Dr Noor Azmi Mat Adenan Consultant Gynaecologist & Gynae-Oncologist
Prevention of cervical cancer : the facts .
Madam X , a 45-year old married executive with 3 school-going children . She was a healthy and busy lady , presented with several months of prevaginal discharge . She came forward only after the discharges started to be mixed with blood and more offensive in nature . Examination revealed a large fungating cervical lesion , filling up the upper vaginal which histological biopsy confirmed to be grade 3 squamous cervical cancer of advanced stage . She also had hydronephrosis on one of her kidneys due to ureteric obstruction . Her ureter was stented , and she was treated with chemoradiation . Her symptoms subsided but several months after completion of her treatments , she developed offensive foul smelling fecal material per vaginal , due to fistula development . Surgery to divert the bowel content was performed needing her to use colostomy bag . She had recurrence of her cancer a few months later , was treated with chemotherapy but succumbed to her disease whilst on treatment , barely 12 months from initial presentation . She never had any Pap smear in her life .
The above scenario was a real case of mine with typical presentation and progression of cervical cancer cases . It is quite a common disease amongst Malaysian women , ranked as third highest after breasts and colon cancers . The incidence is more in women aged 35 to 50 , at the peak of their career . Like any malignancy , the journey of patients with advanced cases is very protracted , with huge loss of time , financial , physical / emotional trauma and chaotic family life .
High risks Human Papilloma Virus ( hrHPV ), especially subtypes 16 and 18 , have been implicated in 80-90 % of cervical cancers and are usually contracted through sexual activities . It is a common infection , afflicting nearly 80 % of sexually active women , more so in those with risky sexual attitudes . Fortunately , 90 % are transient , eliminated by our natural immune system . The remaining 10 %, are called persistent infection . The virus induces a series of cellular changes named as pre-cancerous lesion ( CIN ). Individuals with reduced immunity ; presence of sexually transmitted diseases and smoking are known to favour persistent infection . The CIN states may then progress to either the squamous or adenocarcinoma types of cervical cancers . It also causes other cancers such as vaginal , anal , oral and penile cancers at a much lower frequency .
Prevention of cervical cancer .
Total avoidance of sexual activities means zero risks of exposure but interestingly , penile vaginal penetration is not mandatory in its transmission . It is transmissible via fingers or device , contaminated with genital fluid of infected individual . Although it is almost impossible to avoid exposure , prevention of persistence infective state is achievable .