Cervical cancer

Before the use of cervical screening, the Pap smear, cervical cancer used to be one of the leading causes of female cancer deaths.

While cervical cancer has a lower death rate than uterine and ovarian cancers now, in areas of the world where there are no screening programs, it can be found quite late and therefore will have worse outcomes.

Cervical Cancer and HPV

In the majority of cases, cervical cancer comes from contracting HPV, the human papillomavirus. Cervical cancer rates are also expected to continue to decrease from more and more women getting the HPV vaccine. It is important to get vaccinated to avoid getting HPV because up to 80% of all sexually active men and women have had HPV at some point.

Are there different types?

The main two types of cervical cancer that we see are called squamous cell carcinoma which accounts for 80-90% of cases, and adenocarcinoma which accounts for 10-20% of cases. There is also a chance that you might have both squamous cell carcinoma and adenocarcioma in the cervix which is called mixed carcinoma.

While almost all cases will fall into these categories, in rare circumstances other types of cancer can be found in the cervix such as small and large cell cervical cancer, melanoma, sarcoma and lymphoma.

Who is more likely to get it?

There are some risk factors that can make women more susceptible than others, so it's important to know what these are.

1. Over the age of 40 - usually women are diagnosed over this age, however you can still be diagnosed at a younger age
2. Smokers - smoking makes it more likely for cells in the cervix to turn cancerous, especially if the woman also has HPV
3. Risky sexual activity - this includes having a lot of sexual partners, having sex with a male who has a lot of sexual partners, or not using a condom while having sex. All of these make you more likely to get HPV

How can I check for it?

In early cases of cervical cancer it is likely that a woman has no symptoms, however it doesn't mean that she won't. If you are worried about having cervical cancer, having a pelvic exam is key to determine if there are any lesions (cuts or openings) or large lumps in the cervix that may be consistent with cancer.

After an initial exam, a cervical biopsy (tissue sample of the cervix) and/or colonoscopy (camera iserted through bowels to do imaging) might be performed so that the doctor can test tissue and if it's positive for cancer, to test if it has spread. At this time the medical professional might also do further imaging such as a CT, MRI, or PET scan.

I have it. Now what?

Surgery is a main option for many women with surgical cancer. Depending on the extent of your cervical cancer and where it has spread will help the doctor recommend which surgery is best for you.

For when the cells are only precancerous...

• Cryosurgery - this is when the doctors will go into the cervix and freeze off any precancerous cells
• LEEP surgery - the doctors use a wire hook with electricity going through it to burn off any precancerous cells

For when you're young and the cancer is small...

• Cone surgery - cancerous tissue is removed with a cone-like structure which doesn't disrupt your fertility

For when it's cancerous but not too large...

• Hysterectomy - this surgery involves removing the uterus (womb) and the cervix. In this surgery neither the vagina nor the lymph nodes (glands) are removed

• Bilateral salpingo-oophorectomy - this is a surgery where both sets (bilateral) of the ovary and fallopian tube are removed. This is usually done with the hysterectomy as well.

For when it's large but you still want to be able to have kids...

• Trachelectomy - this is when the cervix, surround tissue, and sometimes lymph nodes (glands) are removed while still saving the uterus (womb). This surgery allows the woman to still be able to have a baby, but it is more difficult to do. If you are thinking about having this surgery, it is important to have a surgeon who is skilled in these surgeries.

For when it's large and you can't/don't want to risk saving the womb...

• Radical Hysterectomy - This is one of the largest type of surgery for cervical cancer in which the cervix, uterus, surrounding tissue, part of the vagina, and lymph nodes (glands) are removed. Often a bilateral salingo-oophorectomy (ovaries and fallopian tube removal) will be performed at the same time.

If the cancer returns...

• Pelvic exeneration - This is a very large surgery and should be performed by a specialist. In addition to everything that is removed during a radical hysterectomy, in a pelvic exeneration the bladder, vagina, rectum, and part of the colon are removed as well.

Other treatments apart from surgery used for Cervical cancer include both radiation and chemotherapy. Either of both of these will usually be used if the cancer has spread past the cervix or if the tumor is large (more than 4 centimeters). Depending on your type of cancer and the surgeries that you've had, discuss with your doctor what the best option is for you.