- Occurs in cells of cervix, the narrow part of the lower uterus that connects to the vagina (referred to as the neck of the womb).
- Affects the entrance to the womb.
- Various strains of the human papillomavirus (HPV) play a role in causing most cervical cancer.
- Occurs when the cells of the cervix grow abnormally and invade other tissues and organs of the body.
- When this type of cancer is invasive, it affects the deeper tissues of the cervix and may spread to other parts of the body.
- Most notably the lungs, liver, bladder, vagina and rectum.
- Cervical cancer is slow growing.
- Progression through precancerous changes provides opportunities for prevention, early detection, and treatment.
- One of the most preventable types of cancer.
- The cancer that causes the largest number of deaths among women in developing countries.
- 2nd most common cancer among South African women.
- 1 in every 42 women in South Africa will be diagnosed with cervical cancer.
- Incident rate of cervical cancer in South Africa is reported between 22.8 and 27 per 100 000 women compared to the global average of 15.
- Annually there are 5 743 new cases reported with 3 027 associated deaths in South Africa.
- 99% of cervical cancers are associated with HPV.
Signs and Symptoms
Early stage cervical cancer generally produces no signs/ symptoms
- For this reason, regular screening through Pap and HPV tests can help catch precancerous cell changes early and prevent the development of cervical cancer.
Signs and symptoms of more-advanced cervical cancer
- Unusual bleeding.
- Vaginal bleeding after intercourse, between periods/ after menopause.
- Watery, bloody vaginal discharge that may be heavy/ have a foul odour.
- Pain and discomfort during intercourse.
Advanced cervical cancer
- Blood in urine
- Loss of bladder control
- Bone pain
- Swelling of one of your legs
- Severe pain
- Side/ back pain caused by swelling in kidneys
- Changes to bladder and bowel habits
- Loss of appetite
- Weight loss
- Tiredness/ lack of energy
- Kidney failure due to urinary tract/ bowel obstruction (when cancer is advanced)
- Pap testing is the most typical screening procedure.
- If abnormal cells are detected a colposcopy procedure is performed.
- Uses a lighted microscope to examine the external surface of the cervix during a pelvic exam.
- If abnormal areas are noted, a small tissue sample/ biopsy is taken for examination by a pathologist to look for precancerous changes or cancer.
- Procedure requires no special anaesthesia.
- Similar to having a Pap smear in terms of discomfort.
- Transformation zone of the cervix cannot always be visualised well during a colposcopy.
- One of the following procedures may be performed.
Endocervical curettage or scraping:
- Sample of cells taken from interior canal of cervix.
- Removal of cone shaped portion of cervix around cervical canal.
- Tissue removed with thin loop of wire heated by electrical current.
- Called a loop electrosurgical excision procedure (LEEP).
- Performed in doctor’s office with local anaesthetic.
- Another option is having the cone-shaped tissue fragment removed in an operating room under general anaesthetic.
- Referred to as cold knife conization.
- After the conization/ biopsy procedure the pathologist studies the tissues to determine if precancerous changes/ cancer is present.
- Referred to as cervical intraepithelial neoplasia grades 1 to 3.
- If cancer is present, depending on size and extent of tumour, other tests might be done to help determine the extent to which the tumour has spread.
- Additional tests include chest x-rays, CR/ MRI imaging studies.
- Called a loop electrosurgical excision procedure (LEEP).
- The following tests may also be necessary.
Cystoscopy – examination of the interior of the urinary bladder using a thin, lighted scope
Proctoscopy – examination of rectum
Examination under anaesthesia allows the doctor to perform a manual pelvic examination without causing pain to help determine the degree of spread of cancer within the pelvis
- Risk can be reduced by having screen tests and receiving a vaccine that protects against the HPV infection
- This is a sexually transmitted disease
- More than 100 different types of HPV can occur
- At least 13 of which may cause cervical cancer
- Many sexual partners
- The greater your number of sexual partners, and the greater your partner’s number of sexual partners, the greater your chance of acquiring HPV
- Early sexual activity
- Having sex at an early age increases your risk of HPV
- Other sexually transmitted infections (STIs)
- Having other STIs, such as chlamydia, gonorrhoea, syphilis and HIV/AIDS, increases your risk of HPV
- A weak immune system
- You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV
- Smoking is associated with squamous cell cervical cancer
- Chemicals in cigarette smoke interact with cells of cervix, causing precancerous changes that may over time progress to cancer
- Risk of cervical cancer in cigarette smokers is 2 – 5 times that of the general population
- Birth control pills
- Long-term use of some common contraceptive pills slightly raise a woman’s risk
- Depends on many factors including stage of cancer when diagnosed.
- Treatment options include surgery, radiotherapy, chemotherapy and targeted therapy.
- Different kinds of doctors may be involved in the treatment team
- Gynaecologic oncologist – physician that specialises in treating cancers of the female reproductive organs, including surgery to remove scars.
- Radiation oncologist – physician who uses radiation to treat different kinds of cancer.
- Medical oncologist – specialist in the use of chemotherapy and other medical therapies to treat cancer.
- Performed to remove cancer, especially early-stage tumours
- Hysterectomy may be performed.
- Other procedures that preserve ability to carry a pregnancy can be done in younger women with small tumours.
- Cone biopsy – removal of the inside of the cervix where most tumours begin.
- Trachelectomy – removal of upper vagina and cervix.
- Both used to remove small tumours to preserve fertility.
- Pelvic exenteration – removes uterus, surrounding lymph nodes, parts of other organs surrounding cancer.
- With more advanced cancer.
- Radiation therapy
- External beam radiation therapy – radiation therapy administered from outside source of radiation.
- Brachytherapy – radiation therapy that involves insertion of radioactive sources near tumour for fixed period.
- Can be used together.
- If radiation therapy is given as the main treatment, it is often combined with chemotherapy.
- Side effects include fatigue, diarrhoea, skin changes, nausea, vomiting, irritation of bladder, vaginal irritation and discharge.
- Sometimes menstrual changes/ early menopause if ovaries exposed to radiation.
- Recommended together with radiation.
- May be given before/ after radiation.
- Chemotherapy drugs commonly used for cervical cancer.
- May be treatment of choice for cervical cancer that has come back after treatment.
- Side effects include nausea, fatigue, vomiting, hair loss, mouth sores.
- Targeted therapy
- Refers to drugs specifically developed/ targeted to interrupt cellular processes that promote growth of cancer cells.
- Inhibits ability of tumours to make new blood vessels which is required for tumour growth.
- Used for advanced cervical cancer.
1. Mayo Clinic:
4. Western Cape Government
5. National Cervical Cancer Coalition