BY MARIA ALTAF
The fourth most common cancer in the world, especially Middle and low income countries is cervical carcinoma. According to American society's cancer estimate About 13,960 cases of invasive carcinoma will be diagnosed and about 4,310 will die in 2023. A lot of risk factors are responsible for the carcinoma cervix among which Human papilloma virus exposure is most important.
High risk strains of HPV include 16,18,31,33 35,39,45,51,52 and some of low risk are 6,11,40,42,43,44,54. Keeping in view the scenario of socially and economically backward countries, early age of marriage and increased parity is also one of the key factors for the development of carcinoma cervix. Multiple sexual intercourse with an uncircumcised male, STD's also play and important role.
The peak age of carcinoma cervix is around 50-60yrs. Well, some cancers have strong familial predisposition and cervical cancer is one of them. Some of the warning signs of carcinoma cervix is post coital bleeding, abnormal vaginal discharge with a foul odour, painful intercourse, pelvic pain along the common features of malignancy such as unexplained weight loss and decreased appetite.
Although many of us are aware of carcinoma of cervix (invasive), but very less are known to cervical intra epithelial Neoplasia (CIN). It is a premalignant lesion where cervical squamous epithelium is replaced by cells with varying degree of atypia. squamocolumnar junction, which is also known as transformation zone is an area where endocervix (inner part of cervix) and ectocervix (outer part of cervix) co exist.
It contains both glandular cells and squamous cells. Most abnormal cell changes begin in this junction. There are three grades of CIN (Mild, Moderate and Severe) and they relate to how deeply the abnormal cells have gone into skin covering the cervix. CIN1 is a low grade squamous intra epithelial lesion while as CIN2 and CIN3 are high grade lesions.
It takes years, or decades, for a cervical carcinoma to become invasive but somehow may develop faster with weak immune system. In almost a great percentage CIN doesn't even proceed further due to timely treatment.
Many of us have a misconception that it is only due to early marriage in developing countries that this cancer is common, but at the same time if we talk about the western countries they have an even early exposure. So where we are lacking is the cervical screening procedure. Only 20% females undergo such examination.
Visual inspection by acetic acid (VIA), pap smear and HPV DNA testing are used for early detection of carcinoma cervix. Visual inspection of cervix is done when the disease is still in a curable stage.
It involves visualisation of cervix by acetic acid, when cervix gets exposed to acetic acid for few minutes. Abnormal cells turn white and reveal acetowhite epithelial of cervix.
Pap's smear also known papincolaou's method is also a screening procedure for apparently healthy and symptom free women to discover if there is any need for further investigation to see any malignant change.
If awareness about such tests will be done on regular basis, there will be a lot more reduction in mortality due to cervical cancer.
The author is pursuing her MBBS.
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.