PRECANCEROUS STATE – PAP SMEAR
We will discuss the precancerous stage of cervix cancer.
What is the Cervix?
The cervix is the part of the uterus that connects the upper part of the uterus (the womb) and vagina.
What is Cancer?
Cancer develops when cells in an area of the body grows abnormally. The body cells growth is normally controlled and limited to particular area. Cancer cell growth, if not controlled, spreads to other areas of body and causes damage.
What is Pre-cancer?
These are cell abnormalities that have potential to progress to cancer. Pre-cancerous lesions are not cancer. Pre-cancerous lesions can return to normal but can progress to cancer. The cancer can develop after 10-20 years or as short as 2 years.
What causes pre-cancer and cancer of the cervix?
The main cause of cervical cancer is a virus called Human Papilloma Virus (HPV).
What is Human Papilloma Virus (HPV)?
HPV are a large group of viruses that are linked to abnormal cell growth in humans. There are over 100 types of HPV but type 16 & 18 are identified as main cause of cervical cancer in 99.7% of cases.
HPV is transmitted skin to skin genital contact. Penetrative intercourse is not necessary to become infected. Up to 80% of sexually active women will be infected with HPV at some point in their lifetime. Fortunately most of HPV infections are clear up naturally and are effectively destroyed by body own defences (immune system). Persistent infection with cancer causing HPV types is the necessary cause of cancer of the cervix.
What are the pre-disposing factors?
-HPV type 16 & 18 are common with
-Early sexual intercourse
-Multiple sexual partners.
-Recurrent sexually transmitted diseases.
-Hereditary / Immune status
-Folic acid deficiency
What are symptoms of pre-cancer?
There are rarely any symptoms directly due to pre-cancer stages and that make it dangerous.
Checking for pre-cancer
Cervical screening programs target the early detection, diagnosis and treatment of HPV associated precancerous lesions that may develop into cancer. Various methods are available.
1) Pap test (Cervical Smear)
This is a collection of cells taken from the surface of cervix and tested in laboratory for presence of abnormalities. When abnormal cells are detected the Pap smear may be repeated, also HPV DNA testing, colposcopy (examination of the cervix through magnify devices) or possible biopsy (obtaining a tissue or analysis in the lab) are steps taken by a gynecologist. Abnormal biopsy may be reported as cervical intraepethelial neoplasia CIN. Neoplagia means an abnormal growth of cells.
2) Visual inspection with Acetic acid / venegar (via).
3) Visual inspection with Lugoli iodine (VILI)
Preventing HPV infection
Prevention of infection with HPV reduces rate of precancerous by 90%. Prophylactic vaccine is available for optimal prevention of HPV infection; vaccination should be given prior to sexual contact. Young girls and women will benefit.
Treatment of Pre-Cancer
Most abnormal cells of the cervix will eventually go away. Therefore mild places are closely monitored. However, severe abnormal cells are removed to avoid cervical cancer developing by tumor methods.
1) Cone Biopsy – removal of small conical section of cervical tissues for analysis.
2) Loop Electrosurgical Ection Procedure (LEEP) – electrical current passed through a wire loop is used to remove suspect tumor.
3) Laser Carbon Dioxide laser uses a tiny beam of light to vaporize (turn into steam) the abnormal cells.