The cervix is the lower, narrow part of the uterus, which connects the uterus to the vagina, and is part of the woman’s reproductive system. Cancer of the cervix is called cervical cancer. This type of cancer is usually slow-growing, and can take up to 10 years to develop. Cervical cancer is therefore often preventable by regular screening. This is most often done in the form of a Pap smear, which tests the cells lining the cervix for abnormalities. Over the past decades the number of women diagnosed with cervical cancer each year has been declining, which is thought to be mainly due to the success of campaigns that have raised awareness about the benefits of having regular Pap smears.
Cervical cancer is usually treated by a combination of surgery, radiotherapy or chemotherapy. There are many side effects associated with these treatments, such as fatigue, pain, hair loss, nausea, diarrhoea and vomiting, but researchers are continuing to study cervical cancer to find out more about how it develops, and are looking at better ways to treat it.
In the early stages of cervical cancer there are often no symptoms, however as the disease worsens there are a number of symptoms that a woman may experience. These include:-
· Pain in the pelvic area
· An increase in vaginal discharge
· A sensation of pain during sexual intercourse
· Longer or heavier menstruation
· Abnormal vaginal bleeding such as:-
o Irregular bleeding that occurs outside the normal menstrual period
o Bleeding after menopause
o Bleeding after a pelvic examination, during sexual intercourse of after douching
It is important to note that many of these symptoms can also be caused by other health problems such as infection, therefore it is important to seek prompt medical advice, and to not fear cancer in the first instance.
Cervical cancer is usually first detected by routine Pap smears (see below), which are recommended every two years for women, starting after the first time they have sex. If a Pap smear finds abnormal or cancerous cells in the cervix, then a doctor will suggest other procedures to confirm the diagnosis of cervical cancer or to gain more information on the extent of the disease. Other tests may include:-
Colposcopy is a common follow-up for an abnormal Pap smear. The cervix is observed using a colposcope, which is a type of microscope, with a magnifying lens and a bright light. This makes the tissue of the cervical wall easier to see.
Endocervical curettage involves the use of a curette (a small, spoon-shaped instrument), which is used to scrape a small sample of tissue from the cervical canal.
Biopsy involves the removal of a small area of cervical tissue. The tissue sample is then sent to a pathology laboratory, where it is examined under a microscope for abnormal or cancerous cells. There are two types of biopsy generally used for detecting cervical cancer. A punch biopsy, uses a sharp, hollow device to pinch off small samples of cervical tissue, while a cone biopsy (Conization) removes a cone-shaped wedge of tissue from beneath the surface of the cervix.
If these procedures reveal the presence of cancerous cells in the cervix, then additional tests may be carried out to determine whether the cancer has spread to others areas of the body, and also to determine the severity (stage) of the cancer. For example, X-ray, ultrasound, MRI and CT scan can be used to see if the cancer has spread to the lungs, liver, or elsewhere in the body. There are five stage of cervical cancer. These include:-
Cancerous cells are found only in the top layer of tissue that lines the cervix.
Cancerous cells have spread beneath the top layer of cells, but are found only in the cervix.
Cancerous cells have invaded nearby tissues, such as the upper part of the vagina, but have not spread to the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).
Cancerous cells have invaded the lower part of the vagina and may have spread to the pelvic wall and nearby lymph nodes.
Cancerous cells have spread to the bladder, rectum or other areas of the body.
Physicians who specialise in the treatment of cervical cancer include Gynaecologists, gynaecologic oncologists, medical oncologists, and radiation oncologists. Treatment is dictated by the extent of the cancer and whether it has spread to other parts of the body. Some treatments can affect fertility, so this may also be taken into consideration for women who would still like to have children. The main methods of treatment include:-
Surgery to remove the cervix and uterus, which is called a total hysterectomy, is often advised for women with cervical cancer; however this may not be necessary for cancer at a very early stage. Cancerous tissue can also be removed by conization, cryosurgery or laser surgery. If the cancer is more advanced, then a radical hysterectomy may be required. This involves the removal of the uterus, cervix and part of the vagina. Removal of both fallopian tubes and ovaries (salpingo-oophorectomy) or nearby lymph nodes may also be required. If cancer is found in the lymph nodes, then it may have spread to other parts of the body. Pain, cramping, swelling and bleeding are the most common side effects after surgery to treat cervical cancer. An important consequence associated with the removal of the ovaries is the immediate onset of menopause, and symptoms can often be more severe than those caused by natural onset.
Chemotherapy involves the use of chemicals or drugs that are able to kill cancer cells. These compounds are administered into the bloodstream intravenously and can affect cells all over the body. Because other cells in the body are also exposed to these drugs, they can have dramatic side effects. Cells that are most affected by chemotherapy are those, which like cancer cells, are dividing rapidly, such as blood cells, hair root cells and those in the digestive tract. As a result of these side effects, people on chemotherapy often experience weakness, tiredness, hair loss, poor appetite, nausea, diarrhoea and vomiting. Anticancer drugs can also cause rashes on the skin, hearing problems, loss of balance, joint pain, or swelling of the legs and feet.
Radiation therapy uses high-energy rays, which kill cancer cells, and only affect those cells in the target area. Two types of radiation therapies are used to treat cervical cancer. These include external radiation, where the radiation comes from a large machine outside the body and internal radiation, where thin tubes containing a radioactive substance are placed in the vagina and left for a few hours or up to 3 days. Radiation therapy is often used in conjunction with other forms of treatment. For example, many women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. The side effects associated with radiation therapy depend mainly on the part of the body that is treated. For example, radiation to the abdomen may cause nausea, vomiting or diarrhoea. You may also experience redness, dryness or tenderness of the skin at the target site. Radiation therapy often makes people feel very tired.
There are a number of factors that may increase the risk of cervical cancer. These include:-
· Human papilloma virus (HPV) infection. This is the main risk factor for cervical cancer. There is now a vaccine available for young women, which targets a group of these viruses.
· Lack of regular Pap smears. Cervical cancer is more common among women who do not have regular Pap smears, which allow cell abnormalities to be detected early.
· Immunodeficiency (weakened immune system). For example women infected by the HIV virus, which causes AIDS, have a higher risk of developing cervical cancer.
· Sexual history. Women who have had many sexual partners have a higher risk of developing cervical cancer. Similarly, having sex with a person who has had many sexual partners can also increase the risk of developing cervical cancer.
· Age. Cervical cancer occurs most often in women over 40 years of age.
· Using birth control pills for 5 years or more can also increase the risk of cervical cancer.
· Smoking increases the risk of a women getting cervical cancer.
The best way to reduce the risk of cervical cancer is by having a regular Pap smear. This is a simple test used to look at the cells lining the cervix, and can detect abnormal or cancerous cells before there are symptoms of cancer. By having regular Pap smears, most cervical cancers can be prevented. Early detection can also make treatment more effective. A Pap smear can be done by a physician or a nurse at a health clinic. A cell sample is taken by scraping the cervix. The cells are then smeared onto a slide and sent to a laboratory, where the slide is placed under a microscope and checked for abnormalities such as cancerous cells. Women should begin having Pap smears 2 years after they begin having sexual intercourse, or when they reach age 18 (whichever comes first). Most women should have a Pap smear once every 2 years. If you have a history of abnormal Pap smears, your doctor may recommend that you have them more frequently.