Cancer of the uterine cervix is a gradual form of cancer that can be treated. The cervix is that portion of the uterus that lies at the top of the vagina. Cervical cancer is usually caused by various strains of human papillomavirus (HPV). The Pap smear has played a major role in early diagnosis of this form of uterine cancer. Cases of 'pre cancerous' cervical changes are detected with pap smears and treated in time before they turn malignant. The pap smear test is able to detect any abnormal cells in the cervical region. The 'pre cancerous' condition is referred to as 'dysplasia'. Consequently the morbidity rate of cervical cancer has drastically reduced. Cervix biopsies of different types are diagnostic procedures that can also function as treatments for pre-cancerous lesion in the cervix area.
In the early stages, cervical cancer does not give rise to any symptoms. Symptoms of cervical cancer are abnormal vaginal bleeding and foul-smelling discharge. A woman may also experience pelvic or back pain. There may be weight loss and loss of appetite. Women who have genital warts are at increased risk of cervical cancer. Multiple sexual partners and early age of sexual activity can also make a woman more susceptible to cervical cancer. A woman with a weakened immune system is more at risk of cervical cancer. Cigarette smoking and oral contraceptives have also been known to increase the risk of developing abnormal changes in the cells of the cervix. A doctor will conduct a physical examination to check for any irregular fleshy growth.
Cervical cancer is treated according to the size and stage of the disease. Treatment is also decided based on the woman's age and health. If detected in the early stages, cervical cancer can be treated without removing the uterus or damaging the cervix.
Roche DNA Test
Recently the Federal health, Food and Drug Administration regulators in the US cleared the Roche HPV test to detect the Human Papillomavirus in women aged 25 and above. Roche's is primarily a genetic test that could be done as a first-choice screening option for cervical cancer. This is an advance on the decades-old Pap smear.
Roche diagnostics conducted a study that provided the FDA with reasonable assurance of the safety and effectiveness. Roche's trial included 47,000 women who underwent cervical screening using either Pap or HPV screening. The results were checked for accuracy against final biopsy results that confirmed whether they actually had cancer.
As such doctors use DNA-based tools as a follow-up to confirm Pap smear results. Now, Roche DNA test can be used as a first-choice option for cervical cancer screening, ahead of the Pap test.
The FDA approval comes despite warning from health advocates that approving the DNA test as an alternative to Pap could lead to confusion, higher costs and over treatment of younger women who carry the virus that have little risk of developing actual cancer.
While Roche supported its study results suggesting that genetic testing is more accurate and objective at identifying cancerous growth than the Pap smear, there are no major medical guidelines that recommend HPV testing alone for cervical cancer screening. Some physicians and gynecologists advice holding off using the test until medical societies can provide guidance to some key questions which include how frequently it should be used.
Pap test was the only available screening option for cervical cancer for decades. Due to increased Pap screening, in the US, the number of reported cases of cervical cancer has decreased more than 50 percent in the past 30 years. Yet, an estimated 12,000 cases of cervical cancer are expected to be diagnosed this year. Hence Roche and other test markers developed HPV tests – although the cost of Roche's HPA is twice and even more as that of the Pap which is $ 40.
The American Cancer Society has tried to evolve latest guidelines incorporating both techniques. A Pap test is recommended every three years for those aged between 21 and 29 years of age and older women should have both a Pap test and an HPV test every five years, or only a Pap every three years. Also, according to FDA, women who test positive for HPV 16 or 18 should proceed directly to colposcopy, which is an invasive procedure in which the cervix is viewed with a magnifying device and often tissue sample is collected for testing. A positive test for one or more of the other 12 high-risk HPV strains should be followed by a Pap test to determine the need for colposcopy.
As women in their 20s could be exposed to the danger of more invasive testing that could leave the cervix less able to handle pregnancy later in their life if they undergo a HPV screening, they are advised not to do so.
Roche DNA test claims to have the superior ability to detect HPV DNA and individual types. It is also capable of detecting HPV genotypes present in multiple infections. This can occur in up to 35% patient samples. It uses standardized and quality controlled reagents to do the test. Due to co amplification primer concentrations are used. This minimizes competition.
It helps identify women at risk and optimizes treatment strategies. It helps further stratify women with normal cytology who are HPV positive into different categories. The test also provides physicians with actionable information to treat the highest risk patients immediately.
Cryosurgery is increasingly becoming popular especially in the removal of tumors. Cryosurgery involves the administration of liquid nitrogen at very low temperature to remove tumors and cancerous tissues by cell death. This method is also called as cryogenic cell death. Cryosurgery is also used in the treatment of precancerous tumors in cervical cancer.
Cryosurgery is usually performed when the patient is in a conscious state. Different types of cryoprobes are used to treat cancers or tumors associated with specific regions in the body. Once the cry probe is introduced in the body, the compressed liquid nitrogen with a temperature ranging from -20°C to -50°C is passed into it to freeze and destroy the unwanted tissue through contact. The cells are subject to osmotic pressure changes because of the increased fluid content caused by the cry probe. Cryosurgery is done at regular intervals to promote thawing of the tissue and subsequently freezing it to destroy the layer of cells that are not required.
Precautions and side effects of Cryosurgery
In most cases, an interval of three minutes is given throughout the procedure. The probe inactivates the nerve endings touching the adjacent cells to inhibit the sensation of pain caused by the abnormal tissue. Vascular changes also occur during the procedure such as initial numbness and flushing sensation during the thawing process. Cryosurgery is most suggestive in case of precancerous stages as it enables treatment of the cancerous tissue effectively. It is predominantly used in the treatment of Neuroma, prostate cancer, cervical cancer and skin cancer. Patients generally complain cramping sensation during the procedure which usually subsides on its own.
Other complications include infection and swelling. Since cryosurgery does not require major invasion, the side effects are minimal. Cryosurgery can be done both as external and internal procedure. The healing patterns after the procedure vary from one area of the body to another. In case of skin cancers or melanomas, the deterioration of the unwanted warts and subsequent tissue rejuvenation may take up to six weeks. Malignant melanomas are not treated by using cryosurgery.
Cryosurgery cannot be performed for all types of cancers and on all organs, because of the probability of normal tissue damage and formation of unwanted scarred tissues. Careful analysis is done by the physician to identify the form of tumor and the type of cells associated. Biopsy is performed to detect any form of malignancy or metastases of the respective cancer. Salicylic acid is applied on the warts prior to cryosurgery to reduce the size. In some cases cryospray is used directly on an external growth for a period of 20 to 30 seconds.
Although cryosurgery is one of the most preferred techniques, elderly persons are not suitable for this procedure. Most patients undergoing cryotherapy experience blisters, itching and oozing for a short period of time. Precautions are taken to avoid any form of secondary infection. Cryosurgery associated with skin cancers such as basal cell carcinoma, have side effects such as hypo pigmentation and hyper pigmentation. In some rare cases nerve damages have been reported. Studies indicate that patients who have a history of human papilloma virus infection also prefer cryosurgery for the removal of genital warts.
Bibliography / Reference
Collection of Pages - Last revised Date: January 16, 2019