If caught early, cervical cancer is treatable

Cervical cancer is the third most common cancer among women in the world. The cervix is the lower part of the uterus that connects to the vagina. A woman, therefore, suffers from cancer of the cervix when the cells around the lower part of her uterus grow uncontrollably. 

Dr Noleb Mugisha, an oncologist at the Uganda Cancer Institute, Mulago, says globally, there has been a high mortality rate from cervical cancer due to limited access to preventative measures in low-and middle-income countries. Therefore, the cancer is often not identified until it has advanced.

At 56, Christine Nambuya, a mother of two is battling stage IIB cervical cancer. In November 2019, she started feeling weak all the time and then one morning in June 2020, she woke up in a wet bed.
“I did not have any bladder control issues and I do not remember having the urge to urinate at night. I was confused since I thought I had wet my bed. How had old age caught up with me so quickly?” she asks.

The next night, she put a towel on top of her bedsheet and the next day, she realised that what she thought was urine was instead a clear watery substance. The discharge continued as she gradually became weaker. 

Nambuya went to Mbale Regional Referral Hospital, where she was referred to the family planning unit. Since the doctors suspected she could have cancer, she was reviewed by a gynaecologist who recommended a biopsy and the results confirmed she had cervical cancer.

Signs
Joyce Laker was diagnosed with cervical cancer in January 2011. She felt a mass, accompanied by fatigue and a fever. She thought she was pregnant and at the hospital, the doctors recommended total bed rest.

“I followed this advice religiously but two weeks later, I started bleeding. I called my husband and told him I had had a miscarriage. However, the bleeding continued throughout the day,” she recalls.
Because she had become so weak, she was taken back to hospital. The doctors gave her blood and stopped the bleeding. They also recommended a biopsy, whose results she would get two weeks later.

“The results confirmed I had stage 1 cervical cancer. I was only 29 years old and had just graduated from university the previous year. I felt like the world had come to an end,” she says.

Unlike Laker whose cancer was diagnosed early, Dr Ndozire  Katali, a gynaecologist at Mildmay Hospital, says about 80 percent of women go to hospital when it is too late; usually in the third or fourth stage of the disease when treatment options are less effective.

Causes
Cervical cancer is caused by the Human Papilloma Virus (HPV) type 16 and 18, which also causes vulva, vagina, penis, anus, mouth, and throat cancers. The virus affects at least half of all sexually active individuals and in women, overtime, it causes changes of cells in the uterus, leading to cancer.

The virus is sexually transmitted through unprotected sexual intercourse or contact with an infected person.

“Anyone who engages in unprotected sexual intercourse risks getting HPV infection. Although HPV infection is considered a sexually transmitted infection (STI), it can also be spread through skin to skin genital contact,” Dr Mugisha warns.

In a woman with a strong immunity, it takes 15 to 20 years for cervical cancer to develop and only five to 10 years in women with a weakened immunity, such as those with untreated HIV infection.

“When the body is exposed to HPV, the immune system tries to fight it. You, therefore, develop cancer when the body is unable to fight the virus causing the cells in the cervix to undergo changes,” Dr Ndozire says.

Who is at risk?
Those at risk include women with multiple sexual partners, those who smoke, those that give birth to many children; since many changes happen to the cervix when one gets pregnant. 

Girls who start engaging in sexual activity at an early age, women whose immunity is suppressed, especially those with HIV, diabetes, other cancers and diseases that weaken the immune system are also at risk. 

Symptoms 
A number of women may have the virus and it will continue causing changes in the cervix but without any symptoms, especially in the early stages. However, as the cancer starts to become invasive, spreading to the surrounding tissues, the following signs and symptoms usually occur. 

“The most common sign of cervical cancer is unusual vaginal bleeding. If a woman is experiencing bleeding in between menstrual periods, after sexual intercourse or sudden bleeding after menopause, it could be an indicator of cervical cancer and should seek medical attention as soon as possible,” Dr Mugisha advises.

Normally, women experience small amounts of clear discharge without colour or odour. At the onset of cervical cancer, many may experience a bloody, foul-smelling discharge.

Painful intercourse is another uncomfortable side effect of cervical cancer. Although this can be caused by many other factors, it should never be ignored since it is usually linked to conditions that require immediate medical attention.

“Pelvic pain, cramping and aches during a menstrual cycle are normal but when the pain lasts, happens frequently, or becomes more intense, it could be a symptom of an underlying problem, probably cancer and you need to see a doctor. When the cancer has advanced, one may feel like they have a mass in the pelvis,” tips Dr Ndozire.

Diagnosis 
There are several screening methods that will help detect the smallest changes in the cervix that might lead to cervical cancer. These include the Visual Inspection with Acetic acid (VIA). Here, you get immediate results, which may be positive or negative. 

Once you test positive, Dr Ndozire says, it is not a confirmatory test that you have the cancer but rather, that your cervix is undergoing changes that need to be monitored or have further tests done.
During a Pap smear test, the gynaecologist gets some cells from the cervix which are analysed in the laboratory. It may take about a week to get these results.

A digene HPV DNA test is a bit expensive but gives a clear picture of what type (strain) of virus one has and the appropriate treatment.

Prevention 
To reduce your risk of getting cervical cancer, Dr Ndozire advises young girls to abstain from sex because during adolescence, the cervix is not fully grown and is still undergoing some changes. This is when the cervix is most prone to HPV, hence high chances of getting cervical cancer. 

The nicotine and tar contained in cigarettes affects cells in the body, which makes it difficult for the immune system to fight HPV.

“Women and girls can be vaccinated against HPV. Currently, in Uganda, there are programmes where girls aged between nine and 21 years are vaccinated for the common strains of the virus. Vaccination helps to boost the body’s immunity to fight against HPV,” Dr Ndozire says. 

If you are already sexually active, there are high chances that you have already been exposed to HPV and the vaccination may not be of much help but you can go for routine screening. This will help with early diagnosis which significantly increases one’s chances of beating the disease through treatment.

Every woman above 21 years of age should get screened for cervical cancer every three years. Those with HIV, diabetes and other disease conditions that cause immune suppression should get screened every year. This enables detection of the smallest changes in the cervix and treatment before it is too late.

Treatment
Depending on the stage of the cancer, treatment options include chemotherapy, radiotherapy and surgery which are all available at the Uganda Cancer Institute.

According to the World Health Organisation, more than 342,000 deaths occurred in 2020 due to cervical cancer and women living with HIV are six times more likely to develop the cancer compared to those without. This cancer is the leading cause of gynaecologic cancer death globally.