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 2011, there were 801 cases in Australia.
The incidence of cervix cancer has been reduced by screening (with Pap smears), effective treatment of pre-cancerous changes and a reduction in smoking.
In countries where screening and treatment of precancerous changes are not available, cervix cancer is one of the commonest cancers in women.
What Are the Causes of Cervix Cancer?
Cervix cancer is caused when normal cervical cells change into abnormal cells. 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. The virus infection is cleared up in most women, however some women have persistent infection that may lead to the development of cervix cancer.
There are usually many years between the infection and the development of cervix cancer. As 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. It is still important to have screening ( e.g. Pap smears, HPV testing) as the vaccine reduces the risk of developing cervix cancer, but does not eliminate the risk.
What Are the Symptoms of Cervix Cancer?
Pre-cancerous changes and early cervix cancer may not cause symptoms. Symptoms of cervix cancer include abnormal vaginal bleeding such as bleeding between periods or after sexual intercourse, heavy or longer periods, bleeding after menopause, vaginal discharge, and pelvic pain.
A biopsy is needed to diagnose cervix cancer, when a small sample of tissue is removed for examination by a pathologist.
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 imaging with scans.
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 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. If the cancer has features that suggest the cancer could come back, the team may make a recommendation that a course radiotherapy be given, after the surgery to reduce this risk. Sometimes low-dose chemotherapy is given with the radiotherapy.
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. The treatment team will see the patient regularly, and 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 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.
Treatment may 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 sometimes 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?
Generally, radiation therapy is well tolerated. During radiation therapy, some patients experience fatigue, diarrhoea, rectal and bladder irritation. The skin reaction such as reddening of the skin or sometimes peeling of the skin in the treatment area, is very like sunburn. The team of doctors and nurses will monitor the patient regularly to advise on management.
Late side-effects of radiation therapy include a small risk of significant injury to bowel and bladder. Lymphedema (swelling due to fluid retention) of the lower part of the body may develop. If this occurs, the patient will need referral to a physiotherapist.
Other potential late side-effects are pelvic fractures and narrowing of the vagina. The treatment team will discuss these potential effects of therapy, and techniques to reduce the risks of these developing and treatment if they do develop.
Women who have not undergone menopause will go into menopause from the treatment, as the ovaries are very sensitive to radiation. Sometimes, in young women, the ovaries are moved away from the radiation therapy field before treatment begins, to try to preserve the ovaries’ ability to produce the female hormones, but this doesn’t always work.
Hormonal replacement therapy can be prescribed by the doctor, if the patient develops menopausal symptoms, such as hot flushes.
Women undergoing radiation therapy to the pelvis for cervix cancer will not be able to have children after the treatment. The doctor and treating team can provide advice on fertility.
It is not uncommon to feel emotional during the treatment. Many centres have psychological services available to support patients.
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.
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