Photo by Anna Tarazevich

Overview

When the heavy bleeding started, she never imagined it could be anything worse. Mrs. B, a 28-year-old mother of two has had a heavy bleeding in the past, some of which she took pills for, others went on their own. Her gynaecologist attributed her last heavy flow to an anovulatory cycle, something to do with her ovaries not releasing an egg for the month. It was nothing to worry about, she had said. So when this came, she didn’t think much of it until it refused to go.

Mrs. B went to the hospital where she had several tests done. Full blood count, ultrasound scan, urinalysis. Nothing extraordinary was found, safe for an unusual finding in her urine. Her PCV, which indicates the blood level in her body, was normal. The abdominal ultrasound done didn’t show anything abnormal. Only the urinalysis discovered red blood cells. The doctor told her not to worry but recommended she go for a biopsy, where a tiny cut of her cervix will be taken and viewed with a microscope. The biopsy report came back and the unimaginable had happened: she has cervical cancer 

For many people like Mrs. B., cervical cancer is a strange thing. Cancer is common. It’s on the news. Everyone talks about, but not much or anything at all is ever said about cervical cancer. Or not much that she had heard or read. All she knew about were breast cancer, lung cancer, and prostate cancer. Here she was having to deal with a cancer she's never heard about.

So what’s cervical cancer?

Cervical cancer is the cancer of the cervix, the lower, narrow end of the uterus that connects to the vagina. Around 660,000 women were newly diagnosed with cervical cancer in 2022, making it the fourth most common cancer in women globally. 

Other notable statistics about cervical cancer include:

•  It accounts for death every two minutes
• Nearly 22.5% of these deaths occur in Africa
• About 8% of the cancer is associated with infections with high-risk strains of human papillomavirus (HPV) 
• More than  75,000 new cases and close to 50,000 deaths are reported annually in sub-Saharan Africa
• The World Health Organization projects that by 2030, cervical cancer will claim the lives of more than 443,000 women worldwide, with almost 90% of these fatalities in sub-Saharan Africa. 

This surge in cervical cancer cases threatens to reverse the advancements made by African women in reducing maternal mortality and enhancing life expectancy. Nevertheless, cervical cancer is a largely preventable non-communicable disease, with effective strategies available for primary (vaccination), secondary (early detection), and tertiary (management of diagnosed cases) prevention. 

What are the causes of cervical cancer?

 The primary cause of cervical cancer is a long-lasting infection with specific types of human papillomavirus (HPV). HPV is a transmitted virus that spreads through sexual contact. 

It is estimated that at least half of sexually active individuals will contract HPV at some point in their lives; however, only a small percentage of women will develop cervical cancer. 

Who's at risk for cervical cancer?

Cervical cancer is often associated with identifiable risk factors. Some of these factors can be modified, while others are beyond your control. 

Here are some risk factors you can control:

• Sexual intercourse at an early age: 
• HPV infection
• HIV infection
• Weakened immune system
• Multiple pregnancies
• Long term use ofirth control pills
• Smoking: Cigarette smoking has been linked to a heightened risk of cervical cancer.

While these risk factors re controllable, some are not.Example of an uncontrollable risk factor:

• Family history
• Age 

What are the symptoms of cervical cancer? 

In its early stages, cervical cancer typically does not present any symptoms, making early detection challenging. Symptoms often emerge only after the cancer has progressed. 

When early-stage cervical cancer symptoms do manifest, they may include:

• Irregular vaginal bleeding or heavier menstrual periods
• Vaginal bleeding after menopause
• Vaginal bleeding post-intercourse
• Unusual vaginal discharge that may be watery, foul-smelling, or blood-stained
• Pelvic pain or discomfort during intercourse

As cervical cancer advances, symptoms may encompass those of early-stage cancer, along with:

• Painful or difficult bowel movements
• Bleeding from the anus during bowel movements
• Painful urination 
• Blood in the urine
• Persistent lower back pain
• Swelling in the legs
• Abdominal pain
• Fatigue

These symptoms can also be found in other conditions other than cervical cancer. Consulting a Doctor is essential for an accurate diagnosis. Delaying treatment for cervical cancer due to ignored symptoms can lead to less effective management.

Stages of cervical cancer

The staging of cervical cancer indicates the degree of spread.

There are 4 stages of cervical cancer progression and they are:

• Stage I: Cancer is confined to the cervix.
• Stage II: Cancer has spread beyond the cervix and uterus but not to the pelvic wall or vagina.
• Stage III: Cancer has spread to the lower vagina and possibly the pelvic wall and nearby lymph nodes.
• Stage IV: Cancer has spread to the bladder, rectum, or other distant parts of the body.

Preventing cervical cancer

HPV vaccine

The HPV vaccine is designed to protect against the specific strains of HPV responsible for nearly all cervical cancer cases. Gardasil 9 is effective against nine HPV types, which together account for about 90% of cervical cancers. For optimal efficacy, the second dose should be administered six to twelve months after the first.

Receiving the HPV vaccine does not eliminate the need for regular cervical cancer screening. Women vaccinated against HPV should have their first screening at age 25 and continue every five years thereafter.

How is cervical cancer diagnosed?

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Cervical cancer develops slowly over many years, hence the need for regular Pap smear ( The Pap smear is a procedure that screens for cervical cancer by collecting cervical cells from the lower part of the uterus that connects to the vagina. It can also reveal precancerous changes in these cells, enabling early intervention when required.

In this test, a healthcare provider uses a speculum to gently open the vagina, providing access to the cervix. They then collect cell samples using a soft brush or spatula, which they preserve in a solution and send to a laboratory for analysis. The entire process typically takes just a few minutes and may cause slight discomfort, but it is usually not painful.) To detect early signs of cancer, if positive, a biopsy is ordered.

The biopsy could be any of the following:

• Colposcopic biopsy
• Loop electrosurgical excision procedure (LEEP)
• Cone biopsy 
• Endocervical curettage 
• Cold knife cone biopsy 

An HPV DNA test too can be ordered.

Should the biopsy test come out as positive further investigations would be required to determine if the cancer has spread (metastasized) and to what extent.

The other test include: 

• Renal function test
• Liver function test
• X-ray of bladder, bowels, intestines
• Urine Test
• Ultrasound 

Treatment

Treatment of cervical cancer depends on:

• The stage of the cancer
• The size and shape of the tumor
• The woman's age and general health
• Her desire to have children in the future

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are surgical ways to do this without removing the uterus or seriously damaging the cervix, so that a woman can still have children in the future.

The following treatment options are available depending on the stage of the cancer:

• Laser therapy 
• Cryotherapy 
• Hysterectomy 
• Radiation therapy 
• Loop Electrosurgical Excision Procedure(LEEP)
• Chemotherapy 

Support Groups

Joining a cancer support group can provide emotional relief and connection with others facing similar challenges. Sharing experiences can help alleviate feelings of isolation.

Conclusion

Early detection of cervical cancer is key to effective treatment, making regular Pap smear screenings essential. The HPV vaccine, now available in three different versions, provides crucial protection against the virus that often leads to cervical cancer. Staying on top of both vaccinations and screenings is important for reducing risk. Furthermore, involving family and connecting with support networks can greatly support your journey through treatment.