Cervical cancer is the commonest gynecological cancer in women in the developing world and the third commonest in the developed world. It has a pre-cancerous stage called cervical intraepithelial neoplasia (CIN) which can be detected via some screening tests. With early diagnosis and treatment, more than 95% of early stage of cervical cancer is curable. The average age at diagnosis of women with cervical cancer is 51 years but the pre-cancerous stage can be seen in women in their early twenties. In the United States, an estimate of more than 12,000 new cases of cervical cancers are diagnosed yearly with more than 4,000 deaths from this cancer.

WHAT CAUSES CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER?

The cause of cervical intraepithelial neoplasia (CIN) and cervical cancer is the Human Papilloma Virus (HPV) infection. There are different types of Human papilloma virus but not all affect the anal or genital regions; while some are associated with causing genital wart (type 6,11,42,43 and 44), others are associated with cervical intraepithelial neoplasia (CIN) and cervical cancer (types 16,18,31,33,45,51 etc). Human papilloma virus infection in men can cause cancer of the penis.

WHAT ARE THE RISK FACTORS FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER?

  • Multiple sexual partners (≥ 4 sexual partners in one’s lifetime)
  • High risk sexual partners (a partner with multiple sexual partners)
  • Early onset of sexual activity (<18years)
  • HIV/AIDS
  • Immunosuppression from chronic illnesses or medications
  • Cigarette smoking
  • Long-term use of oral contraceptive
  • Multiparity (multiple child birth)
  • Exposure to diethylstilbesterol in the womb (a medication used in the past to prevent miscarriage)

HOW CAN ONE GET HUMAN PAPILLOMA VIRUS INFECTION?

 Human papilloma virus is transmitted via sexual contact, this can be between male and female and vice versa. Also, men who have sex with men and women who have sex with women. The use of condoms does not offer full protection against the virus; contact with other areas not covered by the condom will result in its transmission.

WHAT HAPPEN AFTER INFECTION WITH HUMAN PAPILLOMA VIRUS?

When an individual is infected, one of these three scenarios might occur;

  1. The individual might not show symptoms, the body in the setting of a good immunity clears the infection.
  2. The virus multiply itself but does not incorporate itself to the individual’s DNA resulting in the formation of genital wart or low grade CIN
  3. The virus integrates itself into the individual’s DNA resulting in transformation that causes high grade CIN or cervical cancer.

IS CERVICAL CANCER PREVENTABLE?

Cervical cancer is a preventable gynecological cancer because it has a pre-cancer stage, this can be diagnosed by screening test and it has vaccines. It is recommended that boys and girls be vaccinated as early as 9 years to 26 years. It is most effective when the individual has not been infected with Human papilloma virus. Therefore, it is recommended to be administered before the first sexual exposure. The dosing is either the 3dosing schedule at 0, 1month and 6months or the 2dosing schedule given at 0 and between 5 to 15months. There are 3 types of vaccines available in use;

  1. Bivalent vaccine: cover for types 16 and 18
  2. Quadrivalent vaccine: covers types 6,11,16 and 18
  3. Nanovalent vaccine: covers types 6,11,16,18,31,33,45,52 and 58.

SCREENING TEST FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER?

It is recommended that screening should start for women at age 21 years irrespective of their age at sexual debut. Either using Papanicolaou (Pap) smear every 3 years for women age 21 to 29 years, Pap smear and Human papilloma virus co-testing after 30 years every 5 years or Pap smear alone. In resource limited setting, visual inspection using 3 to 5% acetic acid can be used or lugol iodine solution. For individuals with HIV/AIDS or those who are exposed to diethylstilbesterol in the womb should be screened yearly. Screening is discontinued at age 65 years after 3 consecutive negative Pap smears or 2 consecutive negative Pap smears and HPV co-testing results.

WHAT HAPPEN IF THE RESULT IS ABNORMAL?

For abnormal Pap smear, a repeat test might be requested in 6 months, HPV test might be done with the same smear sample called reflex HPV testing or further evaluation using colposcopy and cervical biopsy can be done. The option of treatment will depend on the histologic result of the cervical biopsy specimen.