Cervical Cancer: Diagnosis and Assessment
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Taking up the discussion on cervical cancer from my last lines on the subject, it is important to stress the fact that while regular screening for abnormal (pre-cancerous) cells of the cervix is most important in the prevention of the disease, in many cases, the abnormal (dyskaryotic) cells do not progress to become cancerous. In more cases, they revert back to normal. However, in some cases, often years later, the abnormal cells turn cancerous.
As earlier mentioned, in cases of slight abnormal changes (mild dyskaryosis or CIN1), one may simply be offered another test much sooner than the normal, which normal done every three (3) years; in this case, one may be advised in few months from the last test. In many cases, slightly abnormal cells revert back to normal within a few months. Treatment may however, be offered if the abnormality persists.
As an emphasis, the most important thing to note is that a woman is very unlikely to develop cervical cancer, IF...she has regular cervical screening tests at the times advised by the doctor, AND ...has treatment when advised if abnormal cells are detected.
Colposcopy is a more detailed examination of the cervix. Here, a speculum is gently put into the vagina to open it wider so that the cervix can be seen. A magnifier (colposcope) is then used to look at the cervix in more detail. Ordinarily, the test takes some 15-20 minutes. During colposcopy, it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope (histology) to look for cancer cells.
For example, a CT scan, an MRI scan, a chest x-ray, an ultrasound scan, blood tests etc. This assessment is called 'staging' of the cancer. The aim of staging is to find out:
1. How much the tumour has grown, and whether it has grown to other nearby structures such as the vagina, bladder or rectum.
2. Whether the cancer has spread to local lymph glands (nodes).
3. Whether the cancer has spread to other areas of the body (metastasised).
Of course, exactly which tests are needed depends on the initial assessment and the results of the biopsy. For example, the biopsy may show that the cancer is at a very early stage and remains just in the surface cells of the cervix. This is unlikely to have spread (metastasised) and one may not need many other tests. However, if the cancer appears to be more advanced and likely to have spread then a range of tests may be needed.
The implication of staging cervical cancer is that it helps doctors to advise on the best treatment options and it also gives a reasonable indication of the outlook (prognosis).
On the various option, it is advised that one has a full discussion with a specialist who is familiar with the case. They will be able to give the full pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for the type and stage of cancer.
In some cases, treatment aims to cure the cancer. Some cervical cancers can be cured, particularly if they are treated in the early stages of the disease. Although, doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If one is 'in remission', she may be cured. However, in some cases a cancer returns months or years later. This is the reason why health practitioners are sometimes reluctant to use the word cured.
2. Control
Sometimes, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may make the individual to be free of symptoms for some time.
3. Relieve symptoms
Treatment intervention in cervical cancer may sometimes be aimed mainly to ease symptoms. E.g. if a cancer is advanced then, the patient may require treatments such as painkillers or other treatments to help keep her free of pain or other symptoms. Similarly, some treatments may be used to reduce the size of a cancer which may ease symptoms such as pain.
Even if the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. For example, in some cases where the cancer has spread to other nearby structures, extensive surgery may be an option. This may be to remove not only the cervix and uterus but also nearby structures which may have become affected such as the bladder and/or rectum.
Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, to relieve a blockage of the bowel or the urine pathway (urinary tract) which has been caused by the spread of the cancer, some ‘de-bulking’ i.e. removing part of the cancerous tumour blocking these organs may need to be done.
As with surgery, even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain.
Meanwhile, it is noteworthy to mention that the treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. Each case of cancer, particularly the cervical variant, must be analysed as an individual case, it is important to allow the specialist (gynaecologist, oncologist etc) who is familiar with one's case to give more accurate information about the particular outlook for each case, and how well the stage of cancer is likely to respond to treatment.
Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix developing. The vaccine has been shown to work better for people who are given the vaccine when they are younger, particularly before they are sexually active, compared to when it is given to adults. Notwithstanding this comparison, the vaccine is still a very relevant option to embrace in the prevention of cervical cancer by adults and sexually-active adolescents.
As earlier mentioned, in cases of slight abnormal changes (mild dyskaryosis or CIN1), one may simply be offered another test much sooner than the normal, which normal done every three (3) years; in this case, one may be advised in few months from the last test. In many cases, slightly abnormal cells revert back to normal within a few months. Treatment may however, be offered if the abnormality persists.
As an emphasis, the most important thing to note is that a woman is very unlikely to develop cervical cancer, IF...she has regular cervical screening tests at the times advised by the doctor, AND ...has treatment when advised if abnormal cells are detected.
Diagnosis
To diagnose cervical cancer, the doctor will normally do the more routine vaginal examination if a woman presents with symptoms suggestive of a possible cervical cancer. For an instance, If the examining doctor felt an abnormal cervix, the woman is then referred for colposcopy.Colposcopy is a more detailed examination of the cervix. Here, a speculum is gently put into the vagina to open it wider so that the cervix can be seen. A magnifier (colposcope) is then used to look at the cervix in more detail. Ordinarily, the test takes some 15-20 minutes. During colposcopy, it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope (histology) to look for cancer cells.
Further assessment
In cases where cervical cancer is confirmed after histology then further tests may be advised to assess the magnitude of the situation and determine if the cancer has spread to other areas of the body.For example, a CT scan, an MRI scan, a chest x-ray, an ultrasound scan, blood tests etc. This assessment is called 'staging' of the cancer. The aim of staging is to find out:
1. How much the tumour has grown, and whether it has grown to other nearby structures such as the vagina, bladder or rectum.
2. Whether the cancer has spread to local lymph glands (nodes).
3. Whether the cancer has spread to other areas of the body (metastasised).
Of course, exactly which tests are needed depends on the initial assessment and the results of the biopsy. For example, the biopsy may show that the cancer is at a very early stage and remains just in the surface cells of the cervix. This is unlikely to have spread (metastasised) and one may not need many other tests. However, if the cancer appears to be more advanced and likely to have spread then a range of tests may be needed.
The implication of staging cervical cancer is that it helps doctors to advise on the best treatment options and it also gives a reasonable indication of the outlook (prognosis).
Treatment options for cervical cancer
Depending on the stage of the disease, treatment options which may be considered include surgery, radiotherapy, chemotherapy, or a combination of these treatments. The treatment advised for each case depends on various factors. For example, the stage of the cancer (how large the primary cancer tumour is and whether it has spread), and the person’s general health condition.On the various option, it is advised that one has a full discussion with a specialist who is familiar with the case. They will be able to give the full pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for the type and stage of cancer.
The aims of treatment are
1. “Cure”In some cases, treatment aims to cure the cancer. Some cervical cancers can be cured, particularly if they are treated in the early stages of the disease. Although, doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If one is 'in remission', she may be cured. However, in some cases a cancer returns months or years later. This is the reason why health practitioners are sometimes reluctant to use the word cured.
2. Control
Sometimes, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may make the individual to be free of symptoms for some time.
3. Relieve symptoms
Treatment intervention in cervical cancer may sometimes be aimed mainly to ease symptoms. E.g. if a cancer is advanced then, the patient may require treatments such as painkillers or other treatments to help keep her free of pain or other symptoms. Similarly, some treatments may be used to reduce the size of a cancer which may ease symptoms such as pain.
Surgery
One of the commonest treatment option in cervical cancer is to remove the cervix and uterus (hysterectomy) via surgical operation. If the cancer is at an early stage and has not spread then surgery alone can be curative. In some cases where the cancer is at a very early stage, it may be possible to just remove the part of the cervix affected by the cancer without removing the entire uterus. This implies that the woman’s fertility status is preserved.Even if the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. For example, in some cases where the cancer has spread to other nearby structures, extensive surgery may be an option. This may be to remove not only the cervix and uterus but also nearby structures which may have become affected such as the bladder and/or rectum.
Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, to relieve a blockage of the bowel or the urine pathway (urinary tract) which has been caused by the spread of the cancer, some ‘de-bulking’ i.e. removing part of the cancerous tumour blocking these organs may need to be done.
Radiotherapy
Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Sometimes, radiotherapy alone can be curative for early stage cervical cancer and may be an alternative to surgery. However, for more advanced cancer, radiotherapy may be advised in addition to other treatments.As with surgery, even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain.
Chemotherapy
Chemotherapy is a treatment involving the use of anti-cancer medications which kill cancer cells, or stop them from multiplying. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations.Prognosis - what is the outlook like?
It is implicit from the submission above that the outlook for cervical cancer is best in those who are diagnosed early when the cancer is confined to the cervix and has not spread. Treatment in this situation gives a good chance of cure. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Anyhow, even if a cure is not possible, treatment can often slow down the progression of the cancer.Meanwhile, it is noteworthy to mention that the treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. Each case of cancer, particularly the cervical variant, must be analysed as an individual case, it is important to allow the specialist (gynaecologist, oncologist etc) who is familiar with one's case to give more accurate information about the particular outlook for each case, and how well the stage of cancer is likely to respond to treatment.
Prevention is definitely better than cure – take the vaccine option!
As the saying goes, prevention is definitely better than cure and of course much more cheaper in the last analysis. The HPV vaccine has recently been introduced for girls from the age of 12 in some countries where the public health importance of cervical cancer is well acknowledged; although, the Nigerian authorities are far off from embracing these life-affirming public health policy.Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix developing. The vaccine has been shown to work better for people who are given the vaccine when they are younger, particularly before they are sexually active, compared to when it is given to adults. Notwithstanding this comparison, the vaccine is still a very relevant option to embrace in the prevention of cervical cancer by adults and sexually-active adolescents.
