CERVICAL CANCER

While the word Cancer conjures up a frightening picture for everyone, the idea of Cervical Cancer is a particularly alarming one for many women, even though a majority of such cases are cured and the disease can be halted in its early stages. Why don't women seek help sooner? It is either the embarrassment or fear of the smear test that seems to prevent women from going for a regular check. In order to allay those fears, we shall address some of the common questions that are asked about the Pap smear test.
WHAT IS A PAP SMEAR?
The Pap smear test is a simple procedure, which shows any changes in the cells of the cervix (opening of the womb) which might develop into cancer. It can also detect cancerous cells when cancer has actually developed, so that early treatment can be given to halt the spread.
WHY SHOULD WOMEN HAVE A SMEAR?
Quite simply, regular Pap smear tests could save your life. Cancer of the cervix is one of the commonest cancers in women. Having regular Pap smears can detect pre-cancerous cell changes, which are treatable. Early detection of these changes can help prevent and successfully cure cancer of the cervix.
WHAT ARE THE SYMPTOMS OF THE CANCER OF THE CERVIX?
The most common symptom is bleeding after intercourse. Bleeding in between periods and after menopause is also abnormal and should be reported to the doctor. Presence of excessive vaginal discharge at any age should also be investigated.
WHAT CAUSES CERVICAL CANCER?
The cause of cervical cancer is not clearly known. The incidence of the disease appears to rise in women who marry at a younger age, have their first baby at a younger age or have more children. This is thought to be because the cervix is more vulnerable in younger women when it is not fully developed, and just after pregnancy.
Genital infections, such as human papilloma virus (HPV) infection, which causes genital warts, increase the risk of cancer of the cervix. Exposure to synthetic hormones (DES or the pill) is another risk factor for cervical cancer, as it increases the area of the cervix vulnerability to HPV. Women using the barrier methods of contraception are less likely to get cancer of the cervix. Smoking also contributes to a higher incidence of cervical cancer.
WHO SHOULD HAVE A SMEAR?
All women who are or have been sexually active should be tested atleast once every two years. Pap smear testing should begin within a year of the first coital exposure. Although cervical cancer is increasing in younger women, most cases occur in those over the age of 40. The disease can take up to 10 years to develop, and it is recommended that women continue to be tested until they are 65 years of age.
WHERE CAN I HAVE A PAP SMEAR TEST?
You can choose who does your pap smear test. Most gynaecologists will perform the pap smear test at the time of a routine gynaecological check up. If you have recently had a baby, your post-natal check may also include a smear test.
HOW IS A PAP SMEAR PERFORMED?
The smear test is a very simple procedure taking less than two minutes. It can be slightly uncomfortable but is not painful. Try to remember that the doctor is used to taking smears and understands your embarrassment about the procedure.
Once you are lying comfortably on the couch, the doctor will gently insert an instrument called a speculum into the vagina to hold the vaginal walls open. A small wooden spatula (like an ice cream stick) is then used to take a sample of the cells from the cervix. The cells are spread onto a glass slide and sent to the laboratory for examination under a microscope.
HOW IS THE PAP SMEAR EVALUATED?
The cells obtained during the smear test are removed from the surface of the cervix. This surface covering is called epithelium and it is 12-24 cells thick. It rests on a basement membrane, beneath which are the deeper tissues that make up the substance of the cervix. The cells of this surface epithelium progress in shape from large round cells at the basement membranes to flat cells at the surface. They also show a variation in their nuclei as the deeper cells have a large nucleus that becomes progressively smaller and compact as the cells approach the surface.
When there is a disorder of the normal progression of cells from the deeper to the outermost layer of epithelium, then that is called Cervical Dysplasia. If this disorder or maturation is limited to the one-third thickness of the epithelium, it is a Mild Dysplasia; if two-third of the thickness then a Moderate Dysplasia and if full thickness is involved, then a Severe Dysplasia. If the outer cells look the same as those along the basement membrane, then that is a full thickness disorder and is called carcinoma-in-situ (CIS). This is a pre-malignant condition and can become cancer if not treated. It is thought that there is a progression from mild to moderate to sever Dysplasia and it may take years for this progression to develop into cancer. An early detection and treatment can therefore successfully limit the disease progression. The more modern terminology used for these dysplastic changes is Cervical Intraepithelial Neoplasia(CIN). The term Carcinoma-in-situ has been dropped since the word carcinoma means cancer and this is not a cancer.
WHAT HAPPENS AFTER THE PAPSMEAR TEST?
You will be informed about the result of your pap smear as soon as the report is available. Approximately, one in ten tests show some abnormality and need a follow-up action. Your doctor will advice you if any treatment is required.