A simple test is all it takes to prevent cervical cancer

By Carol Aloysius

Cervical cancer in Sri Lanka and globally is on the rise. Yet there is a simple test that can detect and prevent this cancer in women which can lead to death. A pap smear, a simple procedure which takes a few minutes can be done in any out patient clinic or even in mobile clinics. It has no side effects, but will indicate any abnormality of the cells which can be arrested, thus preventing a cancer that kills millions of women worldwide.

Maharagama Cancer Hospital Consultant Oncologist, Dr Lakshman Obeysekara explains what cervical cancer is, how a pap smear can prevent it and treatment procedures.

Excerpts of the interview

Question: Cervical cancer has been ranked as the second leading cause for deaths in Sri Lanka. Are the causes similar to other forms of cancer e.g. breast and thyroid cancer?

Answer: No. The causes for cervical cancer are different from other cancers. There are many risk factors e.g. if a woman has had multiple partners, early intercourse, unprotected sexual contact and sexual promiscuity are some of these factors. It is due to a virus called (HPV) HUMAN PAILLOMA VIRUS. There are many strains of this virus. Depending on the strains the risk vary e.g. HPV 16, 18, 31 are the proven ones that can cause the cancer. Not all types of HPV cause cervical cancer. Some of them cause genital warts but other types may not cause any symptoms. Even without any of the above risk factors one can get the cancer.

Q. Judging from the number of patients attending the Maharagama clinic, what are the ages of women most at risk? Teenagers? Young women? Middle aged women? Elderly women? What makes these age groups at risk more than other age groups?

A. We commonly see patients in middle age like those in the 40s and early 50s. The precancerous lesions also called CIN = CARCINOMA IN SITU starts early in age in the mid twenty's to thirty's and it converts slowly to an invasive cancer. So once they reach the age of 40 or 50. They get the symptoms of a cervical cancer.

Q. What is the main cause or causes for cervical cancer? Genetics? Diet? Unhealthy habits? Can it be prevented?

A. As I have already mentioned, it is mainly related to sexual contact. However, genetic make-up, poverty, unhygienic lifestyle also can lead to this. It is a preventable form of cancer. Health education and screening and doing pap smear tests are the main methods of prevention. Young women are the main target population. We encourage them to get the pap smear yearly after the first sexual intercourse. By doing this we can identify any cellular changes in the cervix and remove it.

If we detect it early or at pre-cancer stage it is 100 percent curable.

Q. In what district of the island do you see a surge in cervical cancer? Urban? Rural? Semi urban? Why?

A. According to the 2006 cancer register, the Anuradhapura district ranks the highest and Polonnaruwa is second.

It is more commonly seen in lower socio-economic groups. Poor hygiene, the lack of knowledge, social barriers, ignorance, are some of the predisposing factors. Semi urban and rural communities are mostly affected. Women who work overseas without their families are also in the high risk category due to well- known factors.

Different forms

Q. Are there different forms of cervical cancer?

A. There are two types SQUAMOUS CELL- CA and ADENO- CA 95 percent belongs to the first category.

Q. Which form is most virulent? Why?

A. The adeno carcinoma is more virulent than the other forms, as it is less sensitive to radiotherapy. So the chances of recurrence is high.

Q. What options are available at state hospitals like Maharagama to detect the disease early? Do you conduct pap smear tests there or are these tests only done at the MOH offices? How often do you need to be screened for cancer?

A. All general hospitals, base hospitals, Maharagama hospital and even the district hospitals are doing the Pap test. MOH offices also conduct these tests. Well Women clinics and they provide the services free of charge.

We recommend the public to get the test done at least once a year. If not after the first one, once in three years is also advisable. If any abnormality is detected in the pap smear the doctor will ask the patient to get the test more frequently - may be every six months as a safety precaution.

Q. What are the services for cervical cancer patients in Maharagama? Is it only a treatment facility?

A. The Cancer Institute Maharagama provides all forms of cancer treatment because it is a tertiary care hospital where all the facilities are available to cater to any form of cancer- related problems. Here we not only provide treatment but also provide health education screening and oncology teaching.

Q. If a patient detected with cervical cancer needs treatment, is this available only at Maharagama? If not, what are the state hospitals where they have facilities for treating patients with the disease?

A. Maharagama is the National Cancer Hospital but there are other hospitals which provide similar treatments such as Kandy, Karapitiya, Jaffna, Anuradhapura and Badulla.

Q. What happens when the hospital runs out of its supply of certain essential drugs for cervical cancer? Do patients have to buy their own drugs and where? Does the hospital cover their expenses? When a poor woman who needs emergency surgery is unable to pay the costs, will the hospital still go ahead with the surgery? Or postpone it till she can raise the funds?

A. Cervical cancer treatment is a straightforward treatment, if the lesion is in the early stage. Surgery is the main stay of treatment. If not chemo radiotherapy is the other option. The hospital does not charge a cent from patients for surgery. Regarding drugs - there are no drug shortages for this form of cancer because limited chemotherapy drugs are used for this cancer. Radiotherapy plays a major role in this regard which is also free of charge.

Q. Cancer drugs in general are often unavailable or in shortage. When this happens do patients have to buy their own drugs from the SPC or the private sector? Does the hospital have a separate fund to bear the costs of poor patients?

A. The hospital spends millions to treat cancer patients. Admittedly there is a shortage of certain drugs due to various reasons occasionally. But whenever shortages occur we make special requests to the MSD (Medical Supplies Division) of the Ministry of Health and request for these drugs, which are very costly. This service is given to any person who comes to the hospital and needs treatment. We do not consider their income.

Q. How many patients (out patients) does the Maharagama hospital treat per day? How many inpatients can the hospital accommodate? Are the available beds enough to meet the demand?

A. We have more than 1,000 outpatients coming for treatment and follow- up services daily. There are 960 beds in the inpatients wards.

The bed capacity is inadequate to provide state-of-the-art treatment. The entire does its best to treat these cancer patients.

Q. We have been told that due to the demand for beds, patients have often had to sleep under beds or sit on chairs even just before surgery. Your comments?

A. It is correct in some wards the number of beds are inadequate so patients have to wait until a bed is vacant. This problem is not only for cancer patients. Most state hospitals in Sri Lanka face this problem due to the limited resources.

Q. There is an allegation that there are too many specialists at the Cancer hospital in Maharagama. Your comments?

A. I totally disagree with that. If at all it is insufficient. In other countries specialists are there for each type of cancers e.g. head and neck cancer specialists, breast cancer, gynaecological cancer specialist. Here in Sri Lanka, we have to cover all types of cancers due to the limited number of specialists. The infrastructure also has to be improved with more manpower.

Q. From your experience as a paediatric cancer specialist, what are the risks that children face in getting cervical cancer?

A. There are oncologists who treat only children. I used to treat them at one time but not any more. According to my knowledge children do not get cervical cancer, but there are other forms of cancer that can arise from the female genital organs during childhood.

Prevention

Q. How can cervical cancer be prevented? Apart from pap tests, are there any new techniques of detecting it?

A. There are vaccines in the market for HPV. By taking this we can protect them for a certain extent. The common strains are used to develop these vaccines. So if the particular strain is responsible for the cancer it can be prevented. Other than that there is a machine called the colposcope, where we can observe the cervix more closely and identify early cellular changes and screen them.

Q. What is the procedure you follow once a patient has been diagnosed with the disease?

A. We do some basic investigations like a biopsy, CT scan and do staging and refer the patient to an onco-gynaecologist for assessment. If he agrees for surgery depending on the stage, it is carried out. If not chemo-radiotherapy will be given.

Survival

Q. What are the chances of survival of a patient in the (1)First stage of the disease (2) Second stage (3)Third stage (4)Final stage?

A. Stage 1 - 80 percent, Stage 2 - 60 percent, Stage 3 - 40 percent and Stage 4 percent - 20 percent with a five-year survival chance.

Q. Your message to women on how to prevent cervical cancer?

A. Be aware of this illness. Learn how it can occur. Get pap smears and medical advice if there are any symptoms like vaginal discharge, post coital bleeding, lower back pain.

Take precautions if you are in a high risk category. Most importantly, lead a healthy lifestyle.

Rasa Shasthra, an ancient Ayurveda system

By Dr. Lalith Kularathna

In the lore of medical science Rasa Shashthra is an Indian Vedic Alchemy. It is an effective medical therapy administered by fusion of purified metals, herbs and other substances to treat illnesses. One of the salient features of the Rasa Shashthra is the use of metals, including one such as Mercury considered to be toxic by modern day Western medical treatment. In addition to mercury, gold, silver, iron, copper, tin, lead, zinc and bell metal are also used in Rasa Shashthra treatment.

These metals are subjected to a process of transmutation to make them substances with curative properties which could heal various illnesses.

These metals and other substances subjected to a procedure called calcination which is described in the Sanskrit literature as Shodhana or "Purification", being the process used to prepare Bhasma (Ash) for administration.

The process of sublimation and purification is designed to get rid of the undesirable attributes of these metals with a view to enhancing their curative properties and therapeutic values. Historically, Rasa Shastra or Vedic Chemistry or Vedic Alchemy, is a scion of the Ayurveda System of Treatment which developed more than 2,500 years ago.

This special branch of medicine is called Rasa Shashthra. Rasa Shashthra system uses metals, gems, minerals and substances considered as poisonous to produce special formulations to combat acute and serious diseases. It is a medical science called alchemy.

The medications are called Rasas comprising metallic ashes called Bhasmas. Rasa Shashthra was invented by a Buddhist monk and practising alchemist called Nagarjuna. He discovered the method of refining precious metals, gemstones and other minerals to produce medications to treat illnesses.

Nagarjuna discovered that Bhasmas are able to carry the herbs mixed with them faster to the desired sites to bring about required healing action immediately. They in fact act as catalysts and increase the bioavailability of the herbs to the cell. After performing the desired action, the Bhasmsas are eliminated through our excretory systems of the human body.

With the practice of surgery started declining as it came to be considered as being invasive, the therapists of the day found a viable solution in Rasa Shashthra as it was able to bring about the effects of surgery whilst doing away with the risks associated with surgical procedures.

Rasa Medicines are highly potent formulas and are administered in very small quantities. They act fast and offer quick relief. Rasa Medicines are tasteless, odourless and truly miraculous in efficiency and potency.

Rasa Medicine System of medical treatment was introduced to Sri Lanka by the renowned Ancestry of Belideniya Ayurvedic Practitioners in 1898. Muhandiram A.P. Waidyasena was the first Rasa Shashthra practitioner in Sri Lanka. Rasa Medicine is fast gaining ground in Sri Lanka.

It has achieved phenomenal success and proven as a sure fire remedy for chronic, life threatening and non communicable diseases. Many hapless people who have been written off by western medical establishment to face near certain death have been rewarded with a new lease of life thanks to robust and effective therapy offered by Rasa Shashthra.

Rasa Medicines obviates the need to go through risky surgeries and bring about speedy relief through much simpler methods of treatment.

Moreover it is less costly as compared to most of the expensive surgical procedures and hence could be availed by the majority starting from lower income strata. Some of the highlights what has to date been accomplished by Rasa Shashthra Therapy in this country proves why it should fostered as a viable alternative treatment for the benefit of the majority in Sri Lanka.

Rasa Medicine Practice has accomplished several remarkable achievements such as:

*Permanent cure for various forms of cancer including Leukaemia,

*Definitive recovery from heart disease,

*Speedy recovery from menacing triglycerides,

*Remedy for Parkinsons disease caused by Vatha,

*Miraculous healing of congenital blindness and

*A proven, simple and effective remedy for dengue

Congenital blindness is a condition that could be considered practically incurable. There have been many a scientific study, research and experimentation carried out to date with the objective of making a breakthrough.

Scientists have made great efforts to evolve a solution and tried gene therapy, but made very little progress so far as they have encountered unexpected complications in the process.

A lot of research work has been carried out on a condition called LCA, a retinal disease which leads to total blindness in adulthood.

Life Style Disease (LSD) is a common currency today. LSDs are associated with the modern day lifestyles of human beings. Due to the vast advancements in industrial development and modern technology countries have become industrialised and affluent.

The resultant diet patterns, environmental factors and fast phase of living people are facing the heightened risk of afflicted by conditions such as atherosclerosis, diabetes, hypertension, asthma, cancer, chronic liver disease, stroke, cardiac disorders, osteoporosis, obesity and depression.

Pre-dominant dependence on use of medication to treat these conditions has exacerbated healthcare problems with some of the side effects of medications result in chain reactions adding on to chronic and serious conditions already affecting people needing increased therapeutic attention.

Many clinical and scientific research carried out have revealed that Rasa medications are capable of quick action on the targeted areas of the human body. These experiments have effectively put to rest the unfounded concerns relating to the presence of heavy metals in medications and their impact on human body. Bhashmas that enter the human body as nano particles have been found to be effective in delivering rapid therapeutic action enhancing the absorption and metabolism of the ingredients which results in very high efficacy of these substances.

This proves beyond any doubt the magical curative properties of the detoxified metals used for Rasa Shasthra Treatment that have practically no parallels in any other form of medical treatment being practised in this world and their importance in tackling mounting healthcare issues of modern day living.