Cervix cancer is a cancer of the cervix, the lower part (neck) of the uterus. It is now a relatively uncommon cancer in Australia. In 2015 there was 857 new cases of cervical cancer in Australia.
The incidence of cervix cancer has been reduced by screening due to the national screening program which started in 1991. It offers free Pap smear tests every 2 years. Since the end of 2017 the Pap smear test has been replaced with a HPV test, this can extend screening times out to every 5 years if HPV negative.
In countries where screening and treatment of precancerous changes are not available, cervix cancer is one of the most common cancers in women.
What are the Causes of Cervix Cancer?
Cervix cancer is caused when normal cervical cells undergo change. These cells grow in an abnormal manner and at an uncontrolled rate.
The most common cause of cervix cancer is a virus, called the human papillomavirus (HPV). This is a virus that many women have been exposed to during their lifetime. The virus infection is cleared up in most women, however some women have persistent infection that may lead to the development of cervix cancer.
It takes many years between the infection and the development of cervix cancer. Because it takes many years before precancerous changes become cancer, and it is possible to detect these changes by screening (e.g. Pap smears), this gives the opportunity of treatment to prevent cancer developing.
The cervix cancer vaccine, given before the woman is sexually active, will reduce her risk of getting cervix cancer. The vaccine is currently given at the age of 12. It is still important to have screening, for example Pap smears and HPV testing as the vaccine reduces the risk of developing cervix cancer but does not eliminate the risk. The vaccine is also given to boys as it helps prevent other HPV related cancers.
What are the Symptoms of Cervix Cancer?
Pre-cancerous changes and early cervix cancer may sometimes not cause symptoms. Symptoms of cervix cancer include abnormal vaginal bleeding such as bleeding between periods or after sexual intercourse, sexual intercourse may also be painful, heavy or longer periods, bleeding after menopause, vaginal discharge, and pelvic pain. People can get other symptoms including nausea, loss of appetite and weight loss which are more non-specific.
In order to diagnose cervix cancer, a biopsy or small piece of tissue is needed to be taken and looked at under a microscope by a pathologist. This is usually done by a Gynaecologist under local anaesthetic.
What are the Treatments for Cervix Cancer?
Once cervix cancer is diagnosed, there are a number of other tests that may be done to determine the best treatment. These may involve blood tests, examinations sometimes under anaesthetic, and scans including CT, MRI or a PET scan.
The treatments involved in cervix cancer include surgery, radiation therapy and chemotherapy. Radiation therapy may be given together with chemotherapy. The choice of treatment will depend on the extent (stage) of the cancer. Other patient factors such as age and general health are also considered in the treatment decision.
A team of doctors including gynae-oncologists (surgeons), radiation oncologists, medical oncologists, pathologists and radiologists will be involved in discussing and making the recommendations about treatment for each patient. Whilst it is usually obvious which is the best treatment, sometimes there may be a choice between surgery or radiation therapy with chemotherapy.
The doctors will discuss what is involved with each of these treatments, and help the patient make a decision.
Surgery is usually recommended for those patients with an early stage cervical cancer. Surgical techniques to remove part of the cervix with conservation of the body of the uterus may allow preservation of fertility in some cases. If there is no cancer left behind, the surgeon will see the patient regularly for check-ups.
The usual surgery for cervix cancer is a hysterectomy. A hysterectomy is an operation to remove the uterus and cervix. This is usually done together with removal of the tissues around the cervix, tubes, lymph nodes and sometimes the ovaries. After the operation, the pathologist will examine the cancer under the microscope. If the cancer has features that suggest the cancer could come back, the team may make a recommendation that a course of radiation therapy be given, after the surgery to reduce this risk. Sometimes low-dose chemotherapy is given with the radiation therapy.
Radiation therapy is a treatment using high energy x-rays to kill the tumour cells. Radiation therapy techniques use advanced imaging and modern equipment to deliver treatments with more accuracy, enabling more precise targeting of the tumour. It also reduces the dose received by normal organs, resulting in fewer side-effects.
External beam radiation therapy treats a larger area that includes the tumour and the lymph nodes. It involves daily attendance at the treatment centre, five days per week, usually for 5 weeks. Treatment takes around 10-15 minutes a day. The treatment team will see the patient regularly to monitor for any side effects of treatment and to manage these. Blood tests are usually done weekly, especially when chemotherapy is also given.
Brachytherapy is treatment delivered directly to the tumour by placing tubes and needles next to and into the tumour. It allows high doses of radiation to be given directly to the tumour with lesser doses received by surrounding normal structures such as bowel and bladder.
The brachytherapy treatrment is very important, as it increases the chances of cure while reducing the risks of injury to normal tissues that are close to the tumour. It usually involves an anaesthetic for the insertion of the tubes. If it isn’t done as a day procedure, it may involve a 1-2 night stay in hospital. More detailed information on brachytherapy can be found in the brachytherapy for cervix cancer document.
Total treatment for external radiation and brachytherapy can take around 2 months to complete. After completion of treatment, the doctor will arrange to see the patient for follow-up. The tumour may continue to get smaller for several weeks after the completion of the course of treatment, and the doctor will monitor this by examination and with scans.
How Effective is Radiation Therapy for Cervix Cancer?
In early stage cervix cancer, the cure rates with radiation therapy and surgery are similar. Factors such as age, other health conditions, and the different side effects of these treatments will be taken into consideration when deciding which treatment would be best. These considerations will be discussed with the patient.
If the radiation is given after a hysterectomy, the aim of the treatment is to reduce the chances of the cancer coming back in the pelvis.
If surgery can’t be performed or if the tumour is more advanced, radiation therapy is an effective therapy for cervix cancer. The chances of cure are related to the stage of the cancer and whether there has been spread of the cancer to lymph nodes. Even if the cancer has spread to the lymph nodes, treatment may still be curative.
The cure rates of cervix cancer have improved with earlier diagnosis and treatment. Technological advances in treatment have reduced significantly the side-effects of therapy.
What are the Side Effects of Radiation Therapy?
Radiation therapy is a painless treatment, you will not see or feel anything during the treatment . You can hear a buzzing noise while the machine is on. It does however have side effects, and these build up gradually during the treatment.
Side effects of radiotherapy can be broken up into acute and late side effects. Acute side effects happen during the treatment, get worse for a week or 2 after completion of treatment and then get better. Late side effects happen months to years down the track and they are usually more permanent.
Acute side effects include:
fatigue or tiredness
bowel and rectal irritation – this can lead to diarrhoea , frequency of the bowel, nausea and vomiting.
bladder problems – including discomfort when passing urine, needing to pass urine more frequently and more urgently
skin changes – red, dry and itchy skin in the treatment area
hair loss in treatment area
vaginal dryness and discharge – this may cause pain and discomfort during intercourse
Late side effects of radiation therapy include:
bladder changes – ongoing discomfort on passing urine, more urgency and less control of bladder function
small risk of bowel blockage
sexual dysfunction – narrowing of the vagina and dryness
rarely: a pelvic fracture or a second cancer
The best person to discuss radiation therapy with for cervix cancer is a Radiation Oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment for you.
Find your closest radiation oncology Treatment Centre
Page last updated: 10/09/2020