| Cervical Cancer
What
is Cervical Cancer ?
Cancer of the cervix: - Our understanding of cervical cancer
has changed markedly over recent years. Arising in the lining cell of the cervix, cervical
cancer seems to be related to factors of sexual behavior and exposure in a complex but
intimate way. It has been recognized that celibate women rarely get this disease, and its
incidence is much lower in women whose sexual exposure has been limited to men who have
been circumcised. On the other hand, women with multiple sexual partners, particularly
during their teens, are at high risk.
Certain viruses including those of the herpes and papilloma
group are increasingly suspected of playing a role in the cause of this disease and
studies are now confirming that diet and other environmental factors play a significant
role in the development of all cancers. There are also many who believe that emotional
factors also influence this cancer.
Therefore, at present, there are a combination of possible
causative factors relevant to cancer of the cervix including diet, genetic susceptibility,
sexual exposures to viruses and psychological factors.
return to top
Symptoms
Once symptoms occur, cervical cancer is often advanced. This
is why the Pap smear (see below) is important. Symptoms include vaginal bleeding between
periods, pain with intercourse, and a vaginal discharge.
return to top
Diagnosis
Cervical cancer can be detected in the very early stages when
in fact it is more accurately described as dysplasia or pre- cancerous. This is thanks to
the development of the Pap smear. During a pelvic exam, the physician takes a small
scraping of the outside of the cervix which is sent for microscopic analysis. Although
established cancers can be diagnosed this way, more commonly certain changes in the cells
can be identified which are thought to precede the development of cancer, or else cancer
confined to the very earliest stages (carcinoma-in- situ) may be identified.
When suspicious findings are found on Pap smears, the next
approach is often colposcopy, whereby the physician views the cervix through a magnifying
lens. In this way, abnormal areas invisible to the naked eye may be seen, guiding any
further biopsies, or treatment. A more extensive biopsy under anesthesia may include a
circular cuff or the cervix (cone biopsy) or even a hysterectomy in extensive cases (see
below).
Please remember, however, that smear tests are the subject
of some controversy because the results are not always accurate. The cervix is subject to
minor changes at various times, some of which may be interpreted in a smear test as being
abnormal. Remember also that the smear test itself has been known to be taken improperly
and thereby produced unreliable results.
return to top
Conventional
Treatment
Pre-invasive cancer detected with the Pap smear can often be
successfully treated with surgical removal, freezing, burning, or lasers. These techniques
can be done under local anaesthetic except when the tissue area is extensive and, in some
cases, a hysterectomy may be advised. The more invasive cancers will require hysterectomy
of a more extensive nature, with removal of surrounding lymph nodes and other sites of
likely spread and there are times when the ovaries may also have to be removed.
Radiation is the usual treatment for more advanced cervical
cancers, and is used by some even in the early cancers as an alternative to surgery. A
unique aspect of radiation therapy for this disease is the implantation of radioactive
substances within the uterus and cervix, allowing higher doses to the tumour while largely
sparing surrounding healthy tissue. This is generally used along with standard external
radiation.
Advanced and disseminated cervical cancer are sometimes
treated with drugs such as methotrexate, bleomycin, platinum and others.
Prognosis for pre-invasive cancers or pre-cancerous changes
using conventional medicine is considered to be good; those cancers which are invasive
only within the cervical tissue are estimated to be curable in over 90% of cases. But
where cancerous tissue extends even just to the immediately surrounding areas, the
prognosis is only approximately 55% and those which have affected the other pelvic organs
drop to about 32%.
As with other medical procedures, there is some controversy
surrounding not just the smear test (see above), but also the treatments themselves.
The Controversy - There are five main possible results from
a smear test: -
1. Inflammatory Changes - an inflammation caused by
bacteria, viruses, etc. and creating cell changes.
2. CIN 1 - Mild dysplasia: Abnormal cell changes in the bottom third or less of the
covering of the skin of the cervix.
3. CIN 2 - Moderate dysplasia - Cell changes in the bottom third to two-thirds of the
epithelium.
4. CIN 3 - (a) Severe dysplasia - Cell changes in a minimum of two thirds of the
epithelium but not the whole layer.
(b) Carcinoma-in-situ - Cancer cells in the epithelium or surface layer of the cervix.
5. Cancer - micro invasive - first stage of more serious cancer. Cancer cells shown below
the epithelium of the cervix into the deeper tissues.
It is important to note that not all cases of CIN 1
and 2 develop into cancer and, even with more severe changes in CIN 3, it has been
reported that only 50% will go on to become cancerous if they remain untreated. (1)
However, as with many medical procedures, there are risks
associated with the aforementioned treatments. For instance, cone biopsies can leave
fibrosis (scarring), weaken the cervix, and make subsequent labours more difficult. Other
treatments may damage the cervix walls and lead to more painful period pains. It is always
advisable to be fully informed of all that a treatment entails before choosing which
treatment might be best for you and these can always be discussed with your doctor.
Remember also, that conventional medical procedures focus
on the symptom, in this case, eradicating the abnormal cells or cancerous growth. They
generally ignore the underlying causative factors, especially diet, lifestyle and
emotional aspects. Fortunately there is increasing clinical, epidemiological and emperical
research revealing that alternative therapies may significantly help in the treatment and
prevention of cervical dysplasia/cancer.
Footnotes:
(1) Here's Health February 1994
return to top
|
