I had attended a forum about cervical cancer last August 29, 2008. Held at Mi Piace, The Peninsula Manila, bloggers were introduced to the facts about cervical cancer, some grim statistics, and some hope on preventing this cancer.

Dr. Ricardo Manalastas, professor at the UP College of Medicine and chief of the Infectious Disease Service in the Department of Obstetrics and Gynecology of the Philippine General Hospital, taught us the basics of this disease and told us what we can do about cervical cancer.

This cancer all begins with the human papillomavirus (HPV). It is a common virus, and about 100 types, most of which are harmless. They do not show noticeable symptoms and will go away on their own. About 30 of these types infect the male and female genital areas. Even if there are no signs or symptoms, it can be transmitted to others.

High-risk types of HPV include types 16, 18, 31, and 45. If infection by these types persists, it can lead to cervical cancer and other cancers of the genital area.

Cervical cancer develops in the cervix, the part that connects the womb and the vagina. It develops when abnormal cells in the lining of the cervix begin to multiply out of control in response to HPV infection. Abnormal cervical cells can gather to form a lump called a tumor.  Benign (non-cancerous) tumors do not spread and usually are not harmful.  Malignant (cancerous) tumors, however, spread from their sources and grow into life-threatening cancer.

A WARNING ON THIS PICTURE: Graphic image. I have blurred this image. To see the clear image, clickity-click. You have been warned.

In 2002, there were 6,000 new cases of cervical cancer reported here in the Philippines, and 4,349 deaths due to this cancer were reported. Worldwide, cervical cancer is the second-most common cancer affecting women and the second-leading cause of cancer death in women.

Women who are in their 40s and 50s tend to get cervical cancer. Women in poor communities are in greater risk because they do not get to undergo cervical cancer screening like Pap smear. A Pap smear is a simple test that can detect abnormal or cancerous cervical cells. Dr. Manalastas emphasized on yearly Pap smear tests, since this could lead to less cervical cancer deaths. And since precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms, a Pap test is needed detect cervical pre-cancers or cancers at a stage when they can be treated most effectively.

As the cancer progresses, one or more of the following symptoms may be noticed:

• Abnormal vaginal bleeding:
  • Bleeding that occurs between regular menstrual periods
  • Bleeding after sexual intercourse, douching or a pelvic exam
  • Menstrual periods that last longer and are heavier than before
  • Bleeding after menopause
• Increased vaginal discharge
• Pelvic pain
• Pain during sexual intercourse

There are several ways to treat cervical cancer. It can be treatable, but it can get expensive at the advanced stages of the cancer. For pre-invasive stage 0 (when the cancer has affected only the outer layer of the lining of the cervix), treatment may include the following:

• Laser surgery uses a laser beam to destroy abnormal cells.
• Cryosurgery destroys cancerous and pre-cancerous lesions by freezing them.
• Loop electrosurgical excision procedure (LEEP) uses a thin wire loop (through which an electrical current is passed) to cut away an area of abnormal cells from the cervix.
• Conization surgically removes a cone-shaped piece of tissue from the cervix.

For stages 1-4 (when the cancer has penetrated into the cervix and possibly to other tissues and organs), treatment may include the following:

• Radiation uses high-energy rays to shrink tumors by destroying the cancer cells’ ability to reproduce.
• Chemotherapy uses anticancer drugs which reach all areas of the body to kill cancer cells, including those that have spread to distant organs.
• Hysterectomy can be performed two ways, depending on the extent of the cancer: 1) Simple hysterectomy is the removal of the cancer, the cervix and the uterus.  2) Radical hysterectomy involves the removal of the cervix, the uterus, part of the vagina and lymph nodes in the area.

Cervical cancer can be prevented if Pap tests are administered regularly. There is also a vaccine that prevents cervical cancer, but it can be very expensive.

Dr. Manalastas believes that the best form of prevention is keeping oneself informed. I agree.