Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the birth canal. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing this cancer.

According to the World Health Organization, cervical cancer is the second most common cancer in women living in less developed regions, with an estimated 445,000 new cases in 2012.

In the Uganda over 4000 women are diagnosed with cervical cancer annually.

In 2012, approximately 270 000 women died from cervical cancer; more than 85 per cent of these deaths occurring in low- and middle-income countries.

Risk factors

Multiple sexual partners, early sexual activity, other sexually transmitted infections (STIs), weak immune system, smoking.

When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells. It takes 15- 25 years for the virus to become cancerous

Symptoms

Early-stage cervical cancer generally produces no signs or symptoms. More-advanced cervical cancer include: abnormal vaginal bleeding after intercourse, between periods or after menopause, watery, bloody vaginal discharge that may be heavy and have a foul odor, pelvic pain or pain during intercourse

Screening

Most guidelines suggest that women begin screening for cervical cancer and precancerous changes at age 21. The tests include:

  • Direct visualization of the cervix after application of some chemicals on it. This is no longer used in developed countries
  • Pap test where by cells from the cervix are obtained, which are then examined in a lab for abnormalities.
  • HPV DNA test which is a better option for women aged 30 years and older, or for younger women with an abnormal Pap test.

Diagnosis is confirmed by getting samples from the cervix and examining them under a microscope for abnormal cells (biopsy)

After diagnosis, the cancer is staged from stage I to IV basing on its extent of spread to other surrounding structures

Treatment involves use of chemotherapeutic drugs, radiation or surgery depending on the condition of the patient with regular checkups. Palliative care may be added to improve the quality of life of the patient

A young African woman receiving the HPV vaccine
A young African woman receiving the HPV vaccine

Prevention of cervical cancer can be achieved by:

  • Vaccination for girls aged 9-13 years as this is the most cost-effective public health measure against cervical cancer
  • Education about safe sexual practices, including delayed start of sexual activity
  • Promotion and provision of condoms for those already engaged in sexual activity
  • Warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
  • Safe Male circumcision (SMC).