Cervical Cancer

I’ve been told that I have cervical cancer. What is it exactly?

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

Some factors that may increase the risk of contracting cervical cancer include:

Suppression of the immune system
History of herpes simplex virus infection
Early age at first intercourse
Multiple pregnancies
Smoking

Various strains of the human papilloma virus (HPV), a common infection spread by sexual contact, are the principle cause of most cervical cancer. When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells.

There are over 100 types of HPV and most do not cause any problems. In women, around 20 strains of HPV are high-risk or associated with the development of cervical cancer. The remaining strains are designated as low-risk as they do not cause cervical cancer but can can cause such problems as genital warts.

What are the symptoms of cervical cancer?

The symptoms of cervical cancer include:

Abnormal vaginal bleeding: bleeding in between your periods, after sex or after the menopause.
Blood-stained vaginal discharge that may have a foul smell.
Discomfort or pain in your pelvis.

As there are often no obvious signs or symptoms in the early stages of the disease, regular smear tests are important for helping to identify women at risk of developing cervical cancer. Regular smear tests may detect abnormal changes in the cervical tissues, before cancer develops. A National Cervical Screening Programme is available in Ireland called CervicalCheck. The government funds this service and provides free smear tests to women aged 25 - 60 years. For more details, contact CervicalCheck at 1800 45 45 55 or visit the CervicalCheck website.

How is cervical cancer diagnosed?

How gynaecological cancer is diagnosed depends on what type of cancer is suspected. Pelvic exams, imaging tests, biopsies, colposcopy exam and possible diagnostic surgery are all methods used to diagnose gynaecological cancer, and where cancer is confirmed, to determine the stage of the cancer. Staging refers to how far the cancer has spread to nearby tissue or organs. Among all of the various types of gynaecological cancer, early detection is crucial. However, detection can be very difficult, especially in the early stages.

Tests such as the following may be carried out:

Transvaginal ultrasound: an ultrasound used to build up a picture of the tissues in your womb. During a transvaginal ultrasound a small metal ‘probe’, covered with a gel is inserted into the vagina. This creates the images in the scan. This test is not painful but may be a little uncomfortable.
Hysteroscopy: a hysteroscope is a thin, flexible tube with a light at the end which is passed through the vagina and into the womb. This allows the doctor to look inside the womb and take tissue samples or a biopsy.
Biopsy: a small amounts of tissue samples are taken from the womb during a hysteroscopy. Biopsies are sent to a laboratory and looked at under a microscope to detect if cancer cells are present.
D&C - dilatation and curettage: during a D&C the cervix and entrance to the womb are gently opened. Samples of tissue from the inner lining of the womb are taken with an instrument shaped like a spoon called a curette. The samples are then sent to the laboratory to be examined.

What treatment options are available for this type of cancer?

The main treatments for cervical cancer are:

Surgery is the most common treatment for cervical cancer. It aims to remove the part of your cervix containing the tumour. The most common types of surgery available include:

Cone Biopsy: a cone–shaped piece of tissue is removed from your cervix.
Trachelectomy: your cervix and nearby tissues are removed but your womb is left in place.
Partial Hysterectomy: your cervix and womb are removed.
Radical Hysterectomy: your cervix, womb and top of your vagina are removed.
Bilateral Salpingo – Oophorectomy: your ovaries and fallopian tubes are removed during a hysterectomy.
Lymphadenectomy: the lymph nodes in your pelvis are removed.