Cervical Cancer

[Soroush Ebrahimi]

Dear Colleagues & friends
Although this article is written for GPs, I thought it would be useful to colleague homeopaths too.

http://www.pulsetoday.co.uk/clinical/ho ... V6NmqJm_N4
It is important to be aware of the symptoms and signs of cervical cancer, so that women can be diagnosed early while curative treatment is still possible.

A key symptom is abnormal vaginal bleeding and, in particular, postcoital bleeding. Cervical cancer is also associated with inter-menstrual and post-menopausal bleeding. Persistent offensive vaginal discharge is another symptom.

Pain during sex, back pain, abdominal pain, incontinence and weight loss are symptoms of more advanced disease. Cervical cancer is a disease of younger women – it is the most common cancer in women under 35 years old. The key questions to ask and pitfalls to avoid are listed in the boxes below.

Differential diagnoses

* Postcoital bleeding and offensive discharge in a young woman will most commonly be caused by a sexually transmitted infection such as chlamydia or a bacterial vaginosis (mainly infection with Gardnerella vaginalis, presenting with a typical fish-like odour).

* Benign cervical polyps can also cause bleeding after sexual intercourse.

* Intermenstrual bleeding may be because of hormonal causes or poor compliance with the combined oral contraceptive pill.

It is important that cervical cancer is excluded in women presenting with these symptoms before they are attributed to benign causes.

Don’t be misled by a recent negative smear because – although rare – interval cancers can occur, as can false negatives.

Investigations

The first and most important step is to examine the patient and visualise the cervix. If the cervix is clinically normal, it is appropriate to take swabs to exclude an infection. Visualisation of the cervix will also enable the GP to exclude benign cervical polyps.

If the cervix is abnormal in appearance, friable or with an exophytic or destructive lesion and contact bleeding, referral to a specialist under the two-week rule is indicated. Don’t take a cytology sample if there is a suspicion of cervical malignancy – cytology is only for screening in an asymptomatic population.
Five key questions

* When did the abnormal bleeding start?

* What triggered the abnormal bleeding? (For example, sexual intercourse, exercise, poor compliance with hormonal medication)

* Is there an associated offensive discharge?

* Is there pain with intercourse or at any other time?

* Is there a history of previous abnormal smears?

*

Five red herrings

1. A recent normal cervical smear – interval cancers and false negatives can occur

2. Patients who are outside the screening age bracket – under 25 or over 65

3. The patient is not currently sexually active

4. Ectropions or polyps - these can coexist with malignancy

5. A normal pelvic ultrasound – an ultrasound scan cannot diagnose cervical cancer.
Regards

Soroush