Cervix Cancer Assessment

A patient with cervical cancer would undergo a cervix cancer assessment involving a full history, gynaecological examination, examination under anaesthetic and an MRI scan.

Cervical Cancer

The cervix is the lower part of the womb that protrudes into the vagina. Cervical cancer is the overgrowth of abnormal cells that exist in the cervix.

Incidence

Cervical cancer occurs in about 1 in 200 women. In England and Wales there are about 2500 new cases and 1000 deaths every year.

Age

Cervical cancer can present at any age. However, the peak incidence occurs in women in their thirties and those in their fifties.

Geographic

South America has the highest incidence of cervical cancer. Muslim women have a relatively low occurrence of this condition.

Causes

Cervical cancer is caused by an infective virus called Human Papilloma Virus. There are nearly 100 different types of this virus but only some are associated with cervical cancer. It is thought that the virus gets into the cells and alters the genetic make-up leading to cancer.

Although any woman can develop cervical cancer, it is more common in those who have had many sexual partners. Women who have a deficiency in their immune system due to AIDS, steroid treatment, or treatment following a transplant are also more likely to develop cervical cancer.

Prevention

Cervical cancer can be prevented by having regular smear (Pap) tests.

All women who are not virgins should have a cervical smear test regularly (at least every three years). A smear test involves having a device called a speculum placed into the vagina and cells scraped off using a wooden spatula or plastic brush that are subsequently analysed under a microscope. The smear test is designed to detect a precursor to cervical cancer called ‘dysplasia’.

If this is found, an investigation called colposcopy is required. This involves a gynaecological examination of the cervix using a specially designed microscope and some dyes. Sometimes treatment is required to remove the ‘dysplasia’. This can be done under local anaesthetic in clinic on most occasions.

Symptoms

Cervical cancer usually presents in one of two ways. Sometimes it is detected in it’s microscopic form after treatment for ‘dysplasia’. Otherwise it usually presents with abnormal vaginal bleeding, bleeding after intercourse, or discharge. In it’s advanced form, cervical cancer can cause back ache by blocking off the tubes from the kidneys.

Treatment

This depends on how advance the disease is at the time of diagnosis. Cervical cancer in it’s very early stages can be treated with an operation to remove part of the cervix. This is called a ‘cone biopsy’. It is still possible to have children following a cone biopsy although the miscarriage rate is slightly higher afterwards.

Other cervical cancers that are picked up early are treated by an operation called a ‘radical hysterectomy’. This involves removal of the whole womb and tissue either side of it. The complication rate is higher than after a normal hysterectomy and some women have problems with urinary and bowel functions. When a woman wishes to preserve her fertility, she may wish to have an operation called a ‘radical trachelectomy’ instead. This operation leaves behind the main body of the uterus and allows a woman to still have children. The operation is still in the early part of it’s development and is still experimental. However, first reports suggest that it is as successful as ‘radical hysterectomy’ for some types of cervical cancer. However, the risk of premature labour and miscarriage following a ‘radical trachelectomy’ is high.

When cervical cancer is more advanced, the treatment that is recommended is a combination of chemotherapy and radiotherapy. Radiotherapy consists of local irradiation to the cervix and surrounding tissue and chemotherapy consists of drug treatment to kill cells that may have spread further. The side effects from this often include narrowing of the vagina, changes in bowel habit, and urinary side effects.

Recurrence

If cervix cancer comes back after initial treatment it is usually fatal. However, some treatments exist that are effective. If the cancer returns at the top of the vagina only, an operation called ‘exenteration’ can sometimes cure this. This operation is an extensive one and may involve removal of the vagina, bowel and even bladder.

Survival

Women with early stage cervical cancer are normally cured completely by surgery. When the disease has spread and is more advance the prognosis is less good with less than 50% of women being cured.

Latest developments

The most important development in cervical cancer is the introduction of ‘radical trachelectomy’ that allows women to preserve their fertility for some early stage cancers. For advanced disease, a form of chemotherapy and radiotherapy has proven to be a more effective treatment. The introduction of ‘Liquid Based Cytology’ which is a new method of taking a smear test, has proven to be more reliable and vaccines are currently under development to prevent the disease.