CERVICAL CANCER IN BOTSWANA

By Monkgogi Khana Khomela and Wedu King

INTRODUCTION

• Cervical cancer is the abnormal cell growth (dysplasia) in the opening of the uterus. This growth has the ability to invade and spread to other parts of the body.

• Current estimates indicate that every year, 250 women are diagnosed with cervical cancer and 111 die from the disease. This is in Botswana alone. Associated with the high prevalence of HIV in the country.

• Cervical cancer ranks as the 1st most frequent cancer among women between 15 and 44 years of age. With a crude incidence of about 24.6%

ETIOLOGY

About 90% cases are said to be caused by the Human Papilloma Virus.

Smoking

Birth control, mostly oral contraceptives

Early sex ???

HPV

• HPV is a non enveloped DNA virus from the papilloma family of viruses.

• There are about 170 types of HPV, most discovered in the 20th centuary BUT its precancerous effect on mammals was brought to light in 1935 by Francis Peyton Rous.

• Cervical cancer has been linked to the high risk HPV16 and HPV18 accounting to 75% of cases and moderate risk HPV31 and HPV45

HPV

• HPV life cycle is similar to every other virus. What may be peculiar to it specifically is that it 'likes’ to replicate exclusively in Keratinocytes. On the outer layer of the skin on Stratified squamous epithelium.

• It makes its entry via microtrauma and invades the cells. Inactivating suppressor genes such as p53 resulting increased somewhat random cell growth.

• In this case HPV is considered a causative agent that is an STI. But the cancer itself is not an STD!

SYMPTOMS

• Vaginal bleeding that isn't normal, such as between menstrual periods, after sex, or after menopause.

• Pain during sex.

• Vaginal discharge that isn't normal.

• A significant unexplained change in your menstrual cycle.

SYMPTOMS

Advanced symptoms:

• Anaemia because of the abnormal vaginal bleeding

• Urinary problems because of blockage of kidney or ureter

• Weight loss

DIAGNOSIS

• Pap smear (screening test)

• Colposcopy and cervical biopsy

CIN (cervical intra epithelial neoplasm) grading:

1-mild dysplasia affecting the basal third

2-moderate dysplasia affecting two thirds of basal cells

3-severe dysplasia affecting more than two thirds of the basal cells

CT scan, MRI, Chest X ray ,ultrasound to check if it has metastasized to any other part of the body

TREATMENT

• Surgery - to remove the cancer depending on the extent

• Radiation- used in certain stages usually combined with surgery

• Chemo radiation -used to treat both early and late stages

• Chemotherapy -used to treat advanced cervical cancer

• Treatment during pregnancy is the same as for non pregnant women

• Follow up care is usually pap smear every 3-6 months for the first 2 years and then every 6 months for another 3-5 years

• Prognosis is 5 years survival rate for the earliest stage but lower if it has already metastasized

PREVENTION

• Have regular Pap test screening

• Quit smoking- as it increases the risk for cervical cell changes

• Get the HPV vaccine- usually recommended for girls from 11-26 years and boys till age of 21. Gardasil and Cervarix are the names

• Reduce the risk of sexually transmitted infections by being responsible ( safe sex)

THANK YOU

REFERENCES

• https://fbcdn-sphotos-h-a.akamaihd.net/hphotos-ak-xpf1/v/t34.0-12/10745054_10205392198431513_1040689020_n.jpg?oh=8f88417c2f3edbd9ad1

• http://www.hpvcentre.net/statistics/reports/BWA_FS.pdf