Cervical cancer

What is cervical cancer?

The cervix is the lower part of the womb which protrudes into the vagina. It is sometimes called the neck of the womb and it has a channel running through the middle which at one end opens into the vagina and at the other opens into the cavity of the womb. Cervical cancer occurs when a malignant (cancerous) growth develops in the cervix.

Cervical cancer is the second most common cancer in women world-wide and there are about 3,500 new cases each year in women under the age of 70.

How does it occur?

Most cases of cervical cancer go through a long 'pre-cancerous' stage where the cells on the surface of the cervix change in appearance for some years before becoming malignant thereby giving a warning sign that cancer may eventually occur. These are the cells that are looked for when a woman has a cervical smear and, since this pre cancerous phase may last for many years, gives the opportunity for treatment to occur before cancer has a chance to develop.

Why does it occur?

No one knows why cervical cancer occurs but it seems to be more common in certain categories of women: those who smoke, those who have had more than one sexual partner, those whose partner has had several sexual partners and women who have had sexual intercourse or a first pregnancy at an early age.

There also seems to be a very strong link between cervical cancer and a virus called the Human Papilloma Virus (HPV) which in some instances causes genital warts. This virus can be passed on during sexual intercourse and seems to play a part in causing many of the cases of cervical cancer. Cervical cancer is extremely rare in those who have not had sexual intercourse.

What are the symptoms?

The pre-cancerous phase gives no symptoms; these warning cell changes can only be detected at this stage with a cervical smear or a colposcopy as described below. Even cervical cancer itself may not cause any symptoms. This is why it is so important for women to have regular cervical smears. It may, however, cause an offensive discharge or vaginal bleeding between periods or after intercourse or it may be the cause of vaginal bleeding after the menopause. There are many other causes for these symptoms but if these do occur then medical advice should be sought.

What are the tests?

• Cervical smear: The simplest test for cervical cancer and pre-cancer is a cervical smear. This is a procedure which is routinely done by a physician, practice nurse or family planning clinic and involves a small instrument called a speculum being inserted into the vagina and a few cells from the surface of the cervix being removed by lightly scraping the cervix with a specially signed spatula. This is sometimes combined with vaginal examination performed by the doctor or nurse.
• Colposcopy and biopsies: If the result comes back significantly abnormal or if the doctor suspects cervical cancer from the symptoms and examination he or she would then refer the patient to a specialist. The specialist would probably go on to do a procedure called a 'colposcopy' where an instrument like a microscope is used to take a closer look at the cervix. This is done as an outpatient and does not require anaesthetic but allows the gynaecologist to make a firmer diagnosis and possibly take small pieces of the cervix (biopsies) to be examined in the laboratory.
• Other tests: If the biopsies confirm cervical cancer, further tests are usually done to "stage" the cancer i.e. to see how far it has spread since this will help to determine the treatment required. These tests may include a pelvic examination under anaesthetic sometimes combined with an examination through a special telescope of the bladder (cystoscopy), lower bowel (procto-sigmoidoscopy) and/or pelvis (laparoscopy).
• CT and MRI scans: The specialist may also order some specialised x-rays or even a CT or MRI scan both of which provide very detailed images of the inside of the body which assist this staging process.

What is the treatment?

Treatment of the pre-cancerous phase before it becomes cancer is usually fairly straightforward and involves either destroying or removing the abnormal cells in a variety of ways. This is often done at the same time as the colposcopy and may be done either without the need for anaesthetic or with the use of local anaesthetic. The cells can be destroyed with laser, by freezing with a special instrument or by cautery with a hot wire.

If the specialist finds that a large area of the cervix is involved or suspects that the pre-cancerous cells are coming from inside the cervical canal he may remove a cone-shaped section of the cervix. This is called a "cone biopsy" and is usually done under general anaesthetic. The tissue removed is then analysed under a microscope.

If a woman is found to have cancer of the cervix then the treatment she receives will depend on a variety of factors including the stage of the cancer, her age and whether or not her family is complete. Usually treatment involves surgery and or radiation therapy. If the cancer is only on the surface of the cervix, the gynaecologist may destroy the cancer cells in ways similar to those described above for pre-cancerous cells.

If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix the specialist may be able to remove just the affected tissue without having to remove the whole womb. However, it is more likely that he will advise a hysterectomy (removal of the womb including the cervix) and sometimes the ovaries and fallopian tubes are removed along with lymph nodes near the womb. This is called a Wertheim's hysterectomy.

In some cases radiation therapy (radiotherapy) is used instead of or as well as surgery and on occasions cancer killing drugs are given (chemotherapy). The specialist will usually discuss why he has decided on a particular treatment and the pros and cons of each type.

Medications

Information	Brand	Generic	Label	Rating
	Accutane	Isotretinoin

Are there side effects of treatment?

The side effects of treatment depend on the type and extent of the treatment. The methods described for removing or destroying small areas of cancer on the surface of the cervix may cause no side effects or at the most may result in crampy pain, a small amount of vaginal bleeding or a watery discharge. However, one effect of a cone biopsy is that the cervix may be weakened as a result and occasionally a woman may require the cervix to have a special stitch put into it to reduce the risk of a late miscarriage.

A hysterectomy is major surgery and therefore the side effects will be those of any abdominal operation but a gradual return to normal activity should be possible over the course of 4 to 8 weeks.

If radiation therapy is given, the woman is likely to feel very tired especially as the treatment continues and she may also get other effects such as skin changes or even a narrowing of the vagina. It is a good idea for the woman to ask what to expect before the treatment starts. This also applies when chemotherapy is used since the side effects are variable but again it is usual for the patient to feel very tired and they are likely to feel nauseous, lose their appetite and also lose their hair.

Can cervical cancer be prevented?

The most important measure for preventing cervical cancer is for all women who are having or who have ever had sexual intercourse to have regular cervical smears at least every five years although some doctors recommend them every 3 years. Nearly 70% of women who die from cancer of the cervix have not had routine cervical smears. Other factors that can help to prevent someone from developing cervical cancer are delaying the start of sexual relations or starting a family until at least the end of their teenage years and using barrier forms of contraception such as the cap and sheath which are thought to protect against cervical cancer. Finally, giving up smoking reduces the risk of developing cancer of the cervix.

Are there new developments in treating cervical cancer?

A vaccine against cervical cancer is currently at the stage of being tested. Since 9 out of 10 cases of cervical cancer are linked to the HPV virus it is thought that by giving a vaccine against this virus to women who have pre-cancerous changes it may protect them from going on to develop cancer.

Last updated 23 December 2015