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Cervical Cancer

  • Cervical cancer: Cancer of the entrance to the womb (uterus). The cervix is the lower, narrow part of the uterus (womb). The uterus, a hollow, pear-shaped organ, is located in a woman's lower abdomen, between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body.
  • Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding. Cancer of the cervix can be diagnosed using a Pap test or other procedures that sample the cervix tissue. Cancer of the cervix requires different treatment than cancer that begins in other parts of the uterus.
  • A number of risk factors have been identified for cervical cancer. Women who begin having sexual intercourse before age 18 and have many sexual partners are at increased risk for cervical cancer. Likewise, if their partners begin having sexual intercourse at a young age and have many sexual partners, especially one who had cervical cancer. The relevance of sexual history is believe to have to do with the chance of infection with the human papillomaviruses (HPV), a sexually transmitted virus, which may trigger cervical cancer. Other risk factors include exposure before birth to the drug diethylstilbestrol (DES), smoking, and immunodeficiency.

Causes of Cervical Cancer

 

  • Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes is associated with infection with human papillomavirus (HPV). In addition, early sexual contact, multiple sexual partners, and taking oral contraceptives (birth control pills) increase the risk of cervical cancer because they lead to greater exposure to HPV.
  • Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer. Certain types of HPV have also been linked to cancers involving the vulva, vagina, penis, anus, tongue, and tonsils. Genetic material that comes from certain forms of HPV (high-risk subtypes) has been found in cervical tissues that show cancerous or precancerous changes.
  • In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer. Girls who begin sexual activity before age 16 or within a year of starting their menstrual periods are at high risk of developing cervical cancer.

Symptoms 


As in many cancers, you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage.

They may include:

  • Pain, when the cancer is advanced
  • Abnormal vaginal bleeding (other than during menstruation)
  • Abnormal vaginal discharge
  • Pelvic pain
  • Kidney failure due to a urinary tract or bowel obstruction, when the cancer is advanced

Treatment

Surgery
Surgery is recommended for women who have small tumours that are confined to the cervix. The type of surgery you have will depend on how far within the cervix the cancer has spread.

Hysterectomy
A hysterectomy is when the uterus (womb) and other parts of the reproductive system are removed. There are two main types of hysterectomy, which are both done under a general anaesthetic:

Total hysterectomy
The uterus and cervix are removed. This can be done via keyhole surgery (laparoscopy) or by an open cut in the abdomen (laparotomy). Your surgeon will advise you on the best method for you.

Radical hysterectomy
The uterus, the cervix, the soft tissue around the cervix and about 2 cm of the upper vagina are removed. This surgery may cause nerve damage, which can affect bowel or bladder function. See managing side effects. You will spend up to a week in hospital after the hysterectomy, depending on the type of surgery you have.

Bilateral salpingo-oophorectomy
Depending on how far the cancer has spread, you may also need to have a bilateral salpingo-oophorectomy. This is when the ovaries and fallopian tubes are removed. They will be taken out at the same time as the hysterectomy. For some women, the ovaries will be left in place to prevent the onset of early menopause. Ask your doctor if this might be an option for you.Women who have a hysterectomy and/or bilateral salpingo- oophorectomy will become infertile, meaning they will no longer be able to have children naturally.

Trachelectomy
A trachelectomy is the removal of the cervix and some surrounding tissue. The uterus is left in place. This is not a common procedure, but it may be used in young women with early-stage cancer (e.g. a tumour smaller than 2 cm) who would like the option of being able to have children in the future. The side effects of a trachelectomy are similar to those of a hysterectomy (see side effects of surgery below), but you will not experience menopause – you will still have periods (menstruate) and be able to become pregnant.

Removing lymph nodes 
During a hysterectomy, your doctor may decide to remove some lymph nodes in the pelvic and/or abdominal area to see if the cancer has spread beyond the cervix. This is called a lymph node dissection or lymphadenectomy. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiotherapy.

A lymph node dissection may cause lymphoedema (see below). For ways to manage this condition, see managing side effects.

Your doctor will explain the side effects of your treatment to you. These can include infertility. If you would like to have children in the future, talk to your doctor before your treatment starts. For more information call 13 11 20 for a free copy of Fertility and Cancer or read more information on infertility.

Side effects of surgery
After surgery for cervical cancer, you may experience some of the following side effects. For more information on these side effects and ways to cope, see managing side effects.

Pain and discomfort
As with all major operations, you may be in pain after surgery. You will be given pain relief medicine through a drip (intravenously) or via an injection into the spine (epidural). If you still have pain, your doctor or nurse can change your medicine to one that is more effective.

Problems with bladder or bowel function
You may feel the sensation of not being able to empty your bladder completely, or emptying your bladder or bowel too slowly. These problems will improve with time. Some women experience accidental or involuntary leakage of urine after surgery for cervical cancer. This is called urinary incontinence.

Lymphoedema
If some of your lymph nodes are removed, your legs may swell because your lymphatic system is not working properly. This is called lymphoedema. Symptoms of lymphoedema may appear straightaway or years after surgery.

Menopause
If you have a bilateral salpingo-oophorectomy and have not been through menopause, the removal of your ovaries will cause sudden menopause.

Sexuality issues
The physical and emotional changes you experience may affect how you feel about sex.

 




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