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Cervical Cancer

cervical cancer

The common early symptom of cervical cancer (cancer of the cervix) is abnormal vaginal bleeding. Most cases develop in women in their 30s or 40s.

What is the cervix?

The cervix is the lower part of the uterus which extends slightly into the top of the vagina. The cervix is often called the neck of the womb.

Types of cervical cancer?

There are two main types of cervical cancer:

  • Squamous cell cervical cancer is the most common.
  • Adenocarcinoma cervical cancer is less common.

Both types are diagnosed and treated in a similar way.

Who gets cervical cancer?

Most cases develop in women aged in their 30s or 40s. Some cases develop in older and younger women. It is rare in women aged under 25 years.

What is the cervical screening test?

Some cells are taken from the surface of the cervix. These cells are sent to the laboratory to be looked at under a microscope. In most tests the cells seen are normal. Abnormal (dyskaryotic) cells are seen in some cases.

Cervical dyskaryosis is not cervical cancer. Cervical dyskaryosis means that some cells of the cervix are abnormal, but are not cancerous. The abnormal cells are sometimes called pre-cancerous cells or dysplastic cells. Depending on the degree of the abnormality of the cells, cervical dyskaryosis is classed as:

Mild dyskaryosis. This is when there are only slight cell changes. This is sometimes called CIN 1. CIN stands for cervical intraepithelial neoplasia.
Moderate dyskaryosis (or CIN 2).
Severe dyskaryosis (or CIN 3). This is when the cells are very abnormal, but are still not cancerous.

In many cases the abnormal (dyskaryotic) cells do not progress to become cancerous. In some cases, they revert back to normal. However, in some cases, often years later, the abnormal cells turn cancerous.

If you have just borderline changes, you may simply be offered another test after a few months. In many cases, slightly abnormal cells revert back to normal within a few months. Treatment may be offered if the abnormality persists. For women with moderate or severe abnormal changes, treatment can clear the cervix of the abnormal cells before they develop into cancer.

What causes cervical cancer?

In the case of cervical cancer, the cancer develops from a cell which is already abnormal - see above. In most cases, abnormal cells are present for years before one of the abnormal cells becomes cancerous and starts to multiply out of control into a cancerous tumour. The initial pre-cancerous abnormality of cervical cells is usually caused by a prior infection with the human papillomavirus (HPV).

Human papillomavirus (HPV) and cervical cancer

Two types, HPV 16 and 18, are involved in the development of most cases of cervical cancer. The strains of HPV associated with cervical cancer are nearly always passed on by having sex with an infected person.Note: within two years, 9 out of 10 infections with HPV will clear completely from the body. This means that most women who are infected with these strains of HPV do not develop cancer.

The HPV vaccine

Vaccine has recently been introduced for girls from the age of 12 . Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix from developing. The vaccine has been shown to work better for people who are given the vaccine before they are sexually active. However, vaccine does not guarantee complete protection against cervical cancer.

Other factors

Other factors that increase the risk of developing cervical cancer include the following:

Smoking. Smokers are 2 times more likely than non-smokers to develop cervical cancer.
A poor immune system. For example, people with AIDS or people taking immunosuppressant medication have an increased risk.

There is a possible link between the combined oral contraceptive pill (COCP) - also known as the pill - and a slightly increased risk of cervical cancer if the pill is taken for more than eight years.

What are the symptoms of cervical cancer?

You may have no symptoms at first when the tumour is small. As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as:

  • Bleeding between normal periods (intermenstrual bleeding).
  • Bleeding after having sex (postcoital bleeding).
  • Any vaginal bleeding in women past the menopause.
  • An early symptom in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex.

All of the above symptoms can be caused by various other common conditions. But if you develop any of these symptoms, you should have it checked by a doctor.

In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

How is cervical cancer diagnosed and assessed?

To confirm the diagnosis

A doctor will usually do a vaginal examination .If cervical cancer is suspected, you will usually be referred for colposcopy.
Colposcopy is a more detailed examination of the cervix. For this test, a speculum is gently put into the vagina so the cervix can be seen. During colposcopy it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope to look for cancer cells.

Assessing the extent and spread

If you are found to have cervical cancer then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest X-ray, an ultrasound scan, blood tests or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:

  • How much the tumour has grown, and whether it has grown to other nearby structures such as the bladder or rectum.
  • Whether the cancer has spread to local lymph glands (nodes).
  • Whether the cancer has spread to other areas of the body (metastasised).

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for cervical cancer?

Treatment options which may be considered include surgery, radiotherapy, chemotherapy, or a combination of these treatments. The treatment advised for each case depends on various factors. For example, the stage of the cancer (how large the primary cancer tumour is and whether it has spread), and your general health.

Surgery

An operation to remove the cervix and uterus (hysterectomy) is a common treatment. If the cancer is at an early stage and has not spread then surgery alone can be curative. In some cases, where the cancer is at a very early stage, it may be possible to just remove the part of the cervix affected by the cancer without removing the entire uterus. This would mean that you could still have children.

If the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. For example, in some cases where the cancer has spread to other nearby structures, extensive surgery may be an option. This may be to remove not only the cervix and uterus but also nearby structures which may have become affected such as the bladder and/or bowel.

Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, to relieve a blockage of the bowel or urinary tract which has been caused by the spread of the cancer.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation to kill cancer cells, or stops cancer cells from multiplying. Radiotherapy alone can be curative for early-stage cervical cancer and may be an alternative to surgery. For more advanced cancers, radiotherapy may be advised in addition to other treatments.

Two types of radiotherapy are used for cervical cancer – external (radiation is targeted on the cancer from a machine) and internal (placing a small radioactive implant in vagina).

Chemotherapy

This is a treatment using anti-cancer drugs which kill cancer cells, or stop them from multiplying. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations.

What is the outlook (prognosis)?

The outlook is best in those who are diagnosed when the cancer is confined to the cervix and has not spread. Treatment in this situation gives a good chance of cure for 8-9 women out of 10. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer.


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