Part 1 of 2 Article: Could one safely assume that every woman in Nigeria knows about cervical cancer as the information is all out there? It is second only to breast cancer as the commonest cause of women’s cancer the world over, isn’t it? In Nigeria, such assumptions could be fatal as the story is slightly different.

Cervical cancer is the number one killer cancer of Nigerian women. Meaning that, while breast cancer afflicts more women, cervical cancer kills more. Now, if every woman knows about cervical cancer- its deadly nature and its preventable nature- why do scores of women besiege gynecological clinics in tertiary institutions across Nigeria on a daily basis, with terrible smell emanating from their emaciated body, seeking a late and costly care to a preventable and largely curable cancer?

Maybe most women haven’t heard about it after all, or they have heard but don’t know what to do about it. Maybe they even know what to do about it but are not sure how to go about it. And when they know how to go about it: where is the time? And where is the money? Yes, the “MONEY” especially in impoverished areas. It then behooves us the need to keep talking about it until every woman hears, every woman understands, every woman screens and every woman preaches it to the next woman.

What is cervical cancer? Cervical cancer is the cancer of the neck of the womb or cervix. The cervix serves as an entrance to the womb. It is that organ that dilates from 0-10cm when a woman is in labour but closes tightly to keep a baby in the womb until delivery. A powerful organ, it is about 4cm in length and 2.5cm in diameter and assumes different shapes in women of different age groups and different reproductive stages i.e. from onset of menses till menopause. Cancer affecting the cervix occurs all over the globe.

Statistics: They are not nice! Every 2 minutes a woman dies of cervical cancer somewhere in the world, about 10,000 Women are at risk of developing Cervical Cancer every year in Nigeria. More than 80% of these will present in advanced stages, when little can be done, 70% of deaths due to cervical cancer occur in developing countries.

In Nigeria 70% of cervical cancer deaths occur in the rural areas, where little is known about the disease, healthcare services are poor and factors promoting cervical cancer are rife.

Causes: The Human papilloma virus (HPV) infection has been linked to practically all cases of cervical cancer. This virus, which is sexually transmitted is found to infect almost all sexually active women and is in fact one of the commonest sexually transmitted infection in the world. There are several types of HPV virus and not all of them are capable of causing cancer.

Also, after an HPV infection, most women will clear the virus and be free of it in a few months to a few years. But in a small number of women, infection with cancer- causing HPV infection persists. When it does, it changes cells in a particular area of the cervix and makes them abnormal. If nothing is done at this stage, the abnormal cells “rejoice” and go on to become full blown cancer cells which begin to spread to the rest of the body. In effect, curtailing HPV infection means curtailing cervical cancer. But there are other factors known as disease modulating factors. What this means is that the presence of any of these factors singly or combined makes it easier for HPV infection to occur and persist while also enhancing the ability of such infection to progress to cancer.

Such factors include: Early age of sexual activity, giving birth to many children, having multiple sexual partners or having a partner with multiple sexual partners, smoking, co-infection with other sexually transmitted infection, poor nutrition and low socio economic status, immunodeficiency such as in HIV. All the mentioned factors except smoking are common amongst African women; when combined with lack of regular screening culture, it is no surprise that while the incidence of the disease keeps falling in other societies, it keeps rising in ours.

Symptoms: Most times, especially at the early stages, cervical cancer does not have any symptoms. Much later, the following symptoms could manifest: abnormal bleeding from the vagina, bleeding after having sex, abnormal vaginal discharge which could be smelly, stomach or pelvic pain, backache.

Treatment: This largely depends on the stage at which the woman presents. At the pre-cancer stages; chances of cure are high and costs of treatments are lower. The abnormal cells can be burnt off, frozen or simply sliced off. Note that, cervical cancer stays for several years at this stage before resolving or progressing to full blown cancers.

In early cancerous stages; options of treatments available are: surgery, chemotherapy or radiation therapy. These measures are far more expensive, with limited availability in Nigeria. In advanced stages: Treatment of cervical cancer is usually palliative.

In conclusion: Early diagnosis of cervical cancer is key, by early detection of pre-cancer, progression to full-blown cancer is averted.

Written with Dr. D. Talabi, Family Medicine Physician, Lagos.
Dr. Ngozi Onuoha. Copyright 2016, Health4Naija LLC. All Rights Reserved.
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