Sunday December 2, 2007 WOMEN'S WORLD BY Dr NOH ASHIKIN MOKHTARRegular Pap smears should be a must – if detected early, cervical cancer is one of the most successfully treatable cancers.
IN my last article, I wrote about cervical cancer, which is the second most common cancer among women in Malaysia. About 99% of all cervical cancers are due to the human papillomavirus (HPV). Cervical cancer occurs when a human HPV infection causes abnormal cells to develop in the cervix and turn into cancer. A woman will not have any signs or symptoms when she is infected with HPV, or during the early stages of cervical cancer.
However, HPV infections can be picked up early and treated before cancerous cells develop. I hope that I have convinced readers about the importance of going for regular Pap smears.
Women between the ages of 35 and 55 are more commonly diagnosed with cervical cancer than any other age.
If it is detected early, cervical cancer is one of the most successfully treatable cancers. In the United States, the cervical cancer death rate declined by 74% between 1955 and 1992, in large part due to the effectiveness of Pap smear screening. The death rate continues to decline each year.
What’s a Pap?
Despite its funny name (Pap comes from a Greek name, Georgios Papanikolaou, who invented the test 50 years ago), the Pap smear plays an incredibly important role in preventing cervical cancer. The beauty of it is that it is simple, affordable and effective.
A Pap smear is a test that checks for changes in the cells of your cervix. The cervix is the lower part of the uterus that opens into the vagina. The Pap test screens for pre-cancerous and cancerous changes in the cervix, although it does not actually diagnose cervical cancer.
Your gynaecologist will use a metal or plastic instrument to open your vagina, then lightly scrape a sample of mucous and cells from your cervix. This sample will be smeared onto a microscope slide and sent to the laboratory to be inspected for abnormalities.
Every woman who is sexually active should have regular Pap smear tests. You should have a Pap test as early as two years after you start to be sexually active. The Pap test may continue to be done even beyond the age of 65 years, depending on your risk factors and your lifestyle.
Making Pap tests better
The best time to schedule your Pap smear is five days after your menstrual period stops. Avoid sexual intercourse, and do not use douches, vaginal medications or lubricants for at least two to three days before the test.
The Pap test that we have been using for the past 50 years has certainly been very effective. But now, the technology has improved to make the test more sensitive.
This new technology (using liquid based cytology) improves on the preparation of the smear by preserving the collected cells in a special fluid. With this method, the cells are less likely to be obscured by blood, mucous and inflammation.
Even though Pap tests, especially with this new technology, are very effective, women and their doctors should be aware that they are not the be-all and end-all.
Firstly, a normal Pap test doesn’t necessarily mean that there is no cancer. If you have abnormal vaginal bleeding and watery or foul-smelling discharge, you should not rely on a Pap test alone, but ask for a diagnostic test.
Secondly, an abnormal Pap test does not necessarily mean cancer either. Your doctor will need to confirm with diagnostic tests like colposcopy and biopsy.
Confirming the diagnosis
The two most common diagnostic tests used to confirm cervical cancer are colposcopy and biopsy. In a colposcopy, the doctor looks at the cervix through an instrument called a colposcope. This test is not painful and has no side-effects.
A biopsy is when your doctor removes a sample of cervical tissue to see whether cancer cells are present. This is the only way to confirm whether you have pre-cancer or true cancer. A biopsy may require you to have some form of anaesthetic.
If abnormal cells are identified during these tests, your doctor may recommend several different methods of treatment.
Treating cervical cancer
Don’t worry, a positive diagnosis of cervical cancer does not mean that you should lose hope. There are several methods available to treat the cancer, or remove or destroy as much of it as possible.
The three main types of treatment are surgery, radiation, and chemotherapy. Sometimes, the best approach is to use two or more of these methods.
Surgery – There are a few kinds of surgery for cervical cancer. Your doctor will help you decide which surgical option is most suitable. I will briefly discuss a few of these.
Firstly, there is cervical cryosurgery, which is a method of using extreme cold to freeze areas of the cervix so that abnormal cells are destroyed. This approach is used to treat pre-invasive cervical cancer.
There is also laser surgery, in which a laser beam is used to burn off cells or remove a small piece of tissue from the cervix for study. Like cryosurgery, laser surgery is only used for pre-invasive cancer, not the invasive form.
Some forms of surgery require part of the cervix (cone biopsy of cervix), the uterus or other organs to be removed. A hysterectomy is a procedure that removes the uterus.
In a radical hysterectomy and pelvic lymph node dissection, the uterus as well as the tissues next to the uterus, the upper part of the vagina, and lymph nodes from the pelvis are removed.
The most radical form of surgery that may be required is pelvic exenteration, where the organs and tissues mentioned above are removed, as well as the bladder, vagina, rectum and part of the colon. This procedure may be recommended if your cancer returns after earlier treatment.
Radiation therapy – Radiation therapy uses high-energy rays to kill or shrink cancer cells. The radiation may be directed from outside the body or from radioactive materials placed directly in the tumour.
Chemotherapy – Chemotherapy uses special drugs to kill cancer cells, via injection or oral therapy. Women often worry about chemotherapy because of the side-effects, but there are now other kinds of medications to prevent or control the side-effects.
The survival rates for cervical cancer are promising. About 92% of women diagnosed with early invasive cervical cancer live at least five years after their cancer is found. In fact, many of these women live much longer than five years.
It is rare that we get to tell people about a screening test that is so simple and reliable in preventing cancer. The Pap smear is one such test – so every woman should protect herself from cervical cancer by scheduling a Pap test with her gynaecologist as soon as possible.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). She is co chairman of Nur Sejahtera, Women & Family Healthcare Program, Ministry of Women, Family and Development. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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