UHS Medical Times 1
Newsletter | January 2018
CERVICAL CANCER
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C rvical Worldwide, cervical cancer is both the fourth-most common cause of cancer and the fourth-most common cause of death from cancer in women. In 2012, an estimated 528,000 cases of cervical cancer occurred, with 266,000 deaths. This is about 8% of the total cases and total deaths from cancer. About 70% of cervical cancers occur in developing countries. In low-income countries, it is the most common cause of cancer death. In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer. World Health Organization
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However, in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. This decline largely is the result of many women getting regular Pap tests, which can find cervical precancer before it turns into cancer. Worldwide, cervical cancer is the second most common cancer in women and the third leading cause of deaths. In 2008, 530,000 new cases were diagnosed and 275,000 deaths resulted. Without urgent action, deaths are projected to rise by 25% over the next 10 years.
Cervical cancer is the 2nd leading cancer and 7th cause of deaths for females in UAE. Most of the cases of cervical cancer in UAE are not detected until they are in the late stages, when it is difficult to treat. www.haad.ae
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WHAT IS CERVICAL CANCER? Cervical Cancer happens when there is an abnormal growth of cells in the lower part of the uterus which is the cervix. Most cervical cancer starts in the transformation zone. The normal cells of the cervix initially develop in pre-cancerous changes that turn into cancer. While cervical cancer starts from cells with pre-cancerous changes, not all women progresses cancer. It usually takes more than a few years for cervical pre-cancer to change to cervical cancer however it can also happen in less than a year. When detected at an early stage, the 5-year survival rate for women with invasive cervical cancer is 92%. Of all the gynecologic cancers, only cervical cancer has a screening test—the Pap test—that can find this cancer early, when treatment can be most effective. Since there is no simple and reliable way to screen for any gynecologic cancers except cervical cancer, it is especially important to recognize warning signs, and learn if there are things you can do to reduce your risk.
CAUSES OF CERVICAL CANCER: Most cervical cancer is caused by Human Papillomavirus or HPV. HPV is acquired through sexual contact with a person who has the virus. HPV is a group of more than 150 related viruses. Each HPV virus in this large group is given a number which is called its HPV type. HPV is named for the warts (papillomas) some HPV types can cause. Not all type of HPV can develop cervical cancer, some of it can result to genital warts. Other types of HPV may not cause any symptoms at all. Some of the cause that can lead to cancer: 1. Multiple Sexual Partners 2. Smoking 3. Early or Multiple Pregnancies 4. Weak Immunity
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RISK FACTORS FOR CERVICAL CANCER 1. Human Papilloma Virus (HPV) Infection – Exposure with HPV is the most vital risk factor for Cervical Cancer. HPV 16 and 18 are considered the high-risk strain that can cause cervical cancer. Other types of HPV will lead to papilloma or more commonly known as warts. 2. Smoking – The harmful substances obtained from cigarette smoke are absorbed through the lungs and carried in the bloodstream throughout the body. Studies have shown that cervical squamous cell carcinoma risk is 1.5 times higher in current smokers versus never-smokers. 3. Low Immune System – The immune system is important in eliminating cancer cells and slowing their progress and spread. A women who is immunocompromised, a cervical pre-cancerous might develop faster into an invasive cancer than it normally would. 4. Other Sexually Transmitted Infections like Chlamydia – Chlamydia like any other sexually transmitted disease can infect the reproductive system. These infections can cause pelvic inflammations leading to sterility. 5. Oral Contraceptives – The long-term use of oral contraceptives have been associated to cervical cancer. 6. Intrauterine Device – The use of IUD has been linked to cervical cancer according to some research. 7. Overweight – Adenocarcinoma of the cervix is more likely to develop in overweight women.
1. The virus invades epithelial layers 2. Infected basal cell 3. HPV in epithelial cells 4. Viral replication
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SYMPTOMS OF CERVICAL CANCER?
Women in pre-cancerous stage or at an early stage of cervical cancer does not show any symptoms. Symptoms often begin when the cancer becomes invasive and affects nearby tissue. The most commons symptoms are:
Heavier and longer menstrual cycle
Unusual vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
Pain or bleeding during sexual intercourse
Abnormal vaginal bleeding is the most commonly experienced cervical cancer symptom
Unexplained or sudden weight loss
However, these signs may also indicate other gynecological condition other than cervical cancer. Overlooking these symptoms may allow cancer to grow more in an advanced stage. It is best to see your doctor to eliminate doubts and higher your chance for effective management.
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DIAGNOSTIC TEST TO DETECT CERVICAL CANCER Cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up. The initial step in finding cervical cancer is usually an abnormal Pap smear test. Pap Smear Test is a gynecological procedure which is usually than in the doctor’s clinic. The doctor will be using a vaginal speculum to open your cervix and from there the doctor by the use of a sterile swab test will scrape the lining of the cervix. It will be sent to the laboratory for examination. The preliminary result will be released in a day or two. An irregular result will lead to further tests which can diagnose cervical cancer like colposcopy and biopsy.
Pap smear test is recommended every 3 years for women ages between 21 and 65. Women who have a higher risk of cancer may need to do pap smear more often.
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HOW TO REDUCE YOUR RISK OF CERVICAL CANCER? Get vaccinated against HPV. HPV vaccination can be given to girls and women beginning at age of 9 to 26 years. Have a routine Pap test. Pap smear test is recommended every 3 years for women ages between 21 and 65. Women who have a higher risk of cancer may need to do the Pap smear more often. Practice safe sex by using condom and having one sexual partner.
Avoid smoking.
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HOW TO PREPARE FOR YOUR PAP TEST? You should not schedule your Pap test for a time when you are having your period. If you are going to have a Pap test in the next two days:
You should not douche (rinse the vagina with water or another fluid).
You should not use a tampon.
You should not have sex.
You should not use a birth control foam, cream, or jelly.
You should not use a medicine or cream in your vagina.
If you get the HPV test along with the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you. When you have a Pap test, the doctor may also perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems. There are times when your doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor which tests you are having, if you are unsure. If you have a low income or do not have health insurance, you may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program.
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WHEN TO GET SCREENED You should start getting regular Pap tests at age 21. The Pap test, which screens for cervical cancer, is one of the most reliable and effective cancer screening tests available. The only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor to find out why you’re having them. If your Pap test results are normal, your doctor may tell you that you can wait three years until your next Pap test. If you are 30 years old or older, you may choose to have an HPV test along with the Pap test. Both tests can be performed by your doctor at the same time. When both tests are performed together, it is called co-testing. If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may then tell you that you can wait as long as five years for your next screening. But you should still go to the doctor regularly for a checkup. If you are 21 to 65 years old, it is important for you to continue getting a Pap test as directed by your doctor—even if you think you are too old to have a child or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids, your doctor may tell you that you do not need to have a Pap test anymore.
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COLPOSCOPY AT UHS Colposcopy is an invasive procedure to closely visualize and examine your cervix, vagina and vulva for any abnormality using an instrument called colposcope. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them. Colposcopy is performed with the woman lying back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position). A speculum is placed in the vagina after the vulva is examined for any suspicious lesions. The procedure normally takes 10 to 20 minutes depending on a patient’s case. If for instance, the doctor finds remarkable finding, your doctor might decide on cervical biopsy during the procedure.
PREPARATIONS FOR COLPOSCOPY Before starting colposcopy, your physician will explain to you the procedure in details. You can freely ask any questions and doubts have in mind. A written consent should be signed by you that gives your permission to carry-on with the procedure. Generally, there is no much preparation needed such as fasting or sedation. But based on your condition, your healthcare provider may request other preparation. Do not use tampons, vaginal creams or medications, douche and vaginal intercourse 24 hours before the test. If you are having your menstruation, your doctor might post-pone the procedure at least 1 week after your period. Alert your gynecologist if you are pregnant, if you have allergies to any medications, latex, tape, iodine and anesthesia. Inform the doctor if you are taking any prescribed and over-the-counter medications, and having any history of bleeding disorders.
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WHAT TO EXPECT AFTER COLPOSCOPY? After the procedure, you may take rest for a few minutes after before heading home. If you had colposcopy with biopsy, your recovery will differ. It will depend on the type of biopsy done and type of anesthesia used if any. It is normal to have mild uterine cramping, spotting and dark or black-colored vaginal discharge for several days if biopsy was done. It is because the dark discharge come from the medicine applied to the cervix to control bleeding. Also, do not touche, use tampons or have vaginal intercourse for 7 days after the procedure or as long as your healthcare provider allows you to. Avoid strenuous activity and lifting heavy things. Report to your doctor if you experienced bleeding, foul-smelling discharge from vagina, fever and pelvic or abdominal pain.
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TREATMENT FOR CERVICAL CANCER Cervical Cancer if detected and managed early can be successfully treated. The choice of treatment is depending on the stage and type of cancer. Your doctor may require 1 or combined management depending on the severity of the disease. 1. Surgery – The procedure to remove part of the cervix is called Radical Trachelectomy. Other surgeries are called radical hysterectomy (surgery to remove the womb) and laparoscopic surgeries (less invasive technique to remove some parts of the cervix). 2. Radiation Therapy – This treatment involves high doses of radiation or implants in vaginal cavity to eliminate cancer cells. Usually, it is combined with surgery. 3. Chemotherapy – In order to kill cancer cells, chemo drugs will be administered in 6-8 sessions depending on the patient’s condition. This is used for more advanced cancer stage. 4. Chemoradiation – For early and late stage, combination of chemotherapy and radiation is being used.
WAY TO RECOVERY FROM CERVICAL CANCER Adopting to a life with cancer is stressful and tough. Being a survivor means that you are returning back to some accustomed things and adjusting to new choices and habits. You have to discuss with your physician about your recovery period, below are some required matters to talk over:
Follow-up check-up
Further tests if needed to be screened for other type of cancer
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Diet and physical activity
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Don’t Forget
ARISE NEWSLETTER ISSUE 10 | JANUARY 2018
To Check December Edition of
NATIONAL GLAUCOMA AWARENESS MONTH
ARISE Nursing Newsletter
GLAUCOMA? TYPES OF GLAUCOMA RISK FACTORS RAISING AWARENESS NURSING MANAGEMENT WHAT IS
With the start of New Year, many people have made their own list of New Year’s resolution so they can start the year off right. The list includes exercise more, eat healthy, quit vices like smoking and drinking, read more books, and the list goes on... As an advocate for change, we nurses can raise awareness and help our clients understand more about glaucoma, a sight- stealing disease. This "sneak thief of sight" is referred as such since one can have an irreversible loss of vision even without any obvious symptoms during the early course of the disease. “Glaucoma can damage your vision so gradually you may not notice any loss of vision until the disease is at an advanced stage,” said Dr. Jeff Taylor, Medical Director to YourSightMatters.com. “Early diagnosis and treatment can minimize or prevent optic nerve damage and limit glaucoma-related vision loss. We want to get patients in to see an ophthalmologist– the earlier the better.” The World Health Organization estimates that about 4.5 million people around the world are going blind due to glaucoma.
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of ARISE Nursing Newsletter raises awareness on Glaucoma. The number of persons affected by Glaucoma is increasing day by day and measures to reduce these numbers are being taken world wide. January
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This edition contains a summary of Glaucoma and its types, risk factors and other information on it.
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