Female Reproductive System

Risk Factors

Cervical cancer is the most common cancer found in the female reproductive system. Detection and prevention of cervical cancer can be straight forward, however, it is still one of the leading causes of deaths related to cancer for Thai ladies (10 per day).

Causes of Cervical Cancer

According to research by Italian doctors Rigomi and Stern (1842), there are no cases of cervical cancer found in nuns and virgins, indicating that this is a sexually induced cancer. Today this has been proven a fact as cervical cancer has been found to be caused by the HPV (Human Papilloma Virus).

Men and women who engage in sexual relations will have contracted the disease previously. Statistics from the United States show that 75% of women aged 18 to 22 will have had the virus.

HPV may be contracted from:

1. Sexual intercourse, Genital-Genital contact, Manual genital, Oral-genital. Condoms can be effective; however it does not full prevent infection.
2. Other means- such as congenital from the mother or shared usage of items such as undergarments or surgical gloves. In theory this is plausible, however cases are few and far between.

The most worrying aspect is that HPV does not show symptoms as such one may not know that one has it or is spreading it to other people.

Symptoms of Cervical Cancer

Prior to cancer and in early stages there may be no evident symptoms, once it has progressed symptoms may include:

1. Abnormal vaginal bleeding
2. Discharge of white substance with bad odour
3. Once it has spread to other organs symptoms may include pain, blood in urine or stool

Although early symptoms may not be evident, this cancer is highly treatable. Effective diagnosis includes Pap Smear in conjunction with HPV (HPV DNA Test) which provide almost 100 percent accuracy.

Diagnosis

Once abnormalities are confirmed by pap smear or HPV Test your doctor may perform further tests such as a Calposcopic Exam or a biopsy. A nappropirate treatment plan will be devised in accordance to the stage of the cancer.

Treatment

Treatment will depend on the stage of the cancer. Early on treatment will be surgical in nature and may include:

1. Therapeutic conization
2. Radical hysterectomy with pelvic lymphadenectomy

Radiotherapy Treatment

Radiotherapy treatment for cervical cancer can be effective in all stages of the cancer. It is often used in combination with chemotherapy, specifically Concurrent Chemo-Radiation treatment.

Radiotherapy includes Teletherapy and Brachy-therapy

Chemotherapy Treatment

Usage of chemotherapy only will be used in cases where the cancer has spread significantly that radiotherapy or surgical treatment is not plausible.

Objectives of Treatment

To fully treat patients with cervical cancer, however due to possibility of recurrence follow-up and check-ups will be required in case of side effects.

Prevention

Given proper understanding, cervical cancer is preventable.

Cervical cancer occurs as a result of HPV, High Risk HPV of which there are 13 types. Of normal HPV is found that types 16 and 18 contribute to cervical cancer (70%). For these two types, vaccines are readily available.

Thai women who receive these vaccinations will reduce their chance of cervical cancer by 70%. Add to this Pap Smear and diagnosis test for High Risk HPV DNA in accordance to doctor’s discretion, then cervical cancer becomes highly preventable.

Wattanosoth Hospital provides a specialized medical team prepared to offer consultation, diagnosis, and holistic treatment services for cervical cancer with modern advanced medical facilities and technology.

Cervical Cancer

Is 3rd on the list of all cancers found in Thai women.

Causes

The exact cause is unknown; however the following are risk factors:

1.  Age (more common in women post-menopause)
2.  Ethnicity
3.  Genetics
4.  Diabetes and hypertension
5.  Medication such Tamoxifen (Novalex) over a prolonged period of time
6.  Previous radiotherapy
7.  Receiving estrogen over a long period. Estrogen Imbalance
8.  Women with obesity or who like to eat a high amount of fatty foods

Symptoms

Many people may experience bleeding from the vagina, especially in women nearing menopause. Other symptoms may include: difficulty urinating, pain when passing a stool, pain during sexual intercourse, and pain in pelvic area.

Diagnosis

1.  Medical history of abnormal bleeding
2.  Ultrasound, Vaginal ultrasound
3.  Endometrial biopsy or endometrial curettage
4.  CT Scan,  PET/CT Scan
5.  Hysteroscopic study)

Treatment of Cervical Cancer

1.  Treatment will depend on stage of cancer
2.  There are numerous procedures for treatment
3.  Surgery of uterus, ovaries, and para-aotic lymph nodes
4.  Radiotherapy before and/or after surgery including Teletherapy and Brachy therapy
5.  Chemotherapy – utilized especially when the cancer has already spread, may be used simultaneously with other treatment methods or to reduce chance of recurrence
6.  Hormonal Therapy – Used in more severe cases as a form of palliative care. In some cases such as early stages of the cancer hormonal therapy can be utilized, positive reactions can mean that even after surgical removal of part of the uterus, the patient may still have children.

Prevention

1.  Contraception
2.  Hormone aspects, such as levels of estrogen in women post-menopause
3.  Getting regular exercise, maintaining a healthy diet and weight
4.  Control diseases such as diabetes and hypertension

Author

Asst.prof.duangmani Thanapprapasr, M.D.
Dr. Panon Kasemsan
Dr. Sosakul Bunyaviroch
Dr. Siriwan Tangjitgamol