By Henrylito D. Tacio
Hong Kong pop star and actress Anita Mui Yim-fong remained an idol throughout most of her career. But her career, however, came to a halt in September 2003, when she publicly announced that she had cervical cancer. She assured her fans that her condition was stable and that she had no fears and would win the fight. “I am not a weak person… I can tell you that I have never had any fears and I will win this fight,” she was quoted as saying.
It was widely believed that she had chosen holistic health treatments rather than surgical therapy because she wanted to preserve the possibility to conceive. Knowing that she would succumb to cancer, she had a series of shows entitled the “Anita Classic Moment Live Concert” that consisted of eight shows at the Hong Kong Coliseum.
Around 4 months after the cancer announcement, she was admitted to the Hong Kong’s Sanitarium Hospital after slipping into a coma. At the age of 40, she died of respiratory complications leading to lung failure on the early morning of December 30.
Cervical cancer is one of the most common cancers affecting women around the world with 500,000 new cases and 250,000 deaths each year, according to the World Health Organization (WHO).
In the Philippines, cervical cancer kills 12 women each day. It is considered as women’s enemy number two. “In the Philippines, cervical cancer is second to breast cancer as the most common malignancy that afflicts and kills women with conservative estimates between 35,000 and 70,000 cases with almost 7,000 new cases added every year,” reports Dr. Cecilia Ladines-Llave, former chair of the University of the Philippines-Philippine General Hospital Cancer Institute.
Between breast cancer and cervical cancer, the latter is deadlier. Rina Jimenez-David, a recognized advocate in reproductive health, puts it this way: “While breast cancer is the most common form of cancer for women in the country, it is not the deadliest. The death toll from cervical cancer is higher than for breast cancer, and this is mainly because by the time its victims come for treatment, it is already too late.”
Women who are 35 years old and above are the most affected. “About 80-90% of confirmed cervical cancer cases occur among women aged 35 or older,” notes Preventing Cervical Cancer Worldwide, published by the Population Reference Bureau (PRB) and Alliance for Cervical Cancer. “Because cervical cancer progresses slowly from precancerous to advanced cancer, the incidence of cancer in most countries is very low in women under age 25. Incidence increases at about age 35 to 40, and reaches a maximum in women in their 50s and 60s.”
The cervix, the lowest portion of the woman sex organ, juts into the vagina where it can be felt, seen, and examined by the gynecologist. Its lips surround an aperture that opens into a canal leading into the interior of the uterus. That’s the route the sperm follows for its rendezvous with the egg. During pregnancy, the cervical lips become progressively softer so that they can dilate sufficiently when it is time for the baby to exit the womb.
“The cervix sees lots of action in the lifetime of most women, from the trauma of innumerable penile thrusts, to a variety of infections,” notes Dr. Isadore Rosenfeld, the author of The Best Treatment. “No small wonder, it is often the seat of cancer.”
About 85 percent of cervical cancers are squamous cell carcinomas, which develop into the scaly, flat, skin-like cells covering the outside of the cervix. Most other cervical cancers develop from gland cells (adenocarcinomas) or a combination of cell types (adenosquamous carcinomas).
“Cervical cancer can penetrate deep beneath the surface of the cervix, enter the rich network of small blood and lymphatic vessels that line the inside of the cervix, and then spread to other parts of the body,” explains The Merck Manual of Medical Information. “In this way, the cancer can spread to distant areas as well as to areas near the cervix.”
Generally, the primary underlying cause of the uncontrolled growth of severely abnormal cells in the cervix is human papillomavirus (HPV), the most common sexually transmitted infection worldwide.
More than 70 types of HPV have been identified, but only 23 of these infect the cervix. In the Philippines, the most common types of HPV are the types 16 and 18, both of which caused 70% of cervical cancer. The two types also cause 40-50% of vulvar cancers and 70% of vaginal cancers, said Dr. Rey de los Reyes, a gynecologic oncologist.
While HPV is so common, not too many women know about cervical cancer that it causes. “Each woman has to be well informed about this disease,” urges Dr. Mildred Yutuc, a practicing obstetric-gynecologist. “In this way, she will be aware of its presence before it is too late.”
But most Filipino women seem not to have heard of cervical cancer. In fact, two-thirds of the cases detected in the country are already in the advanced stage of the disease, according to Dr Delos Reyes.
Filipino women usually don’t go to a doctor unless there is something unusual. Unfortunately, cervical cancer like other forms of cancer usually has no early symptoms which makes early detection difficult.
In some instances, some symptoms may manifest like abnormal vaginal bleeding, increased vaginal discharge usually whitish to yellowish in color, pelvic pain, and pain during sexual intercourse.
Unlike breast cancer, it is not hereditary. Filipino women also abhor going to a doctor because cervical cancer is regarded as a sexually transmitted disease. As Dr. Philip Chua, a medical practitioner who writes a column for a national daily, points out: “The risk of developing cancer of the cervix is inversely related to the age at first sexual intercourse and directly related to the number of sexual partners over the lifetime of the woman.”
In other words, the younger a woman was the first time she had sexual intercourse and the more sex partners she has had, the higher her risk of cervical cancer. While women may contract HPV when they are young, cervical cancer is most likely to develop in women 35 years or older.
“While cervical cancer is sexually transmitted, it doesn’t necessarily mean that you’ve been sexually promiscuous (or a prostitute!) if you should develop cervical cancer,” Jimenez-David wrote in her Philippine Daily Inquirer column. “Even if you’ve been monogamous, your partner may not have been, and even just a single encounter with an infected partner could end up infecting him with HPV which he in turn could pass on to you.”
While HPV does not generally affect the health of a man, it can lead to cervical cancer in a woman. “You never know what cancer-causing agents a lover may bring to your cervix,” says Dr. Rosenfeld. “It is especially important to be prudent in your pre- or early teens because that’s when the cervix is probably ‘set up’ or primed for cancer developing later in life.”
Although nobody really understands why, more women who smoke cigarettes have cervical cancer than do nonsmokers. “Their cervical mucus, and that of passive smokers, too, contains a large amount of nicotine,” Dr. Rosenfeld explains. “So, if you’re worried about getting cancer of the cervix – not to mention cancer of the lung, bladder, mouth or pharynx, or a heart attack – stop smoking, right now, and never start if you haven’t already done so.”
An ounce of prevention is better than a pound of cure, so goes a saying. Unlike other cancers, the progression of cervical cancer is really slow and has a huge interval (which takes five to 10 years, or even 15 to 20 years).
Papanicolau smear tests, or pap smears, have saved a lot of lives of women in industrialized countries. The Philippines seems behind on this as most Filipinas are hesitant to such screening. They are either shy or they don’t want to find out that they may be carrying the disease.
Councilor Dr. Josephine Villafuerte, who used to be the city health officer of Davao City, said that a pap smear is a test of a sample of cells taken from a woman’s cervix. “The test is used to look for changes in the cells of the cervix that show cervical cancer or conditions that may develop into cancer,” she was quoted as saying by SunStar Davao. “Pap screen testing should begin at age 21. Routine screening is recommended every two years for women 21-29 years old. For certain women 30 years and older who have had three consecutive normal screening test results, testing can be done every three years.”
The Department of Health (DOH) said cervical cancer is curable if detected early. In fact, it can be actually prevented by getting vaccinated against HPV. But once a woman is diagnosed with cervical cancer, it has to be treated.
According to the National Cancer Institute (NCI) in the United States, treatment options for cervical cancer depend on the following: the stage of the cancer, the size of the tumor, the patient’s desire to have children, and the patient’s age.
“Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born,” NCI advises.
Treatment for cervical cancer involves surgery and radiation therapy. Sometimes, chemotherapy or biological therapy is used. Surgery removes abnormal tissue in or near the cervix. If the cancer is only on the surface of the cervix, the doctor may destroy the cancerous cells in ways similar to the methods used to treat pre-cancerous lesions.
Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. Chemotherapy is the use of drugs to kill cancer cells. It is most often used when cervical cancer has spread to other parts of the body. The doctor may use just one drug or a combination of drugs. Biological therapy is treatment using substances to improve the way the body’s immune system fights disease. – ###
