Cervical cancer is the presence of malignant or cancerous cells in the cervix – the lower, narrow part of the womb (or uterus) connected to the vagina. [1,2,3] While cervical cancer is mostly slow-growing, it can reach the deeper tissues of the cervix from where it may spread (or metastasise) to other body tissues or organs, such as the lungs, liver, bladder, vagina, or rectum. [1]
Women between the ages of 35 to 44 years are most likely to develop cervical cancer, but it may also occur in older women, especially those that are not regularly screened with a Papanicolaou (or Pap) smear. Pap tests can reliably detect cervical cancer during its early stages. It has helped significantly to reduce the number of deaths from cervical cancer each year.1 In South Africa, cervical cancer is the second most common cancer among women, but unfortunately, still, the cancer women succumb to most.2 However, cervical cancer can easily be treated if detected early and regular screening is extremely important. [2,3,4]
The majority of cervical cancer cases are linked to infection with the human papillomavirus (HPV). This virus and its variants (there are about 100 different strains) have been linked to skin warts, genital warts, and other skin disorders as well as cancers involving the vulva, vagina, penis, anus, tongue, and tonsils. [1,2,3] The two strains that most commonly cause cancer are HPV-16 and HPV-18.3
HPV, which is a common virus, is spread through skin-to-skin contact, body fluids and sexual intercourse. [2]
Those you may be able to control (at least to some extent)
If any of the following holds true for you, you might have a higher risk of developing cancer of the cervix:
Those outside your control
It is important to remember that, even should you have one or more of these risk factors, you are not destined to develop cervical cancer. It is important, however, that you go for regular gynaecological examinations to screen for it. [3]
The risk of getting cervical cancer can be reduced with the help of a vaccine. CANSA (The Cancer Association of South Africa) supports the Department of Health’s HPV School Vaccination Programme. Vaccination is recommended for all women aged 9 to 26 years (provided they are not sexually active). Your doctor will also be able to provide you with information about and access to the vaccine. It is important to note that women who have been vaccinated still need to go for regular gynaecological examinations and Pap smears. [2]
Cervical cancer is curable if detected early. Hence it is important that all women are screened with Pap smears.2,3 CANSA recommends that women who are sexually active (or who have been sexually active) should have Pap smears between the ages of 18 to 20 years. Thereafter, it is recommended to have a Pap smear at least every 3 years. Women should continue to have Pap smears until they are 70 years of age. [2]
It is also important to practice safe sex by using condoms and limiting your number of sexual partners. Lifestyle changes, such as quitting smoking, will not only lessen your risk of cervical cancer but also improve your overall health. [5]
In the early stages, cervical cancer may be asymptomatic; in other words, there may be a complete absence of symptoms. [1,3,4,5]
Once cancer has grown, it may cause:
When cancer spreads to surrounding areas or distant body regions, it may give rise to:
If you experience any of the following symptoms, it is best to see your doctor as soon as possible:
A Pap smear is part of a woman’s routine gynaecological examination. During this procedure, a speculum is inserted into the vagina and a doctor performs a smear of the surface of the cervix. This will transfer cells from the cervix to a specimen bottle from where the cells are taken to be examined under a microscope in a laboratory. If abnormal cells are detected, your doctor may elect to remove a piece of the cervix – this is called a biopsy and it can be performed in the rooms or in theatre, depending on the size of the specimen to be removed. [1,2,6]
A colposcopy may also help to diagnose cervical cancer. This is similar to a Pap smear, but a harmless dye or acetic acid is used to stain the cervix so that it is easier to identify abnormal cells. These are then examined with the use of a magnifier, or colposcope, which magnifies the cervix by 8 to 15 times. Once identified, a biopsy of the abnormal cells will be taken. This procedure is usually also performed in a doctor’s room.
There are also more invasive procedures to assist with a cervical cancer diagnosis. The first one is called LEEP (loop electrosurgical excision procedure). This procedure can be performed by a gynaecologist in his/her room. An electrical wire is used to excise a sample of cervical tissue. The second procedure is usually performed under general anaesthesia in the theatre where a part of the cervix is removed (this is called conisation) with a LEEP, a scalpel (cold knife), or a laser. [1,6]
The results of the above tests may reveal no abnormalities, precancerous changes, or invasive cancer. Precancerous changes are usually called squamous intraepithelial lesions. Squamous refers to the type of cell that lines the inside of the cervix while intraepithelial informs doctors that the abnormal cells (or lesions) are only present in the superficial layers. These cells may not develop into full-blown cancer, but there is always a risk that they may become cancerous and invade deeper tissue layers. [1]
Invasive cancer is diagnosed when the biopsy shows that the abnormal cells are no longer restricted to the superficial layers but that there is deeper penetration. To determine whether cancer has spread and, if so, how far, you may have to go for the following tests:
The results of these special investigations will enable your doctor to “stage” cancer. Staging is determined by the size of the tumour in your cervix, how deep it has penetrated, and how far it has spread. Cervical cancer can range from stage 1 (localised cancer that is small and that may have spread to nearby lymph nodes; least severe) to stage 4 (with spread to distant tissues or organs such as the lungs, bones or liver; most severe). [1,3]
Precancerous lesions
In some instances, LEEP or conisation may be sufficient to remove the abnormal area. Alternatively, you may have to return for a larger excision, once again making use of LEEP conization, excision with a scalpel, freezing (also called cryosurgery), cauterisation (burning or diathermy), or laser procedures to remove or destroy the lesion. These procedures usually restrict the damage to nearby, healthy tissue to a minimum. [1,6]
Sometimes, especially if your family has been completed, or if you are close to menopause, your doctor may suggest a hysterectomy where the womb and cervix are surgically removed. This is, of course, not a suitable option for women in their reproductive years who still wish to have children. [1]
Invasive cancer
The four main treatment options are surgical removal, radiation therapy, chemotherapy, and biological therapy (also called immunotherapy or targeted therapy). Surgical removal and radiation therapy are the two most common treatments. Chemotherapy is usually reserved for cancer that has spread to distant organs or tissues. Biological therapy may help to shrink tumours or slow their growth if chemotherapy alone is not effective enough or if cancer has spread. [1,3,6]
Take-home message
Cervical cancer is preventable, treatable, and curable, especially if detected early. Remember to go for regular gynaecological check-ups, including Pap smears. It is also important for younger women to consider the vaccination, especially in the presence of any risk factors.