Introduction to Cervical Cancer
Cervical Cancer or carcinoma of the cervix is the commonest form of female genital cancer in developing countries.
While the disease is preventable, absence of an effective screening system results in most cases presenting late with advanced disease.
In developed countries, the incidence of cervical cancer has fallen considerably due to regular screening procedures (e.g. Pap smear, visual inspection with acetic acid, Human Papilloma Virus [HPV] test).
Vaccination against cancer-causing HPV infection is the ideal method for primary prevention of cervical cancer.
Treatment of cervical cancer requires the services of a gynaecological oncologist and radiotherapist.
Treatment includes surgery and/or radiation and/or chemotherapy. Surgery involves removal of the central tumour as well as the lymphatics draining the area (Wertheim’s hysterectomy).
This extensive surgery should be carried out only by trained specialists. Radiation treatment often involves localized pelvic irradiation.
Human papilloma virus (accounts for 80% of cases).
Causes of Cervical Cancer
- Sexual promiscuity
- Multiple child births
- Infections with Herpes Simplex Hominis type II, and HIV
- Smoking
- Low socio-economic status
- Family history
Symptoms of cervical cancer
Cervical cancer is usually asymptomatic especially in its early stage. It is only diagnosed on routine cervical screening.
Symptoms of advanced cervical cancer include the following:
- Abnormal vaginal bleeding
- In between regular menstrual periods
- After sexual intercourse
- Post menopausal bleeding
- Abnormal vaginal discharge
- Lower abdominal pain
- Pain during sexual intercourse
- Weight loss
- Urinary symptoms e.g. dysuria, frequency, incontinence
- Rectal pain
Signs of Cervical Cancer
Early disease:
- Erosion of cervix or changes of chronic cervicitis
Late/advanced disease:
- Ulcerative or fungating cervical lesion on speculum examination
Investigations of Cervical Cancer
- Cervical biopsy
- FBC and sickling status
- Blood urea and electrolytes
- Serum Creatinine
- Serum uric acid.
- Chest X-ray
- Ultrasound of Kidneys
- CT Scan and or Magnetic Resonance Imaging (to detect aortic nodes and metastases to the lungs and liver)
- Pelvic examination under anaesthesia
- Cystoscopy and proctoscopy with or without biopsy to allow visualisation of vesical or rectal mucosa
Treatment for Cervical Cancer
Treatment objectives
The treatment objectives of cervical cancer include the following:
- To treat central tumour
- To treat areas of tumour spread with the aim of eradicating the disease
Non-pharmacological treatment
- Surgery
- Radiotherapy
- A combination of surgery, and radiotherapy
Pharmacological treatment
Evidence Rating: [A]
Adjuvant chemotherapy (See referral below).
See Cancer of the cervix for more
Referral Criteria
All patients must be referred to a specialist for evaluation to decide on stage of disease and best mode of treatment.
Treatment of carcinoma of the cervix is best done in hospital under specialist team care.