CERVICAL CANCER

CERVICAL CANCER 2017-04-25T12:20:07+00:00

THIS IS ONE CANCER THAT CAN BE PREVENTED

All sexually active women are at risk for the development of cervical cancer. This is one cancer that can be prevented, in most cases, with regular PAP tests to screen for premalignant changes.

OFTEN RELATED TO HUMAN PAPILLOMA VIRUS (HPV)

The cervix is the part of the uterus connected to the upper vagina. It is what dilates during childbirth so the baby can travel to the birth canal.

There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal. Approximately 85% of cervical cancers are squamous cell cancers and the remainder adenocarcinomas. Most of these cancers are related to human papilloma virus (HPV).

Cervical cancer is a slow growing disease and therefore usually not noticeable on visual examination. It occurs most often in the pelvis.

Abnormal Discharge and/or Bleeding

There may be no symptoms of a very early cervical cancer. Any abnormal bleeding or discharge should be checked out as that could signal the presence of the disease. Abnormal bleeding occurring after sexual intercourse may be a sign that new, weak blood vessels caused by the cancer have broken. Abnormal discharge as a sign of cancer can occur when the malignant tissue outgrows its oxygenated blood supply.  Some of the cells then die, the tissue becomes infected, and a watery or foul-smelling discharge is noticed. If you’ve been treated for a vaginal infection that does not go away, this could also be a symptom.

Bladder and/or Kidney Blockage

As the cancer increases in size, it usually grows laterally toward the pelvic wall, often obstructing the tubes from the kidneys (ureters) that bring urine to the bladder. If that happens to both of the ureters, this will result in renal failure, coma and death.

Leg Pain

When cancer of the cervix grows into the pelvic wall, it presses on the nerves that go to the leg and causes constant leg pain. In addition, this cancer can spread by way of the lymphatic system. The lymphatic vessels drain from the cervix to clusters of lymph glands along the pelvic wall.. If the pelvic lymph nodes on one side of the pelvis become obstructed with cancer , it will cause swelling in the leg on that side. Both of these leg issues can be signs of advanced cancer.

The diagnosis of cervical cancer is often not difficult as the growth is usually big enough to be seen. It can then be biopsied.

If it arises from inside the cervical canal, then it may not be visible. This will require that a portion of the cervix be removed for diagnosis.

Doctors should not rely on a PAP test to rule out cancer in a woman who has symptoms or findings that could be due to a cancer. Cancer can only be excluded by the proper biopsies. Approximately 10% of women with an obvious cancer of the cervix will have a PAP test that is essentially normal. This is because there is so much inflammation and dead cell debris that it masks the cancer cells. Very rarely, the cervix may be too small or inaccessible to biopsy properly. In these situations, a hysterectomy may be the best treatment.

While your doctor will consider which treatment may be right for you, many cervical cancers can be treated with surgery.  If the tumor is large and/or more advanced, a combination of chemotherapy and radiation may be the best course of action.

Radiation

Radiation therapy usually requires a treatment each day, five days a week, for about five weeks. Each treatment takes about 30 minutes. This is called external or teletherapy. The entire pelvic area is irradiated by an x-ray beam usually generated by a linear accelerator. Everything in the pelvis is irradiated, bladder, rectum, large intestine, small intestine, bone and skin. Following this treatment, a radioactive source is placed inside the cervix and vagina and left in place a few minutes or several days. This is called an implant, radium implant, intracavitary implant or any of several other names. A more accurate term is brachytherapy which means slow therapy.

Surgery

Stage IA cancers that invade less than 3mm deep can sometimes be treated by simple hysterectomy or even in special cases by cone biopsy. All other Stage I cancers are treated either by radical surgery or radical radiation.

Some stage IIA cancers can also be considered for surgery. Surgery for stage IB and some IIA cancers requires a radical hysterectomy and removal of the pelvic lymph nodes. Radical hysterectomy means that the cervix is removed by staying as far away from it and the cancer as possible. A regular or simple hysterectomy removes the cervix by staying as close to it as possible.

Otherwise, all stage II, III and IV cancers are treated with radiation. Occasionally ultra-radical surgery is done on some stage IVA cancers.

Cancer surgery requires that the cancer be removed with as good a margin of uninvolved tissue as can safely be taken. The radical hysterectomy technique removes all the supporting ligaments to the cervix which means that the dissection is very close to the bladder and to the rectum. The ureters have to be dissected out and the tissue around them removed. A radical hysterectomy with removal of the lymph nodes takes about 3 hours to perform. A simple hysterectomy takes only about 1 hour. The ovaries are not a part of the problem with cervical cancer and can be left in place in young patients. If, after surgery, the pathology indicates that there are positive lymph nodes or that the surgical margins are close, then pelvic irradiation with or without chemotherapy may be advised.

Ultraradical pelvic surgery for advanced or recurrent cancer means that all the pelvic organs are removed. This is called a total pelvic exenteration. The uterus and cervix, vagina, bladder and rectum are removed. Sometimes a vagina can be reconstructed. If the rectum can be reattached then there will be no need for a colostomy. Sometimes a continent urinary reservoir can be constructed. Otherwise a bag will have to be placed for the urine to drain through an ostomy in the abdominal wall. This ultra-radical surgery is done if there is an extensive cancer involving the bladder or rectum, but without spread beyond these structures. It is also done for cancers that recur after pelvic radiation if they are confined to the pelvis.

Chemotherapy

In general, when cancer of the cervix is being treated with radiation, chemotherapy is also given to increase the effects of the radiation. Otherwise, chemotherapy is not used as initial treatment for cancer of the cervix. There are some investigational studies in which chemotherapy is given first and then either surgery or radiation performed. Chemotherapy may also be initiated in stage IV cases.

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