Cervical Cancer

Topics: Human papillomavirus, Cancer, Cervical cancer Pages: 5 (1613 words) Published: September 2, 2013
75,000 or more of our countrywomen will die from this disease every year. Hence India accounts for 26.7% of the incidence and 27% of deaths due to this disease world-wide. This disease is truly a scourge for our countrywomen. Cervical cancer can be detected in early or pre-invasive stages with the help of screening, thus greatly reducing the morbidity and mortality. In developed countries with an organized Pap’s smear screening program on a national level, the incidence and mortality from cervical cancer has been dramatically reduced. However, screening of all women in India is likely to remain an unrealized goal due to various reasons. So far, screening has not been implemented properly and has had no impact on the incidence or death rates in India. Hence some other preventive intervention must be considered. It has been established that infection with high risk human papillomavirus type is a necessary cause of cervical cancer in almost 100% cases. HPV type 16 & 18 are responsible for 70% of the invasive cervical cancers. Hence a prophylactic vaccine against these HPV types will be able to provide the population wide primary prevention against the disease. This, if implemented properly, could be the more viable and practical option in a country such as ours. However, even for vaccinated persons, screening has to continue. So establishment of screening protocols and facilities for screening have to be organized.

Detection and Management of Pre Cancerous Lesions of the Carvix

1. Detection
There is as yet no organized screening programme for the country. Screening was recommended in 1984 when National Cancer Control Programme (NCCP) was launched. Subsequently programme has been revised, the last one being in 2006. However, it is recommended that women undergo periodic cancer screening based on the following criteriae. 1. Sexually active women above 30 years of age. 2. Sexual life more than 10 years. 3. More than 3 pregnancies and labour. Screening methods to be used 1. Visual inspection of Cervix with 3% or 5% acetic acid (VIA). 2. Visual inspection of Cervix with Lugol’s Iodine (VILI). 3. Pap smears from Ectocervix & Endocervix. 4. Introduce HPV testing whenever possible. 5. Introduce Colposcopy whenever possible.

2. Management
Visual inspection with acetic and (VIA) and visual inspection with Lugol’s Iodine (VILI) are 2 simple tests to detect pre cancerous lesions of the cervix. In VIA, after swabing the cervix with 3% or 5% acetic acid, pre cancerous lesions appear as a white thickned patch. It may be on the cervix or on the vagina. In VILI Lugol’s Iodine is used. Normal epithelium stains dark brown due to the glycogen content. Precancerous lesions appear unstained or as yellow patch. VILI can be performed afte VIA. Both these tests are simple and comfortable to the patient and can be per formed by para medicals. In VILI, the distinction between normal and abnormal epithelium is clearer and easier to note. It also is more acceptable to the patients as it does not cause burning since it is an aquous solution of Iodine. Acetic acid may cause temporary burning. However, VILI has lesser specificity and sensitivity than VIA. Cases undergoing VIA / VILI are Classified as: ■ ■ ■

negative positive suspicious of Cancer

The latter are cases where a frank growth or ulcer or bleeding area is seen. 1. VIA or VILI positive women about 10-15% women are likely to be tested +ve by these methods. Recommended management. 1. Careful assessment by a Doctor, preferably Gynecological check up. 2. Treat infection, anemia, nutritional deficiency and follow up. 3. Advise Pap smear test and treat accordingly. 4. Consider biopsy and treat accordingly. Some VIA cases seen as erosion after abortion or delivery may not require active treatment. 5

Detection and Management of Pre Cancerous Lesions of the Carvix

2.

Women with abnormal smears Many terminologies are used in Cytology. The following chart gives a comparative...
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