Cancer of the Cervix - Fact Sheet

	The Cervix
	What is Cancer of the Cervix?
	Causes
	Symptoms
	Diagnosis
	Treatment

The Cervix

The Cervix is the lower-most part of the uterus (womb). It is the part that protrudes into the top of the vagina, and it connects the uterus to the vagina. The function of the cervix is to act as a barrier between the outside world and the cavity of the uterus.

What is Cancer of the Cervix?

Cancer of the cervix is probably the most preventable of all cancer that occur in women. It affects women in all age groups, but is most predominant in Qld in 1998 amongst women in the 30-39 year age group, closely followed by those in the 40-49 year age group. Cervical cancer grows slowly and goes through a pre-cancerous phase which may last for several years before cancer actually develops. This pre-cancerous phase is best diagnosed by a Pap Smear, which is designed to pick up the presence of pre-cancerous cells developing on the cervix.

Essentially, cancer of the cervix can only exist in women who have been sexually active. Any women who has become sexually active should undertake regular Pap Smear Testing every two years. The Human Papilloma virus is though to be the primary and most important causal factor in the development of cancer of the cervix.

Causes

Human Papilloma Virus (HPV), also known as wart virus, is thought to be the primary and most important causal factor in the development of cancer of the cervix. Other factors that may affect a woman's chances of developing cancer of the cervix include age, a high number of children, long term use of oral contraceptives and smoking.

Symptoms

Early stages of cancer of the cervix are usually without symptoms, although if symptoms do occur, post-coital bleeding (bleeding after intercourse) is one of the more common. Any women who has noticed bleeding from the vagina after sexual intercourse or has noticed a blood stained discharge from the vagina not related to periods should see her family doctor without delay.

Diagnosis

Cervical Cancer can be detected using Pap Smear Testing. This involves the doctor taking a sample of cells from the cervix to be examined by a pathologist. Should cancer of the cervix be suspected, then further examinations may be necessary, including a physical pelvic examination, cystoscopy, chest X-Ray, CT scan and/or blood tests.

Treatment

All stages of cancer of the cervix can be treated. The treatment depends on the stage of the individual's disease; the type of disease; and the patient's age and overall medical condition. Three kinds of treatment may be used either on their own or in combination with others, depending on the these conditions. Treatments include surgery, radiation therapy and chemotherapy.

If the changes in the cervix are detected in the precancerous phase, while it is still CIN 3, then treatment will be by either:

	laser local excision (LLETZ) - this involves a large loop excision of the transformation zone
	diathermy - this refers to electrodiathermy, which uses an electrical current to cause a localized area of heat for the purposes of stopping bleeding or destroying tissue. It may be used in an operation to stop small blood vessels bleeding rather than having to tie them off manually. It can also be used to burn off abnormalities when treating cancer of the cervix.
	Cone biopsy - this is a relatively simple, generally operative procedure which removes a cone shaped piece of tissue from the cervix so that the tissue can be sent to the pathologist for examination
	Simple hysterectomy - there are two types of simple hysterectomy: total and sub-total. A total hysterectomy involves removing just the uterus and the cervix, with no attempt to remove any of the adjacent structures or upper vagina. Total hysterectomy has nothing whatsoever to do with the removal of the tubes and ovaries - this is a salpingo-oophorectomy. Sub-total hysterectomy involves the removal of the uterus and leaves the cervix behind.

If cancer develops into the early stages, where it is still limited to the cervix, treatment will be by surgery or radiation therapy, although surgery is generally recommended. The operations performed are called a radical hysterectomy and radical pelvic lymphadenectomy. These operations involve the removal of the uterus, cervix, a small portion of the vagina, the tissue on either side of the cervix (parametrium) and the lymph glands from along the blood vessels in the pelvis.

This operation must be performed in a hospital under a general anaesthetic, and preferably by a gynaecological oncologist.

If the tumour is large or aggressive, near other organs, or if there is a tumour in the lymph nodes, then further treatment will be recommended with radiation therapy and/or chemotherapy.

In the later stages of cancer of the cervix, treatment is mainly by radiation therapy and chemotherapy. Once the tumour has spread beyond the cervix to other organs, then more extensive surgery may be considered. This will be determined on a case-by-case basis, due to the need for individualised treatment.

If you have any questions about your treatment, don't be afraid to ask your doctor. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel this would be helpful.