymph glands.

RADIOTHERAPY :

High-dose delivery to the cervix and vagina, and minimal dosing to the bladder and rectum: Externalbeam whole pelvic radiation. Transvaginal intracavitary cesium: Transvaginal applicators allow significantly larger doses of radiation to the surface of the cervix.

OUTCOME OF TREATMENT:

These are best assessed by a 5-year follow-up which shows a cure rate of up to 80% with Stage 1 and about 10% with Stage 4. This range of cure emphasizes the value of early diagnosis and treatment; the tragedy is that so many women do not receive treatment until the disease is advanced.

RECURRENT CERVICAL CARCINOMA

Thirty percent of patients treated for cervical cancer will have a recurrence. Recurrence of cancer can occur anywhere but occur mainly in the pelvis (vagina, cervix, or lateral pelvic wall).

By Dr. TASSANG Andrew. Mr. EWANE Theophile.

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