Cancer Of The Cervix

Abdominal cancer

Those who are diagnosed with abdominal cancer, whether it is cancer of the uterus, ovaries or cervix, gets many considerations:

• Why was I sick?
• How will it go me?
• The treatment will be successful?
• Will I still feel like “woman”?

Both in connection with that diagnosis is made, during treatment and beyond, the most experience the situation as a crisis in their lives. Uncertainty and anxiety are natural reactions. Being diagnosed with cancer is a personal experience. In this information letter you will find information about cancer of the cervix. You can also read about the different therapies.

Information letter is primarily directed at the patient, but we hope that it will be read by the patient’s relatives and other interested parties. An information circular can never give answers to all questions, but it can be a support. It might give you more knowledge about your illness, and it might also remove some misunderstandings.

Cancer of the cervix

Every year some 400 South African women diagnosed with cancer of the cervix. The disease is the ninth most common cancer in women. Many more women are diagnosed and treated stages of the disease. It is generally on the cell changes that the physician considers by routine investigation.

For many women with cervical cancer detected the disease early. In these cases there is good opportunity for healing.

The uterus is the size of a light bulb with a weight between 40 and 70 grams. The wall consists of muscle layers and internally by a mucous membrane. It is part of the mucosa, which is ejected by menstruation. The cervix is ​​part of the uterus and opens into the vagina. The cervix can be seen by a gynecological examination and labeled in the vagina. You may not even notice whether you have cervical cancer.

Most cases discovers during routine examination by the doctor. Women will be convened every three years from the age of 23 years, the doctor takes a cell sample from the cervix. The aim is to detect precursors of cervical cancer and treat them before they develop into actual cancer. The vast majority of cell changes will never develop into cancer.

Cancer of the cervix can also appear between the studies. The most common symptoms are bleeding during intercourse or during physical activity, possibly by some vaginal bleeding associated with urination. As can be constant trickle a little blood or bloody discharge from the vagina. In more advanced stages there may be pain, like drain from the kidney to the bladder can be clamped. This leads to accumulation of urine in the renal pelvis, which can occur with the pain in the flanks, where the kidney is sitting.

In younger women due to bleeding during sexual intercourse very rare cancer, but they should still be examined by the doctor. In women after menopause, a vaginal bleeding or bloody vaginal discharge should always be examined, though most cases not caused by cancer.

How common is cervical cancer?

In the period 2008-2012, an average of 372 new cases of cervical cancer per. years in South Africa. It is a dramatic improvement, as previously three times as many.

This improvement is mainly due to the fact that women are routinely tested for cell changes on the cervix, thereby capturing many in the early stages, before it develops into actual cancer. See also. cell changes .

In recent years, as a part of the childhood immunization program  offered vaccination of young girls against the two types of Human Papilloma Virus (HPV) responsible for most cases of cervical cancer. This has and will further reduce the number of new cancer cases.

What causes cervical cancer?

Cervical cancer is a sexually transmitted disease caused by a viral infection with HPV (human papilloma virus). There are more than 100 different HPV types, and some can hit people. Some types of HPV can cause genital warts (condyloma). Other HPV types can cause cell changes on the cervix. Cell changes in the cervix are often transient but may develop into cancer if not treated in time. See also. section on ‘cell changes’ and ‘HPV’.

There is a link between cervical cancer and sexual habits – the more partners you have had, the greater is the risk of becoming infected with one of the most dangerous HPV types and thus to get cervical cancer. This does not mean that the number of sexual partners as such has a meaning but simply the risk that you are infected with one of the ‘dangerous’ viruses is greater. Tobacco smoking increases the risk of cervical lesions and cervical cancer. This is because tobacco reduces the ability to repair the diseased cells and the ability to get rid of the virus again.

The disease can be associated with a certain lifestyle leads to that individual feels the piston when they are diagnosed. Many feel they are to blame for that they have gotten this cancer. It is therefore important to remember that cervical cancer is also often found in women who have had few sexual partners and have never smoked. It is also important to know that most women have been infected with HPV without getting sick. We do not yet know why some people become healthy by themselves, while others develop cancer.

Surveys

Screening for cervical lesions, cervical cancer prevention

Women between 23 and 50 years are offered a pap smear every three years and women between 51 and 65 every five years. You are invited to the screening study via a letter. It is important to emphasize that in healthy women with normal tests is a Pap smear every three years is sufficient. It is therefore not necessary to take separate additional samples by visiting the gynecologist associated with such. contraceptive advice or pregnancy.

The study carried out by the doctor takes a cell sample from the cervix with a spatula or a small brush. The sample is examined under a microscope. All samples showing cell changes are checked and treated in accordance with approved guidelines. You use cell samples to detect early precursors of cervical cancer that can be treated before they develop into cancer.

Cell samples in some cases may show early signs of cancer, and in rare cases can develop into cervical cancer, which are not caught by cell samples. In other cases detected cervical cancer in women who for one reason or another have opted out of cell samples.

Colposcopy and tissue samples (biopsies)

If you have cell changes, there will often be a need for a more thorough examination of the cervix. Using a special telescope can gynecologist examine the cervix and look for cell changes or cancer. Often taken tissue samples – also called biopsies – from the cervix. This can be done without anesthesia, but it is possible to put a local anesthetic. At the same time, take the further a cell sample or a smear from the cervix.

Is the examination of biopsies or serious precursors therefor is made a conic. Hereby cut the lower part of the neck of the uterus. There are two objectives of the study: removing the diseased tissue and to examine whether there is healthy tissue between the lesion and the remainder of the uterus and vagina.

Is there cancer biopsies, a conic sometimes be adequate treatment. Other times, a surgical removal of the uterus may be required, and some cases be treated with chemo- and radiotherapy.

further studies

If the tests show cervical cancer, it is important to examine whether the disease has spread, or whether it is limited to a small area of ​​the cervix. This is done at a specialized gynecological department at a gynecological examination under general anesthesia. At the same time make it a special x-ray scanning – a PET / CT scan, which almost certainly can show whether there has spread to lymph nodes and surrounding tissue.

Various stages of the disease

Cervical cancer is divided into different stages, depending on whether the disease has spread or not. The division has great importance for which treatment should be offered and how seriously ill you are. In stage I cancer tumor limited to the cervix. This is true for about 50% of cases. Stage IV, which is much rarer, is the most serious. Here the tumor has spread and grown into other organs near or has spread through the blood or lymphatic system to other organs in the body. Between these two extremes is the stage II and III.

Pregnancy and cervical cancer

If you are pregnant and less than six months pregnant when the disease is discovered, you will be advised to terminate the pregnancy. It is obviously a very difficult decision, but the disease may require immediate treatment and can not be carried out if you are pregnant. If there are less than three months left of gestation, consider waiting a few weeks and make cesarean before treatment starts.

If you have not been pregnant, but want to become what is there for cervical cancer in the early stages the opportunity to operate so that the uterus – and thus the possibility of pregnancy – are preserved.

What treatment is there?

Your doctor, based on your specific case, suggest a particular type of treatment. It is based on many years of international and South African experience.

The treatment of precursors

Is this merely cell changes – called precursors of cancer – the disease can be treated with a conic / cone biopsy.

You can read more about the precursors to cervical cancer here .

Treatment of Cervical Cancer

If the disease is in stage IA, IB, and most cases of stage IIA, you will be offered surgery. Radiation therapy is in these stages equivalent to surgery but most patients are advised to choose surgery when radiation treatment will damage the surrounding tissue and the ovaries, which then can no longer produce the female hormones. In these stages it is often elderly or physically weak women receiving radiotherapy. Risks of surgery can be high for these women.

By the operation the uterus is removed, the upper part of the vagina and the closest lymph nodes. The procedure is called radical  hysterectomy . The operation can be made through an incision in the stomach or as a keyhole surgery.

There may be complications associated with surgery. Some women in the post-surgery problems emptying the bladder spontaneously. With very few these problems are permanent. About 5% will cause the generation of swelling in the legs due to lack of drainage of the lymph, and between 1 and 3% will have a fistula – a small passage – between the bladder and vagina.

Radiation treatment

If the cancer has reached stage IIB, III or IV, you will be offered radiotherapy. As mentioned earlier, this is also the case if the doctor determines that you will not withstand the load of an operation. In some cases, a combination of surgery and radiation therapy to be the most effective.

The radiation treatment can destroy cancer cells without affecting healthy cells in excessive degree.

The treatment is given in the form of external irradiation (external beam radiation). The treatment is given every day for five or six weeks – depending on the spread of the disease. The treatment takes a few minutes each time, and is in itself painless. It does not require admission to hospital.

Some stages are also treated with radiation inside the cervix. This will come close to cancer cells and have high energy in the diseased tissue and less in healthy tissue.

Often you give chemotherapy and radiation at the same time because it makes treatment more effective.

Treatment with chemotherapy

This form of treatment used relatively rarely alone for cervical cancer. Chemotherapy may still be considered if the disease shows signs of returning. Chemotherapy is often given together with radiation therapy, as it makes treatment more effective.

Side effects

Radiation treatment is given in many small doses. Experience shows that this gives the fewest side effects. For some patients, this means that they can live an almost normal life, even if they get treatment.

But be prepared that may arise genes. In the majority of the irradiated will be bothered – eg. the skin will have a pinkish tone by a slight sunburn. Some will look tanned, and skin may become somewhat thickened. This condition can last up to a year or more after treatment. You may also experience fatigue, nausea, diarrhea, abdominal pain and a burning sensation during urination associated with treatment.

Ask the staff that give you radiation treatment, how best to reduce the inconvenience. They have extensive experience in the field.

There can also occur later complications of radiation therapy are. Upon irradiation of the ovaries cease production of sex hormones. Therefore coming younger women in an artificially induced menopause . Hormone therapy can help in a number of physical problems. But many find anyway situation as mentally very stressful. Among other things, because the possibility of getting pregnant is no longer present.

In some cases, ovarian hormone production get started again after a few years, but occurs predominantly in young women.

It is possible to move the ovaries out of the radiation field of an operation. In this way, ovary spared and preserve hormone production.

A relatively new option in younger women who need radiation therapy is to remove one ovary and freezing it down until the treatment is over and the cancer disappeared. It is possible to operate the ovaries again and to get them to work. There are obtained multiple pregnancies and normal births with this method. However, in the case of cervical cancer only to retain hormone production, when the uterus is unable to carry a pregnancy after radiation.

Vaginal dryness is also a common side effect of radiation therapy and can also provide genes associated with sexual activity. The genes can usually fully or partially alleviated by the use of moisturizing creams and hormone creams.

In women who have had radiation therapy to the abdomen may later cause gastrointestinal discomfort. Consult your doctor and possibly with a clinical nutritionist.

Many wonder if you become radioactive by the rays. This is not the case and you do not suspend the other risk because of the treatment.

Important with good information

Ask questions! It is important that you understand the reasons for the advice that your doctor provides. By getting involved in disease and treatment do you make the best help.

How is long-term prospects?

Cervical cancer is a serious disease that is fatal if not treated.

If one is operated and should not receive aftercare followed one of the gynecological department, where you had surgery. Have you received aftercare going monitoring of the oncology department – where one has received the treatment.

The first year will be checked every 3 months, every 6 months the second and third year and once a year the 4th and 5th years. After this follow-up completed and you should contact your own doctor if you get new genes or suspect that the disease has come back. In the coming years, women in the earliest stages IA and IB probably not be followed up, but should even be aware of the danger signals and turn in suspected disease.

Overall – for all stages and for all ages – will 88% of women with newly diagnosed cervical be alive one year after and 67% will be alive five years later. By the end of 2012 there lived almost 9,000 women in South Africa diagnosed with cervical cancer, and since there is less than 400 new cases each year, many of them lived for many years after diagnosis.

There is a clear correlation between the stage at diagnosis and mortality. This means that the earlier the disease is discovered, the less likely you are to die from it.

In medicine you use the term 5-year survival. It is a measure of how many patients with a given disease in a given stage are alive after five years. There is a statistical concept that says nothing about the individual’s future. No one can predict how it will go with the individual woman with cervical cancer. The below 5-year survivals should be taken with these reservations.

5-year survival

• Stage IA: 96-97%
• Stage IB: 85-90%
• Stage II: 65%
• Stage III: 30-40%
• Stage IV: 10%