There are several risk factors involved in contracting HPV. They include, multiple sex partners, poor nutrition, and presence of other sexually transmitted diseases, sex at an early age, smoking and substance abuse.
Intercourse is not required for the virus to transfer from an infected man to a woman. The virus lives very happily in secretions and on the surface of the scrotum and penis and is easily transferred by genital-to-genital contact. Being a virgin does not protect you from an HPV infection. The chances of both having an infection and then going on to develop cervical lesion because of an infection increase the more male sexual partners a woman has. (Rushing 195)
Smoking is the second greatest risk factor. The by-products of nicotine are concentrated 1000 times in the cervical tissue. There is an interaction between the HPV infected cervical cells and substances found in cigarette smoke, which promote the development of cervical cancer.
“Cervical cancer is preventable and often curable is discovered early. Proper diagnosis, evaluation and treatment of abnormal Pap tests will allow the prevention of cervical cancer.” (Rosenfeld 322)
Approximately half of all cervical cancers occur in women who do not get regular pap tests, these women either do not have health insurance, they are shy about having the test or their cultures prevent them from having it. Language barriers and lack of education are other reasons that women do not get regular pap tests. Women 60 or older simply do not view themselves as being at risk. (Hartman 427)
One other type of prevention is the new HPV vaccine. This vaccine is recommended for females between the ages of 9 and 26. The vaccine called Gardasil targets four types of HPV, types 6 and 1, which cause about 90 percent of all genital warts and types 16 and 18, which cause 90 percent of all cervical cancers. Gardasil is given in three doses over a six-month period and studies have shown that immunity is still high after five years.
Cervical cancer is diagnosed by several tests. The first test is called a pap test and is a test that is typically done annually. A pap test is a screening test and not a diagnostic test. This test not only screens for HPV but also several other sexually transmitted disease such as Chlamydia, Herpes and Trichomonas. Tests should be performed yearly on any woman over the age of 18 and on younger females who are sexually active.
The Pap test consists of scraping cells from the cervix and looking at them under a microscope. If the cells are normal the patient can schedule a return visit in one year. If abnormal cells are detected than further evaluation and treatment is needed. Further treatment is determined by how abnormal the cells are. The abnormal cells found in the cervix are called cervical intraepithelial neoplasia or CIN. There are three stages of CIN, they are, CIN I in which the cells are mildly abnormal, CIN II in which the cells appear moderately abnormal and CIN III, where the cells are severely abnormal. CIN III is also known as carcinoma-in-situ or cancer that is in place. The cells appear cancerous but are limited to the surface of the cervix.
The cell samples are sent to a pathologist for examination, as he views the samples under a microscope he is looking for two types of cells, squamous carcinomas and adenocarcinomas. Squamous carcinomas are cancer cells that develop in the lower portion of the cervix and account for 85-90 percent of all cervical cancers. Adenocarcinomas account for 10-15 percent of all cervical cancers and are found in the upper portion of the cervix. Once the pathologist has determined the type of cancer cell then further diagnosis is needed to determine the stage. This determination is usually done by the doctor and is called a colposcopy with biopsy. This procedure is where the doctor looks at the cervix with a small microscope and takes larger samples of the cervix not just the surface cells. These samples are then sent to the pathologist to determine the stage of the cancer.
This staging is based on the FIGO system. Once the stage of cancer has been determined then further treatment can be decided. If the cancer is stage 0 then generally the colposcopy with biopsy will get rid of the abnormal cells. Deeper invasive cancers need a more extreme treatment. Stage I cancers can be removed using either a cold conization also known as cone-biopsy or the loop electro surgical excision procedure also known as LEEP.
The LEEP procedure is less invasive and can be done in the physician’s office using a local anesthesia. A thin wire carrying an electrical current is used to remove a thin layer of the cervical tissue. If the cancer cells are deeper in the cervical tissue than the cold conization is recommended. This procedure must be done under general anesthesia in an operating room. A scalpel or laser is used to remove a thicker piece of the cervical tissue. Most women who have the cold conization can return home the same day.
If the cancer has spread to the vaginal canal or in to the uterus, generally a hysterectomy is recommended. A hysterectomy is the removal of the uterus, the cervix and if necessary the ovaries and lymph nodes in the pelvis.
If the cancer is advanced than a combination of treatments may be required. This combination can consist of surgery, radiation and/or chemotherapy. Radiation therapy can be delivered to the affected site in two ways, either by an external beam, which is non-invasive and is similar to a chest x-ray. The other way to deliver radiation is by placing the radiation close to the cancer, usually by some form of implanted internal device. Cervical cancer is one of the few cancers that in its early stages can be completely treated by radiation. In more advanced stages radiation can be used to control the spread of the disease.
The five-year survival rate for women with cervical cancer varies depending on the stage of the cancer. Approximately two-thirds of women diagnosed with invasive cervical cancer survive long term without experiencing a cancer recurrence. In the remaining one-third the cancer comes back months or years later, however most recurrences happen within two years of receiving initial diagnosis. (Hartman 462)
A diagnosis of cancer produces a roller coaster of emotions. Diagnosis and treatment can cause great distress both physically and emotionally.Follow-up care can cause feelings of anxiety or sadness often because of the fear of recurrence.
Certain feelings such as disbelief, fear, anger, anxiety and depression seem to be the most common. The patient feels disbelief generally at diagnosis, they are unable to concentrate, cannot believe this is happening or may deny the diagnosis and pretend that nothing has happened.Fear comes from the unknown.The imagination takes over and the patient’s mind comes up with all kinds of terrible things that the cancer might do. The patient can also feel fear of treatments and procedures and their side effects or fear that they cannot handle everything that is being thrown at them.
Anger portrays itself in the feeling of unfairness and often gets taken out on close friends and family. Tests, treatment and cancer recurrence are all factors that can bring on the feeling of anxiety. Anxiety can also be brought on by medical factors such as uncontrolled pain and certain medications.
Anxiety and depression should be closely watched as sometimes they become overwhelming and the patient may need psychological help with coping. Both disorders have specific side effects that should be watched for. Signs that can indicate anxiety has exceeded its normal threshold include intense worry or fear, restlessness, trouble sleeping, fatigue, rapid pulse, shortness of breath, sweating or chills or a feeling of detachment.Signs of major depression can be persistent sadness, feeling of anxiety, changes in appetite or sleep patterns, loss of energy, mood changes, feelings of helplessness, hopelessness, worthlessness or guilt or recurring thoughts of death or suicide. (Hartman 501)
The physical impacts on a patient can lead to emotional impact. Some of the physical impacts are chronic pain; sleep disturbances, nausea, loss of appetite and weight loss and loss of physical activity. Invasive cervical cancer that requires a hysterectomy has its own impacts on the physical body, which are hot flashes, night sweats and vaginal changes such as dryness and painful intercourse. Chemotherapy can cause a long-term physical impact. Osteoporosis is a side effect of chemotherapy and causes the bones to become brittle. Drugs from chemotherapy can affect the brain and loss of memory or concentration difficulties can occur.
