Dumaguing: Getting to know cervical cancer

DISEASES of the female genito-urinary tract are numerous and extremely common, so we at SunStar Baguio, in commemoration of March being International Women's month, want to show our affection, love and gratitude to all the women we care about, who gave meaning and purpose to our lives- mothers, grandmothers, aunties, sisters, wives and daughters, by bringing to the fore an aspect of their health and well-being, which sad to say, late when diagnosed, thus may have morbid results.

Cancer of the cervix is one of the most dreaded cancer among women, which joins the short list of breast and colon cancers. Statistics show that cancer of the cervix accounts for 10-15% of the deaths of women all over the world. It is the most studied form of neoplasia (cancer) in the body in terms of its evolution and biology.

Cervical cancer may occur at any age but the peak is usually at 40 years.

Black women are 2 times affected, 2 times more risk with married women.

Very low among Jewish women and almost zero among religious, celibate women e.g. nuns and virgins. Epidemiologists are unanimous in saying that, unlike breast cancer which has a very strong hereditary predisposition as well as sensitivity to hormonal fluctuations, lately dyslipidemia- cholesterol/triglycerides issues- cancer of the cervix is more associated with the personal circumstances of the patient. example, multiparty or the numerous number of pregnancy/delivery with the trauma attendant to it- sexual intercourse, later, vaginal delivery ; physical forces that may cause some form of inflammation of the cervix of the woman. Women who had sex at a much younger age, and who have had numerous consorts are also at higher risk. The issue of circumcision becomes significant with the glaring statistics provided by the very low incidence of cervical cancer among Jewish women. We all know that circumcision is an integral part of the Jewish religion. Researchers like Wynder et al, in their experiments put smegma- the white cheesy odorous substance that collects on the glans penis of uncircumcised men- unto the vagina of mice, all of whom later developed cancer of their cervix. The culprit is the HPV or human papilloma virus, which thrives and likes to grow in the smegma. This hall mark finding brought a series of heated debates and arguments between proponents as well as opponents of circumcision, which up to this day, the choice has become more of a personal choice rather than a general doctors' recommendation, a situation which has spawned some hilarious conditions in which, supposedly a woman, concerned about her future health, would have the right to know and see the merchandise-so to speak- whether her now suitor and future husband is cut or uncut.

My pathologist-friend says that 95% of cervical cancer is squamous cell carcinoma, of which the fungating type with its ugly cauliflower-like mass is most common type, followed by ulcerating and the rarest type is the infiltrative type, all of which arise at the so-called squamocolumnar junction of the upper 1/3 and lower 2/3 of the cervix. The usual presenting signs and symptoms are excessive vaginal discharge, pain and bleeding after sexual intercourse, dysuria or painful urination and hypogastic or pelvic discomfort. At this juncture, these symptoms evolve very slowly which explains why the cancer may have deteriorated already to advanced stage when discovered/diagnosed.

For our younger colleagues still in the academe, the first and very basic screening test is the Schiller's test in which the cervix is painted with iodine or potassium iodide (KI). A healthy cervix contains a lot of glycogen which therefore give the cervix a bright mahogany brown color. Otherwise, a pale looking cervix is not a welcome sight, which requires more studies, a Papanicolau smear, the results of which may segue into a punch biopsy of the cervix to ascertain if indeed, a malignant process has started.

Almost always, whenever cancer is discussed, of any organ, a question invariably comes, which is the best therapy for that kind of cancer. And also, allow me to say, that even the experts would say, it depends on the cancer, at which stage it is, its location- there are some inoperable cancers- and their ultimate decision is on the TNM - tumor, nodal involvement and metastasis - of the cancer.

To all the women who have made our lives worth living, thank you. Please take good care of yourselves too. We love you!

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