Happy Monday!
This week is Cervical Screening Awareness Week and I wanted to use this
opportunity to recover cervical cancer, the screening processes and what to do if
you have an abnormal smear test.
CERVICAL CANCER IS PREVENTABLE!
I hope you find this post informative and interesting. Girls – please get
your smears done regularly, it could save your life!
The Cervix:
The cervix is
basically the neck of the womb (uterus). It is the opening to the womb from the
vagina. The cervix is a very strong muscle which is usually tightly shut but it
does open during labour so the baby can come out. The outer surface of the
cervix has a layer of cells which are almost skin-like. When these cells become
cancerous it is known as squamous cell cervical cancer. There are glandular
cells lining the inside of the cervix producing mucus. Cancer of these cells is
called adenocarcinoma of the cervix. There is an area of the cervix known as
the transformation zone. This is around the opening of the cervix leading onto
a narrow passageway that runs into the womb. This zone is where cells are most
likely to become cancerous.
Risks and Causes of
Cervical Cancer:
* Human Pampilloma
Virus (HPV) is the most common and biggest cause of cervical cancer. HPV is
passed on from person to person via sexual contact. There are many different
types of HPV and not all of them cause cervical cancer. One type causes genital
warts but not cervical cancer. However other types are considered high risk.
These types can lead to cells in the cervix changing and becoming cancerous.
Most women who have HPV and develop cervical cancer will have had other
infections caused by HPV in the past. However, not every woman with HPV will
develop cervical cancer.
* Smoking can lead to
cervical cancer; women who smoke are more likely to develop this type of cancer
then women that do not smoke.
* Taking the pill can
also increase your risk but the reason for this is not yet known
* Women that have bore
a large number of children also have a slightly higher risk as are women with a
weakened immune system.
Symptoms:
Before I start listing
the symptoms, please note that pre cancerous cells do not produce symptoms.
This means having a smear test is hugely important – you can catch the cancer
before it even develops. It is also important to know that the following
symptoms do not instantly mean you have cervical cancer but it is important to
go to your doctor if you have any of these symptoms:
* Bleeding between
periods
* Bleeding during or
after sex
* Bleeding at any time
after the menopause
* Discomfort or pain
during sex
Jo’s Cervical Cancer Trust
Jo’s Cervical Cancer Trust is also known as Jo’s Trust
and it is the only UK based charity to focus solely on women that have been
affected by cervical cancer and their families. They also help women dealing
with cervical abnormalities. They aim to offer information, advice, friendship
and support to these women, regardless of their age and status. They also try
to educate women on the importance of cervical screening and to provide support
for the women that have abnormal screening results or ladies that have a
cervical cancer diagnosis.
Jo’s Trust has a mission: “Our mission is to see
cervical cancer prevented, reduce the impact for everyone affected by cervical
abnormalities and cervical cancer through providing the highest quality
information and support services and campaigning for excellence in cervical
cancer treatment and prevention."
The trust also has some core values and all the work
they do is based around them. These qualities include remaining people focused,
providing the highest quality, valuing and respecting others and empowerment.
The trust provides support groups, allowing women to
come together, bond and share experiences. They also have a helpline to provide
support, they have an online forum for people to come together in the comfort
of their own home and a yearly meeting for women to get together and enjoy
themselves. They also provide many helpful information leaflets which can be
found on their website.
Jo’s Trust is a fabulous charity which does amazing
things for women in the UK. I whole heartedly agree with their mission and
their core values and I would love to see them succeed and help make cervical
cancer a thing of the past. Please do check out their website and find out ways
to help them achieve their goals. You can also find them on twitter @JosTrust
Smear Tests:
It is hugely important
to have cervical screening as preventing cervical cancer from developing is
vital. Cervical cancer is actually one of the only cancers that is preventable
because if pre cancerous cells are detected through screening then they can be
treated before they have a chance to become cancerous.
Women between the ages
of twenty five and sixty are encouraged to have smear tests every three to five
years to detect any changing cells in their cervix. During a smear test, a
doctor or nurse will insert a speculum into your vagina and scrape anyway a
sample of cells from your cervix. These cells are then placed into a small pot
of liquid and send to be analysed. You will then be contacted with your results
and any abnormal smears will require further investigation.
You don’t have to be
over the age of twenty five to develop cervical cancer; some younger women do
develop it as well. However, in the UK, smear tests are not encouraged until
twenty five because your cervix is still developing in your teens and early
twenties. This means the likelihood of you getting an abnormal result is more
common but usually nothing to worry about. After Jade Goody’s horrifically
young death, a campaign was launched to lower the smear test age limit but
medical professionals do not agree with this. If you are under twenty five and
are concerned about your cervical cancer risk – please do speak to your GP and
get some advice. A private gynaecologist may allow you to have a smear test but
it would depend on your individual circumstances.
PLEASE DO NOT BE SCARED TO HAVE A SMEAR TEST –
THEY ARE UNCOMFORTABLE AND UNLADYLIKE BUT THEY DO SAVE LIVES! A FEW MINUTES OF
DISCOMFORT IS BETTER THEN A BATTLE WITH CERVICAL CANCER!!!
It is also important
to note that an abnormal smear result does not mean you have cervical cancer.
If you are contacted and told your test was abnormal then please do not ignore
it, go and see what your doctors have to say.
I’m approaching my
twenty third birthday so I am not entitled to smear tests yet. I’ve heard
horror stories about them and I am slightly worried about them. However, I will
be forcing myself to attend my smear tests appointment when they are available
to me. If I do develop pre cancerous cells – I will be finding them and I will
be stopping them from developing.
Points to
Consider:
You can have a smear test at
several different places:
* Your GP’s surgery should
offer them
* A family planning clinic
* A genito-urinary clinic
* An antenatal clinic
* A private health clinic
* Marie Stopes
You are well within your rights to request a female doctor or nurse
performs your test but any male doctors will be chaperoned by a female staff
member anyway. It is important to state if you require a female at the time of
booking your appointment.
A smear test should be scheduled whilst you are in the middle of your
menstrual cycle (between periods) as it will be very difficult to see your
cervix and get a cell sample whilst you are bleeding.
Age Limits:
There are varying age limits
for women in the four nations of the UK.
* Women between the ages of
twenty five and sixty four are screened every three to five years in England
and Northern Ireland.
* In Scotland, cervical
screening is offered to women aged between twenty and sixty.
* Wales offers cervical
screening to women aged between twenty and sixty four.
Research has shown that screening every three years prevents 84/100 cases
of cervical cancer that would develop if they weren’t caught by the smears. So
getting a smear test every three years is recommended by the NHS up until you
are fifty years old. Abnormal cells develop at a much slower rate in women over
fifty so screening is recommended after five years for women in that age group.
Your local primary care trust will contact you whenever it is time for a
screening for you. I cannot stress the importance of attending these
appointments enough – it could save you from a battle with cancer.
The Screening Process:
Cervical cancer is
preventable. This is because pre cancerous cell changes can be picked up before
they have a chance to develop. A cervical cancer screening test is known as a
smear test. This involves a doctor or a nurse using a speculum to take a small
sample of cells from the surface of your cervix. It sounds horrific and it can
be very uncomfortable but I am going to try and explain it as clearly as I can!
You will need to take off your
underwear and lie back on the couch/bed. Being as relaxed as you possibly can
be will make the procedure less uncomfortable.
Occasionally, the person doing the test will perform a vaginal examination
first. This means they will place two gloved fingers inside your vagina to make
sure your womb is in the correct position and that it feels like it’s a normal
size. They will use their other hand to press down on your abdomen and gently
feel your womb.
Then comes the actual smear
test: The speculum is placed inside your vagina and has two arms which are used
to spread the sides of your vagina apart so the cervix can be clearly seen. A
small brush is then inserted and used scraped along the surface of your cervix
to collect a sample of your cells. The brush and the cells are then sent to a
lab in a pot of liquid and examined under a microscope. Any abnormal cells are
reported and further investigation on these cells will be needed.
The Results:
The important thing to
remember with smear tests results is: DON’T PANIC!!! Cancer is not the only
cause of abnormal cells or an abnormal result. Sometimes you may be asked to go
back for a repeat test, again don’t panic, it could be because:
* You were on your period and
the blood meant your cells weren’t visible enough
* Your cervix was inflamed and
the cells weren’t visible enough
* An infection was blocking
the view of the cells
* There were not enough cells
collected in the first test
You may also be told that your test was borderline. This means cell
changes have been noted but they were so very close to normal that they are
probably nothing to worry yourself about and they will probably return to
normal by themselves. You may be asked to go back and have another test in a
few months to monitor the situation. You may also be offered a HPV test as HPV
is a cause of cervical cancer. If you do test positive for HPV then you will
probably been sent for more tests, including a colposcopy to monitor your
cervix and the cell changes.
Cervical erosion can be picked up by smear tests. This is not cervical
cancer. This means the glandular cells which are normally found inside your
cervical canal are now visible on the surface of your cervix and it can be
inflamed. This is a common condition for teenage girls, pregnant women and
women on the pill. It can make you bleed slightly but it usually goes away by
itself with no need for treatment.
Abnormal Tests Results:
Abnormal results are usually
reported like this:
Mild Dyskaryosis or CIN
1(mild or slight cell changes)
If you are told that you have
mild cell changes then you will probably be told to get a colposcopy straight
away or to wait and have another smear in six months. Sometimes mild cell
changes will go back to normal by themselves but it is important to monitor
them and go back for any tests advised by your medical team. If a second test
shows abnormal cells then a colposcopy is definitely needed to assess the
situation.
Moderate Dyskaryosis or
CIN 2 (moderate cell changes)
Treatment will be needed if
you have moderate cell changes but you only usually need it once. Then you will
have follow up tests to monitor the cells in your cervix. If you have
successful treatment after an abnormal smear and carry on having regular smears
then you are unlikely to get cervical cancer. If you do not have treatment then
you are at real risk of developing cervical cancer
Severe Dyskaryosis or CIN
3 (severe cell changes)
This is also sometimes known
as carcinoma in situ (CIS) which sounds like cancer but it isn’t. This means
some cells in your cervix look cancerous but are all found in the skin layer
which covers your cervix. It won’t be “true” cancer until it breaks through the
layer and starts to spread into the surrounding tissue. Urgent treatment is
needed for this kind of smear result but if it is moved ASAP then cancer can be
prevented.
All these results mean the cells found are pre cancerous meaning if they
are left to go untreated, they could develop into cancer of the cervix. YOU DO NOT HAVE CERVICAL CANCER IF
YOU ARE TOLD YOU HAVE ABNORMAL CELLS.
9/10 smears come back normal. 1/20 shows a borderline or mild cell change.
Most of the time these cells will return to normal by themselves. 1/100 shows
moderate cell changes whilst 1/200 show severe changes. Less than 1/1000 shows
cancer.
First Steps:
If you have mild cell changes then you may be told to
wait six months and have a repeat test. This is because mild cell changes
usually sort themselves out. If you have moderate to severe cell changes then
you will probably be referred to your local hospital for a colposcopy. This is
an outpatient procedure and it is basically a close examination of your cervix
which doesn’t actually go inside your vagina. The doctor or nurse specialist
uses something like a magnifying glass to look at the cells on your cervix in
more detail and takes a biopsy to send to the lab for further examination.
Types of Treatment:
Laser Therapy (Laser Ablation): some cells can be
burned away by a laser in an outpatient procedure. For this kind of treatment
you will lie on a bed with your legs in stirrups whilst a doctor places a
speculum into your vagina to hold it open whilst they point a laser beam at the
abnormal areas. You will be given local anaesthetic to numb the area and
prevent pain. The laser is a very strong and hot beam of light and it burns
away the abnormal cells. This can cause a slight burning smell whist you are
having the treatment but that just means the laser is working so try not to
worry. You should be able to go home as soon as the treatment is finished. You
may experience period type pains but they should go away with the normal
paracetamol or ibuprofen and some bed rest.
Cold Coagulation: This name is a
little misleading as the treatment isn’t cold at all! You lie on a bed with
your legs in stirrups whilst a doctor inserts a speculum to hold your vagina
open. A hot probe is then used to burn away the abnormal cells. You shouldn’t
be able to feel the probe but it can cause some period type pains which should
go away a few hours after the treatment has finished.
Cryotherapy: This is
basically cold coagulation but with a cold probe instead of a hot one. The cold
probe freezes the abnormal cells. The procedure is exactly the same as the cold
coagulation.
Diathermy: This is done
under local anaesthetic. An electronic current is used to cut away the tissue
that contains the abnormal cells. It is a fairly quick procedure and it usually
done as an outpatient case which means you should be able to go home
afterwards. It can cause bleeding or discharge for about four weeks after the
treatment but sanitary towels will have to be used as tampons have to be
avoided for four weeks. Sex must also be avoided for four weeks following a
diathermy procedure.
Cone Biopsy: This is a minor
operation that can be used to diagnose cervical cancer or to treat abnormal
cells. The entire area containing possible abnormal cells is removed. It is
called a cone biopsy because a cone shaped area of tissue is removed from the
cervix. This is called the transformation zone. This can be done under general
or local anaesthetic.
Hysterectomy: If you are past
menopause, or have had all your children, then your doctor may suggest removing
your uterus. This is usually suggested if you have had abnormal cells more then
once or if the cells are severely abnormal.
These treatments do sound rather uncomfortable and
scary but it is massively important to have abnormal cells treated to prevent
them developing into cervical cancer. Please do remember to book yourself in
for a smear if you are due one. As I’ve said before, a little discomfort is
nothing compared to a battle with cervical cancer.
HPV Vaccines
Some cervical cancer cases are caused by the human papilloma virus (HPV)
which is also sometimes known as genital warts or the wart virus. There are
over one hundred different types of HPV and some cause genital warts. Lots of
types of HPV are passed on through sexual contact and most women will be
affected by HPV at some point. Most of the time the virus will just go away
with no treatment but some types can increase your risk of developing cervical
cancer. HPV types sixteen and eighteen cause about 70% of cervical cancer
cases, which is roughly about 7/10 and most of the
other 30% are caused by other high risk types of HPV.
Extensive research into HPV has been done over the
years and two cervical cancer vaccines have been created. These are celled
Gardasil and Cervarix. Research is on-going into these vaccines and their
effects will become clearer as time goes on but here is some information on the
two vaccines:
Trials have been done with Gardasil, using women
between the ages of sixteen and twenty six. Some were given the vaccine and
some were given placebos. They were all monitored to see if they went on to
develop HPV. Research has shown that Gardasil protects against some types of
HPV including types sixteen and eighteen. Since then Gardasil has been given a
licence in the UK and can be used on young girls and women between the ages of
nine and twenty six.
Cervarix has also gone through rigorous trials
involving women under the age of twenty six. They discovered that Cervarix can
prevent HPV. It has also been licenced for use in the UK and is used to prevent
pre cancerous cervical changes in women between the ages of ten and twenty
five.
UK schoolgirls aged between twelve and thirteen (year
eight at secondary school are currently being offered the Cervarix vaccine as
part of the HPV vaccination programme. This involved the girls having three
injections over a six month period. Their parents have to sign a consent form
before their daughter can have the vaccinations and they should discuss the
vaccine with their daughter so she can decide whether or not she would like it.
From September 2012 the vaccination programme will switch to the Gardasil
vaccine as this protects them against genital warts as well as cervical cancer.
It is also possible to have the vaccination done privately should you wish to
do so.
The vaccines are given to twelve year olds because
they are unlikely to have already become sexually active and caught HPV.
Research has shown that the vaccine works best in younger women. You can still
have the vaccine if you are already sexually active; it won’t get rid of HPV if
you already have it but it can protect you from developing other types of the
infection. It may be worth having if the type you have isn’t type sixteen or
eighteen as these are the two that are most likely to cause cervical cancer. It
is vital to have all three injections to make sure you are properly vaccinated.
Side effects of the vaccine are usually very mild but
they can include:
Headaches and aching muscles, dizziness, fever, diarrhoea
stomach pains and itching and soreness around the injection area.
IT IS IMPORTANT TO REMEMBER THAT YOU
STILL NEED TO HAVE REGULAR SMEAR TESTS WHEN YOU REACH THE MINIMUM AGE REQUIRED.
WHILST A VACCINE WILL HELP PROTECT YOU, SCREENING IS STILL NEEDED!!
If you are interested in having a cervical cancer
vaccination – please contact
your GP or Jo’s Trust.
I hope this blog post
has given you all the facts. I hope it has persuaded you to have a smear test
if you haven’t already.
xxx
