What Is Cancer?

Cancer is a disease which occurs when the cells in a part of the body divide without control, and develop the potential to spread beyond the original site (the primary cancer) through the bloodstream or lymphatic system to reach a new site where they may form a secondary or metastasis.

Where Is The Cervix?

The cervix is the lower part of the womb (uterus) and is often called the neck of the womb. It is possible for your doctor to see and feel the cervix during an internal (vaginal) examination.

Situated close to the cervix are a collection of lymph nodes. These are small glands, each about the size of a bean. The lymph nodes make up part of the lymphatic system. This is a network of glands situated throughout the body, linked by fine threads through which a colourless fluid, the lymph, passes and acts as a defence against disease.

How Does Cancer Of The Cervix Develop?

Cancer of the cervix can take many years to develop. Before it does, early changes occur in the cells of the cervix known as cervical intra-epithelial neoplasia (CIN). These cells have the potential to develop into cancer if left untreated. The Pap smear test is designed to detect CIN so that treatment can be given to prevent a cancer from developing. The Pap smear can also sometimes detect a cancer that has already developed.

Risk Factors For Cervical Cancer

Possible risk factors include the following:

• Human Papillomavirus (HPV) infection
• HIV infection
• Weakened immune system
• Cigarette smoking
• History of sexually transmitted disease
• Multiple sexual partners (either the individual or her partner)
• Onset of sexual intercourse at an early age

What Are The Symptoms Of Cancer Of The Cervix?

The Pap smear test can pick up cervical cancer at a very early stage, before any symptoms have occurred. The most common symptom of cervical cancer is abnormal bleeding, such as between periods or after intercourse. Often there is also a smelly vaginal discharge, and discomfort during intercourse. In women who have had their menopause there may be some new bleeding. The sooner you see your doctor and the earlier a diagnosis is made, the better the chance of treatment being successful.

How Is It Diagnosed?

Your family doctor will examine you and arrange a referral for specialist advice and treatment.

Pap Smear Test

The Pap smear test is commonly used as a routine test to detect early cell changes (CIN). This is known as cervical screening and is aimed at women with no symptoms. However, if there are abnormal signs or symptoms, a specialist assessment is required even if the Pap smear is normal.

Colposcopy

This is done at a specialist’s or hospital clinic. A colposcope is like a small microscope and allows the doctor to make a more thorough examination of the abnormal cells on the cervix. A small sample of surface cells (a biopsy) may be then taken from the cervix for examination under a microscope by a pathologist.

Cone Biopsy

If the abnormal area cannot be seen properly with the colposcope, a cone biopsy may be carried out. This is often done under a general anaesthetic.

A small cone-shaped section of the cervix, enough to remove any abnormal cells, is taken for examination under a microscope by a pathologist. The pathologist’s report is important as it gives your doctor information about the exact type of cancer.

Are There Different Types Of Cervical Cancer?

There are two main types of cancer of the cervix. The most common is called squamous cell carcinoma. The other type is called adenocarcinoma. The pathology report is important as it will influence the advice you are given about the best form of treatment for you.

What Further Tests Will Be Done?

If the tests show that you have cancer of the cervix, your doctor may do some further tests to check for any spread of the disease. These help the doctor to decide on the best type of treatment for you. These may include any of the following.

Chest X-ray to check that your lungs and heart are healthy.

CT scan in which several small X-rays are taken of the area in question and fed into a computer. This builds up a detailed picture of the size and position of the cancer.

Magnetic Resonance Imaging (MRI scan) which is similar to a CT scan, but uses a magnetic field instead of X-rays to build up cross-sectional pictures of your body.

Examination under Anaesthesia (EUA) which is an examination of the vagina and cervix under a general anaesthetic. A cystoscopy (examination of the internal lining of the bladder) may be performed at this time. It allows the doctor to examine you thoroughly without causing you any discomfort, and decide on the Stage of the cancer.

Are There Different Stages Of Cervical Cancer?

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the extent of the cancer and the grade helps the doctors to decide on the most appropriate treatment.

Generally cervical cancer is divided into four stages, from small and localised (stage 1) to spread into surrounding structures (stages 2 or 3) or other parts of the body (stage 4). If the cancer has spread to distant parts of the body this is known as secondary cancer (or metastatic cancer).

What Are The Types Of Treatment Available?

The choice of treatment depends on a number of factors, including your age, general health, the type, stage and grade of the tumour. Sometimes, especially in the early stages of cancer of the cervix, either radiotherapy or surgery can be used, as both give similar results.

Surgery

Surgery is usually the first treatment for cancer of the cervix in its early stages (where it is confined to the cervix). Radiotherapy is an alternative especially when medical conditions pose a risk to surgery.

The operation for cancer of the cervix usually involves the removal of the womb (hysterectomy), and sometimes a small part of the vagina and lymph nodes. If the cancerous cells have spread only very slightly beyond the surface cells of the cervix, it may be possible to treat this with a cone biopsy.

The ovaries may also be removed but, where possible, they are not taken out in young women as their removal brings on an early menopause. For this reason surgery may be more suitable for young women than radiotherapy, as radiotherapy to the pelvic area stops the ovaries from working and brings on an early menopause. If it is necessary to remove the ovaries, the symptoms of the menopause can often be prevented by replacing the hormones with tablets or creams (hormone replacement therapy). Your doctor will be able to discuss this with you in more detail.

Radiotherapy

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.

Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer may come back. It may be given in combination with chemotherapy.

Your radiotherapist, who plans your treatment, will be able to help you with any concerns you may have.

Chemotherapy

Chemotherapy is the use of special anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy may be given in combination with radiotherapy to improve the effectiveness of the radiotherapy. Several clinical trials have shown that giving chemotherapy together with radiotherapy increases the effectiveness of the treatment, reduces the risk of the cancer returning and increases the number of women who are cured.

Chemotherapy may also be given to women whose cancer has spread to other parts of the body or whose disease has come back after radiotherapy. It is used in this situation to try to shrink and control the disease and relieve symptoms, with the hope of prolonging good quality life.

What Happens After Treatment?

After your treatment has been completed you will need to have regular check-ups and possibly X-rays or scans. These will often continue for several years. If you have any problems or ongoing side effects from the treatment, or notice any new symptoms, in between these times, let your doctor know as soon as possible.

How May Cancer Of The Cervix Affect Your Sex Life And Fertility?

The treatments for cervical cancer may also affect your sex life, but many of these effects can be prevented or treated.

You may experience menopausal symptoms (if you have not yet had the menopause) as a result of your treatment. Many of these symptoms can be eased by hormone creams or tablets, prescribed by your doctor. If dryness of the vagina during sex is a problem your doctor can prescribe a lubricating gel which can be applied during sex.

Having sex soon after treatment for cancer is perfectly safe. Regular gentle sex will help the vagina regain its suppleness and you should be able to resume your usual sex life a few weeks after the radiotherapy. Vaginal dilators are also very useful to improve the suppleness of the vagina after radiotherapy.

A hysterectomy or radiotherapy for cervical cancer will stop you from being able to have children in the future. Some women feel that this loss takes away part of their womanhood and they feel less feminine. It can help if you give yourself plenty of time to grieve and adjust to this change. You may find it helpful to talk to a counsellor, who is specially trained to listen and to offer support. The Women’s Cancer Support Group can provide this service.

How Do You Handle Your Feelings?

Most people feel quite overwhelmed when they are told they have cancer. A number of feelings build up, which can get muddled and change quickly. These feelings are part of the process that people go through in trying to come to terms with their illness. Husbands and family members often need as much support and guidance in coping with their feelings as you do. These feelings you may experience include:

• Shock and disbelief
• Denial
• Anger
• Blame and guilt
• Resentment
• Withdrawal and isolation

If you, or your family, are finding it difficult to cope with these feelings it may be helpful to talk to a trained counsellor or psychologist. Your specialist can arrange this service for you. It is usually helpful to bring these feelings out into the open so that they can be aired and discussed. Bottling up feelings can make everyone feel angry and guilty.

What Can You Do?

Understanding your illness

If you and your family understand your illness and its treatment, you will be better prepared to cope with the situation. In this way you at least have some idea of what you are facing. For information to be of value it must come from a reliable source to prevent it causing unnecessary fears. Personal medical information should come from your own doctor who is familiar with your medical background.

Practical and positive tasks

At times you may not be able to do things you used to take for granted. But as you begin to feel better you can set yourself some simple goals and gradually build up your confidence. Every person is different and you should do whatever suits you, taking things slowly and one step at a time.

Who Can Help?

The most important thing to remember is that there are people available to help you and your family. Your specialist and cancer support group can put you in touch with persons trained to listen, counsel and give practical advice to address your physical, emotional, financial or domestic concerns. These would include your oncology nurses, the hospital medical social worker, the hospital psychologist and medical specialists who are experts in the emotional problems of cancer patients.