A B C D E F G H I J K L M N O P R S T U V W

CANCER OF THE CERVIX

What is Cancer of the Cervix ?

The cervix is the lower part of the womb which protrudes into the top of the vagina. A narrow canal runs through the cervix which opens up into the cavity of the womb. The lower end is called the external os, the upper end the internal os. The skin of the vagina is the same as the tough skin of the body surface. However, in the canal, the lining is much more velvety and delicate. Where two types of skin meet is called the squamo-columnar junction. This is where most cancers of the cervix start. Cancers of the cervix may not cause symptoms at all. This is why regular examination and smears are necessary. Cancers of the cervix may, however, cause abnormal bleeding and discharge. Any bleeding or offensive discharge which occurs after the menopause must be reported to your doctor and investigated. If a woman is still getting her periods, it can be more difficult to decide how much bleeding to take seriously. Bleeding after intercourse and bleeding between normal periods needs to be checked. Any marked change in vaginal discharge, especially if very smelly, should also be reported. This abnormal bleeding and discharge is caused by the growth which usually looks like an ulcer.

How does Cancer of the Cervix occur ?

Most cancers go through a pre-cancerous stage which is detected by smear tests and by colposcopy (an examination through the vagina with a magnifying telescope). Once this reaches the severest form of change about 1 in 3 patients will progress to cancer of the cervix if not treated. Milder pre-cancer changes may go back to normal without any treatment. The pre-cancerous stage can be quite long, even some years. It is safe, therefore, to watch the cervix closely in some cases where the smear only shows early changes.

Why does Cancer of the Cervix occur ?

There now seems little doubt that cancer of the cervix is very closely related to sexual behaviour. The risk increases with the number of sexual partners a woman and her partner have had. It also increases the earlier intercourse is started and in those who smoke. Some infections which are sexually transmitted may play a role in cervical cancer. Such infections include the wart virus. Women who never have intercourse very rarely get cancer of the cervix. The disease is also less common in sexual relationships with a constant single partner. Barrier methods of contraception may also reduce the risk.

Treatment Involved for Cancer of the Cervix

The diagnosis may be made at the time of a colposcopic examination when a patient is sent to the hospital because of an abnormal smear test. It may be necessary to take samples of tissue from the cervix under general anaesthetic to confirm the diagnosis. This examination will also help decide the type of treatment to be used. The surgeon will assess very carefully, under the same anaesthetic, how far the growth has spread. Usually it will just be confined to the cervix itself. Sometimes it may have spread towards the bladder or rectum (the lowest part of the bowel) or into the top part of the vagina. If the growth spreads out sideways it may block the ureters. These are the tubes which carry urine from the kidneys to the bladder. For these reasons, the doctor may ask for a kidney x-ray or a cystoscopy. This is a procedure for looking into the bladder with a fine tube passed through its outside opening. Another test is called a CT (computerized tomography) scan. This is a series of x-rays which will show up spread of the growth outside the cervix. The purpose of these tests is to stage the growth from stage 1 to 4. Stage 1 is the smallest growth, stage 4 the most advanced.

Treatment involves either surgery, or radiotherapy, or a combination of the two. Drugs (chemotherapy) are just beginning to be used in cervical growths but this approach is still largely research. Surgery is usually used in early stage 1 or 2 growths. In some very early stage 1 tumours it may be possible to remove the cancer by cutting out a cone shaped piece of tissue form the cervix, This is called a cone biopsy. Usually, however, it will be necessary to remove the whole womb. This operation is called a Wertheim's or extended hysterectomy and is a bigger operation than a normal hysterectomy for heavy periods. This is because it involves removing more of the tissue next to the womb and some of the lymph glands in the pelvic area as well as the womb itself. The ovaries can often be left. When cancer of the cervix is treated by hysterectomy the lymph glands that are removed are examined under the microscope. If this shows that the tumour has already spread to the lymph glands then further treatment with radiotherapy will be given after surgery. Radiotherapy may also be used instead of surgery to treat cancer of the cervix. This may be either because the cancer is too advanced to be treated by surgery or because the patient is not well enough to undergo an operation. In fact the cure rates even for early stage tumours are similar for both surgery and radiotherapy. Surgery is usually preferred for younger patients with early tumours because it produces less narrowing of the vagina and discomfort with sex afterwards than radiotherapy.

During Treatment of Cancer of the Cervix

Radiotherapy may produce an increased vaginal discharge. This is because the treatment is killing the cells which are then being discharged. However, if there has been a lot of bleeding, the treatment will stop the bleeding. Radiotherapy may irritate the bladder or rectum and cause temporary diarrhoea or symptoms of cystitis (burning when passing water and a need to pass it frequently). Sometimes the skin feels a little burned. As with any hysterectomy there is a small risk of blood clots forming in the legs. There is a slightly higher chance than in a standard hysterectomy that the bladder or the ureter may be injured at the time of hysterectomy. This may cause urine to leak in to the vagina producing a watery discharge and may need a further operation to fix.

After Treatment of Cancer of the Cervix

Sometimes the diarrhoea and cystitis symptoms continue after treatment is finished. In the end they do get better. All patients treated for cervical cancer are followed up regularly and frequently. To start with, follow-up will be every few weeks, then every few months, and then annually. Radiotherapy may make the vagina smaller and the skin may also be rather sensitive. This means there may be sexual difficulties afterwards. These should be openly discussed with your doctor. You may be made menopausal if radiotherapy treatment is required. It is possible with this type of cancer for the patient to have female hormone replacement therapy for treating menopause symptoms.

If Cancer of the Cervix is Left Untreated

Cervical cancer would spread into other surrounding organs, such as the bladder and bowel.

Effects on Family of Cancer of the Cervix

This is a curable disease, especially when treated early. Positive and optimistic support is essential. A woman treated for cervical cancer will be frightened it will return and may feel her femininity is lost. She must be treated with undemanding love, especially by her sexual partner. Remember: safe sex and regular smear tests reduce the risk of this disease.