About 1 in 200 women develop cervical cancer. It can occur at any age with two peaks in
incidence ocurring in women in their thirties and fifties. The highest incidence of cervical cancer occurs in South America. More detail on cervical cancer can be found at www.colposcopy.co.uk.
Cervix cancer (with the exception of some rare types) is caused by Human Papilloma Virus. There are over 100 types of this
virus but only some are associated with cervical cancer. The most common are types 16, 18, 31, 33, and 45. The virus alters the genes in the cells allowing them to make proteins (called E6 and E7) that promote cancer. More on HPV and the wart virus can be found at www.colposcopy.co.uk.
Almost any woman who has been sexually active can develop cancer of the cervix. However, it is
more frequent in women who have had more partners. It is also more common in women whose husbands / boyfriends have had more sexual partners. Immunodeficiet women (such as those with AIDS, after an organ transplant, or those on steroids) are also more likely to develop
cervix cancer.
Women who have regular smear tests are much less likely to develop cervix cancer. In the UK, women who are not virgins are recomended to have a smear test every three years until the age of fifty and then five yearly until 65. This involves a speculum being placed into the vagina. Cells are 'scraped' off the cervix using a plastic brush or spatula. These cells are placed onto a slide and analysed in the laboratory. The test is designed to detect a 'pre-cancer' called ‘dyskaryosis’. If found, a test called
colposcopy is sometimes needed. Colposcopy
involves an examination of the cervix with a special microscope. Sometimes treatment is required to
remove the an area of pre-cancer which at biopsy is called ‘CIN’ (Cervial Intraepithelial Neoplasia or Cervix In the skin New cell). This can often be done in the clinic under local anaesthetic.
Cervix cancer can cause a number of symptoms.
Sometimes it is detected after treatment for ‘CIN’.
Sometimes cervix cancer presents with abnormal vaginal bleeding, discharge, or bleeding
after intercourse. When advanced, cervix cancer can present by causing back ache from a blockage of the tubes from the kidneys to the bladder (ureters).
Treatment depends on how advance the disease is. A measure of how advanced the disease is is called the 'Stage' (I - IV). In it’s very early stages it can be treated
with an operation to remove a cone of tissue from the cervix (cone
biopsy). Fertility is preserved following a cone biopsy but in some cases the miscarriage rate may be slightly higher afterwards.
If the cancer is at a higher (but still low) stage it can be treated by an operation called a ‘radical (or Wertheims) hysterectomy’. This involves
excision of the womb and tissue either side of it called the parametrium. The complications are greater than after a standard hysterectomy and some women have
bowel and urinary problems afterwards. Other complications include nerve damage, bleeding, thromboembolism (economy class syndrome), and infection.
If a woman wishes to
preserve her fertility. Instead of a radical hysterectomy she she may wish to have an operation called a ‘radical trachelectomy’. This operation leaves behind the main part of the uterus allowing a woman to have the potential to still have children. The
operation is relatively new and still
experimental. First reports suggest that it is as good as curing some cervix cancers as
‘radical hysterectomy’. Additional complications from radical trachelectomy include the
risk of premature labour and miscarriage.
If a cervix cancer is more advanced, the therapy
is normally a combination of chemotherapy and radiotherapy (chemoradiotherapy).
The side effects from this may include
narrowing of the vagina (stenosis), changes in bowel habit, and urinary side
effects. In the worst cases it can cause bad damage to the bowel (radiation enteritis) and bladder (radiation cystitis).
Cervix cancer that returns after initial treatment it is often fatal. Some treatments exist in some circumstances. If the cancer returns
at the top of the vagina and no where else, an operation called ‘exenteration’ is sometime appropriate. This operation may involve
removal of the vagina, bowel and even bladder and is assoicated with a high complication rate.
The aim of treatment for early stage cervical cancer is curative. For stage 1 disease with negative lymph nodes this can be achieved in 19 out of 20 cases. When the disease is more advanced, the prognosis
is less good.
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