Cervical cancer is the commonest reproductive tract cancer in Nigeria. It is also common in women who are highly reproductive, that is women who have multiple births.
According to Dr. Khadijat Afolabi Oboirien, a consultant Gynaecologist at Dalhatu Araf Specialist Hospital DASH, Lafia, cervical cancer is a malignancy or cancer of the mouth of the womb.
She said, “The womb has a mouth called the cervix. So, this cancer affects just the mouth of the womb and from the mouth of the womb, it can spread downwards to the vaginal and other parts of the reproductive tract as well as even far away from the reproductive tract. It is common in the female reproductive age group.
“We find it in two different groups of women, the very early and later reproductive age group. We can see it even as early as 35 years and we can see it as late as 55 years.”
Dr. Oboirien said the exact cost is unknown but Human Papilloma Virus (HPV), infections have been linked to cervical cancer. HPV is a sexually transmitted infection.
She said risk factors of cervical cancer include early sexual intercourse, women who have multiple deliveries and smoking.
On the symptoms, she said, “When you have regular vaginal bleeding, that is different from menstrual bleeding it is a very common symptom of cervical cancer, but sometimes this bleeding can be very severe that you pass blood clot and occasional copious vaginal discharge.”
The consultant gynaecologist said the condition is diagnosed when women present with irregular vaginal bleeding or swollen vaginal discharge.
“We need to ask questions about how long they have been having it and further questions that may suggest cervical cancer. But mainly during the examination of the cervixes what allows us to make this diagnosis is if you find a swelling on the mouth of the womb, and this can involve the whole cervix and then even spread to the lower parts of the vaginal, even up to the bladder where the urine stays, or even the rectum where faeces is stored.
“A part of that swelling is usually taken during that examination and used to stage the disease.
“We send the tissue for histology. Histology is a microscopic examination of the tissue, and allows us to see the disorderly growth of the cells and that it is cervical cancer.”
The expert said cervical cancer is a very preventable disease. She said there is a need to sensitise women on preventive measures on the age of first sexual intercourse so that the infection by HPV, the use of contraception such as condoms to prevent sexually transmitted infections including the human papillomavirus and the reduction in the number of partners because the more sexual partners you have the more chances of having an infection.
She said it is also important for women to go for cervical cancer screening via Pap smear. “Pap smear allows us to detect women who have pre-malignant lesions women so they don’t have cervical cancer.”
Screening also helps those who already have cervical cancer to be treated at an early stage, she said, adding that treatments usually offered are surgery, chemotherapy and radiotherapy.
“So when you use those treatments, you can effectively cure cancer, but for women who present in advance stages, those cancers have gone beyond the cervix, and involve sometimes the kidneys, the ureters and cause, chronic kidney disease or chronic liver failure. Here you find women who cannot make urine because the cancer has blocked the ureters. When this happens even if we offer radiotherapy or chemotherapy it is not to cure the disease but just to make the quality of life better until the cancer can even make the patient succumb and die from that disease,” she explained.
Dr. Oboirien, said there is hardly a month the Dalhatu Araf Specialist Hospital, for example, does not see two or three cases of cervical cancer.
“Most times they are already at the advanced stage where surgery cannot be done. So we refer them to other places.
My advice for women is that once they start having sexual intercourse they should go for a Pap smear so that we detect the pre-cancer stage early.
“Pap smear is cheap and accessible. It is cheap if you compare cervical cancer screening which is roughly N1, 000 and N2, 000 to treating the malignant stage where you need surgery, radiotherapy( which you can spend N500, 000) or chemotherapy.
“So you need to go for screening and if you are below 49 years of age, you can screen every three years and if you have not screened before at least have one screening in your lifetime that will help us detect the cases earlier.
“In fact, even before we get to that cervical cancer screening women should have contraception.
“We should limit our family size. Limit the number of sexual partners you have too”.
She said women should not be shy of going to the hospital once they start having symptoms of vaginal bleeding adding that all that is required at the premalignant stage is to burn it off.
“Women should present early so they can get proper treatment,” she said.
She said deaths from cancer are usually due to bleeding because, by the time the cancer is now growing, it grows such that it starts affecting the vessels that are close by.
“The patient can bleed all her blood volume out. So, another thing that kills them is infection when they get infected because that place you have the tissues growing rapidly, dead tissues are forming there and whenever you have dead tissues you have microorganisms and those microorganisms can enter into the vessels and then cause infection for the woman.
“Another thing that kills them is chronic renal failure. We call it Uraemia. It is a result of chronic renal failure. They don’t make urine, have hiccups, and sometimes they can even become unconscious, not responding from there they can die, the kidney stops functioning and starts accumulating the substances that they are supposed to separate.
So some of those substances can even affect the heart and the heart can stop so the woman dies.”
The expert said another very important way to prevent cervical cancer is the use of vaccination using the human papilloma (HPV) vaccine.
“The human papilloma vaccine is available in some places in Nigeria but it’s not available in Nasarawa state. It is advised that before women start having sexual intercourse they should have that vaccination.”
While saying the vaccine is quite expensive and not yet included in the National Immunisation Schedule she called on states to create awareness campaigns on cervical cancer for women and make free screening services available so many can be encouraged to go for screening.