info@saratani.or.tz

Our email

+255 757 120 337

9:00 A.M. - 5:00 P.M.

Donate Now

Cervical cancer

Cervical cancer also known as cancer of cervix is the disease that begin when cells in the cervix change and start growing out of control. Change of those cells does not always lead to cancer as sometimes can lead to precancerous conditions that normally go away on their own. Sometimes those precancerous conditions can lead to development of cancer. Abnormal growth of cells in the cervix can lead to development of tumor which can either be benign or malignant. Benign tumor is the one that is enclosed in one area and cannot spread to other parts of the body. Benign tumor is not cancer but just a precancerous condition while malignant tumor is the one that is not enclosed in one area and can spread to other parts of the body. To understand well about cervical cancer, it is important to know a little bit about the structure and function of the cervix.

About Cervical cancer
Cervix is a part of the female reproductive system located at the lower part of the uterus. It is between the uterus and the vagina. It is sometimes called neck of the uterus. Cervix helps to hold the uterus during development of baby in the uterus. Cervix is mainly made up of two parts, the inner part (inner surface) also called endocervix and the outer part (outer surface) also called ectocervix.
• Endocervix is made up of glandular cells that secretes mucus that help to lubricate the vagina and help the sperms travel to fallopian tube for fertilization process.
• Ectocervix is made up of squamous cells Squamous cells and glandular cells of cervix meet up at the junction called transformation zone. In the transformation zone is where most cell changes that lead to cancer start.

Types of cervical cancer
There are mainly two types of cervical cancer depending on the type of cells which the disease starts from.
• Squamous cell carcinoma. This is the type of cancer that develop from squamous cells. This is the most common type of cervical cancer in Tanzania
• Adenocarcinoma. This type of cancer develop from glandular cells.


RISK FACTORS OF CERVICAL CANCER
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but do not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. Risk factors of cervical cancer include the following.
• Human papilloma virus (HPV) infection. There are different kinds of human papilloma viruses (more than 150 strains). Among those 150 strains of HPV, there are those that only cause growth called papilloma (warts) and those that are highly linked with several cancers. Among cancers that are linked to some strains of HPV is cervical cancer.
• Smoking. Tobacco smoke has chemicals with the potential of destroying cells in various body parts including the cervix. These damages may lead to development of cancer.
• History of the disease in the family. Women in the family with the history of the disease (mother or sister had a disease) are said to be at an increased risk of developing the disease than those who are not in such families.
• Long term use of oral contraceptive pills. Some studies indicate that, women who have used oral contraceptive pills for a long period (more than five years) are at an increased risk of developing cervical cancer. The risk decreases after stopping using those pills. Hence it is advised that, women should discuss with their doctors if the benefits of those pills outweighs the risk before staring using the pills.
• Weakened immune system. Women with weakened immune system are at higher risk of developing cancer of cervix than those with strong body immunity. Body immunity helps to destroy HPV viruses, so having a weakened body immunity system will increase the risk of HPV infection which might lead to cancer. This group of women include those with HIV –AIDS and those using drugs to lower body immunity after transplantation.
• Exposure to diethylstilbestrol (DES). DES was the drug used in 1940S up until early 1970s to prevent miscarriage. Some studies indicate that, women whose mothers used this kind of drug are at an increased risk of developing cervical cancer than normal.
• Overweight. A woman who is overweight, is at an increased risk of developing adenocarcinoma of cervix.

PREVENTION OF CERVICAL CANCER
To prevent something you need first to know what causes that thing to happen. Since until now the real cause of cervical cancer is not clearly known, the only way of preventing development of this cancer is to detect and treating precancerous conditions and preventing those precancerous conditions from developing. Early detection can be done through regular screening tests while prevention of precancerous conditions can be done through,
• Using HPV vaccine. Since there are HPV vaccines, it is important to be vaccinated in order to prevent HPV infections
• Avoid to have multiple sex partners
• Avoiding sex with those who have many sexual partners
• Avoiding to start having sex at very young age
• Using condoms to prevent HIV transmission

EARLY DETECTION AND SCREENING OF CERVICAL CANCER
When it comes to cancer, early detection normally provide better treatment outcome. When cervical cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening process. Screening is the process of running some tests to someone who has no signs and symptoms of the disease to check for the presence or absence of the disease. For screening of cervical cancer pap test and HPV test are mostly used. These two tests involve taking a sample of cells from the cervix and examining it in the laboratory to see if there are any abnormal changes (signs) that might require further investigations to prove if it is cancer or not.

SIGNS AND SYMPTOMS OF CERVICAL CANCER
Normally people with cervical cancers start to experience signs or symptoms while the disease is still at an early stage. But sometimes those signs and symptoms are caused by medical conditions which are not cancer, hence seeing the doctor upon experiencing any of those symptoms is strongly advised. Signs and symptoms of cervical cancer include the following; • Experiencing some pain during sex • Vaginal bleeding. This include between periods, after having sex, after menopause or after pelvic examination • Having unusual vaginal discharge. The discharge may contain blood and be after menopause • Unexplained pelvic or back pain

DIAGNOSIS OF CERVICAL CANCER
Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease. Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer. Laboratory tests: Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.
• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance, blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance, the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.

Diagnostic imaging
Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include; • Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure. the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body.
• Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.

Biopsy
Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include; • Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum) In addition to medical history and physical examination diagnosis of cervical cancer normally involves the use of biopsy, blood tests, chest X-ray, CT scan, MRI scan, PET scan, colposcopy which is used to examine examine vaginal walls and surface of the cervix and pap test (pap smear).
• Pap test or pap smear is the test used to check cells inside the vagina and cervix. This test is normally done to those who haven`t had this test done already. During the test a speculum will be used to open the vagina and a small brush or swab will be used to remove some cells from the surface of the cervix. This tissue sample is sent to a laboratory to check for abnormalities.

TREATMENT OF CERVICAL CANCER
Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps. After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option. Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored. In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials. If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time


Treatment options
Treatment of cervical cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. Generally multidisciplinary team for treatment of cervical cancer includes, surgical oncologist, gynecologist, gynecological oncologist, medical oncologist, radiation oncologist and other health care professionals like oncology nurses, women`s health physiotherapist and palliative care team. Treatment options include the following,

Surgery
Surgery is the treatment option which involve removing the tumor and some surrounding health tissues by an operation. Some pelvic lymph nodes may also be removed. This treatment option can be done by surgical oncologist or gynecological oncologist. There are a number of different operations for cervical cancer depending on the size and position of the disease. These operations include;
• Hysterectomy. Hysterectomy is the surgical option that involve removing uterus and cervix depending on the extent of the disease. Hysterectomy is divided into two types.
• Total hysterectomy. This involve removing the uterus and cervix without removing structures next to the uterus. In this pelvic nodes are normally not removed.
• Radical hysterectomy. This involve removing the uterus, cervix and upper part of vagina. Some of the Pelvic nodes also removed. removed There are types of hysterectomy which may involve removal of the ovary and fallopian tube depending on medical reasons. This kind of operation is called salpingo-oophorectomy and if both ovaries and fallopian tubes are removed it is called bilateral salpingo-oophorectomy.
• Trachelectomy. This is a surgical option that leaves a woman with the ability of having children again. This option is not normally used but it can be applied to young women with very early disease. In this option cervix and some surrounding tissues are removed but the uterus is left in place. Nearby lymph nodes are normally removed.
• Exenteration. This is an option which is normally not used but it can be applied to those with the disease that has recurred (come back after treatment). The surgery involve performing radical hysterectomy together with removing some other organs depending on extent of the disease (organs affected). Those organs removed may be vagina, rectum, lower colon or bladder.
Side effects of surgery
Side effects of cervical cancer surgery will depend on extent of surgery itself. Some of the possible side effects include the following;
• Pain
• Bleeding
• Risk of infection
• Risk of early menopause. This may happen to young women who had bilateral salpingo-oophorectomy.
• Lymphedema. If your surgery involved removing lymph nodes, you may experience lymphedema which is the excess fluid in legs or pubic areas.
• Sexuality. After surgery there may be some changes in how you feel about sex due to physical and emotional changes that you are experiencing.
Radiation therapy
Radiation therapy is the treatment option that involve using high energy x-rays or other radiation particles to destroy cancer cells. This treatment option is given by a specialized doctor known as radiation oncologist. There are two main ways of delivering radiotherapy, externally (external beam radiation therapy or internally (brachytherapy). Most women with cervical cancer have both types of radiotherapy.
• External beam radiation therapy. This is a type of radiation therapy whereby radiation dose is given to the tumor from the source (machine) placed outside the body. During treatment, you will lie on the treatment table and radiation beam will be aimed to the tumor.
• Internal radiation therapy (brachytherapy). Brachytherapy is a way of delivering radiotherapy directly to the tumor from inside your body. Brachytherapy may be given following completion of external beam radiation therapy.
Side effects of radiation therapy
Side effects of radiation therapy depends on the dose given and areas treated. Most of the side effects will last for short period of time following completion of treatment. Some of the possible side effects include the following;
• Mild skin reactions
• Fatigue
• Hair loss
• Loose bowel movement
• Upset stomach
• Diarrhea
• Radiation cystitis. This will cause burning feeling when urinating and feeling the urge to urinate more often
• Vaginal stenosis. Narrowing of vagina can be prevented by using vaginal dilators.
• Vaginal dryness.

Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells or slow its growth. Chemotherapy is given by a specialized doctor known as medical oncologist (gynecological oncologist). Chemotherapy may sometimes be given together with radiation therapy (chemoradiation) or in combination with surgery either before or after surgery. Drugs are given orally as pill or through injection into veins (intravenously). Side effects of chemotherapy
Side effects of chemotherapy depend on the kind of drug used, dose and periodic time by which the drug has been used. Some of the possible side effects of chemotherapy include the following;
• Mouth sores
• Nausea and/or vomiting
• Hair loss
• Loss of appetite
• Risk of infection due to decreased white blood cells
• Feeling tired as a result of low red blood cells
• Easily bruised and bleeding

Targeted therapy
Targeted therapy is a new treatment option of cervical cancers which aim to prevent tumor cells to develop their own blood vessels as a result tumor cells will die from lack of nutrients as blood will not be reaching those tumor cells. Since tumor has the tendency of developing their own blood vessels by the process of angiogenesis, these drugs are designed to stop this process (angiogenesis inhibitors). This treatment option is normally used to those cases that have spread to other parts of the body or have recurred or cannot be treated by surgery or radiation therapy. Common drug used for this kind of treatment is Bevacizumab (Avastin).
Side effects of targeted therapy
Side effects of this type of treatment differ from those of normal chemotherapy. Some of the possible side effects include the following;
• Feeling tired
• High blood pressure
• Loss of appetite
• Risk of bleeding
• Wound healing problems

TACASO is dedicated to eliminating cancer as a major health problem, and improving the lives of those living with cancer

OUR ADDRESSES

address: Dar Es Salaam - Tanzania
email: info@tacaso.or.tz
phone: +255 757 120 337

SOCIAL MEDIA