Yasmin Williams - HEALTH-WISE TODAY, WE discuss cancer of the cervix (the neck of the uterus or womb). The cervix joins the top of the vagina to the uterus.
The cancer registry at the University Hospital of the West Indies (UHWI) reports non-invasive cancer of the cervix (cancer in situ) as the second most diagnosed cancer in Jamaican women followed closely by invasive cancer of the cervix.
To prevent this or any cancer, one must avoid risk factors and increase protective factors as possible.
PREVENTION FACTORS INCLUDE:
Screening history
Human Papilloma Virus (HPV) infection
Sexual history early onset of sexual activity; multiple partners; partner with multiple partners
Smoking
HIV infection
Diet
SCREENING HISTORY
A woman who has not been having regular pap smears is more likely to get cervical cancer, especially if she is over 60 years. A pap or papanicolau smear is a test to identify abnormal cells on the surface of the cervix or neck of the womb. The doctor who is performing the test puts the patient in a special position, usually one called the lithotomy position, and then gently inserts an instrument called a speculum into the vagina.
The two parts of the speculum are carefully separated while in the vagina so that the lateral walls of the vagina are pushed out of the way and the upper vagina and the opening or os of the cervix are in full view. A wooden spatula or a special brush or a cotton tipped swab is inserted in the os and surface cells are removed. These cells are placed on a glass slide, fixed to the slide and then stained. The slide is then examined under a microscope by a cytologist. The cells are examined for atypia or malignancy. The idea is to find abnormal cells if they are present.
Previously, pap smears were reported as being class 1, 2, 3, 4, or 5. A class 1 pap smear meant that only normal cells were seen while class 5 meant that cancer cells or malignant cells were seen. Now, the Bethesada System of reporting is used. The changes are reported as either low grade or high grade squamous intraepithelial neoplasm (SIN) or cervical intraepithelial
neoplasia (CIN) 1, 2, 3.
A pap smear reported as low grade SIL or CIN 1 indicates that the cells examined showed abnormality in size, number and shape. The changes in the cervical cells are said to be 'on a continuum' with the possibility of the least abnormal cell regressing to normal and the most abnormal cells becoming malignant or cancerous. These cancerous cells have the potential for local invasion in the surrounding tissues as well as the potential to spread to other areas of the body.
When abnormal cells are found on the pap smear, the cervix is further examined using a colposcope, an instrument similar to a microscope. Before the cervix is viewed with the colposcope it is wiped with vinegar then stained with iodine. The cells which are normal will be seen as brown while the abnormal cells will be seen as white or yellow.
Pap smear test taking should always be followed or preceded by the bimanual pelvic examination in which the uterus, ovaries and surrounding tissue and organs are examined. The walls of the vagina are also examined as the speculum is withdrawn from the vagina.
Every family doctor should educate every sexually-active woman about the importance of a regular pap smear and pelvic exam. The Jamaican Ministry of Health, the Health Authorities and the relevant non-governmental organisations must continue to expand relevant public education programmes and improve and expand access to the required clinical service.
The take home message today is -- all sexually-active women should have regular pap smears and pelvic exams to detect precancerous lesions before the lesions becomes invasive cancer and to detect invasive cancer at an early stage when it is curable.
Next week, we will continue the discussion of this topic.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist.
