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.
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.
Cervical cancer occurs in about 1 in 200 women. In England
and Wales there are about 2500 new cases and 1000 deaths every
Cervical cancer can present at any age. However, the peak
incidence occurs in women in their thirties and those in their
South America has the highest incidence of cervical cancer.
Muslim women have a relatively low occurrence of this condition.
Cancer of the cervix 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, are taking certain medication, or treatment following a transplant are also more
likely to develop cervical cancer.
Cervical cancer can be prevented by having regular
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 in a clinic on most occasions.
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.
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’
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.
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.
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.
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.