Cervical cancer is the second most common cancer in women, but it kills more women yearly than breast cancer. It’s caused by the human papillomavirus, a widespread virus that most sexually active women will get. It is, however, whether the virus hangs around in the vagina, persists and integrates into the cervix, and then causes cancer with time.
If cervical cancer develops, it will usually present with a persistent abnormal discharge and bleeding. This bleeding can be precipitated by sexual intercourse.
If persistent bleeding occurs, a pelvic examination and inspection of the cervix must be done. This is done with a particular instrument, called a speculum, which opens up the vagina so that the mouth of the womb can be seen. This isn’t painful but rather intrusive and uncomfortable.
A Pap smear/HPV test is done with a scraping of the cervix with a brush. This should be done according to the national guidelines. If cancer is seen on the cervix, a biopsy will be taken in the rooms. The biopsy isn’t painful but can bleed.
Treatment of pre-cancerous lesions is essential. It consists of looking at the cervix with a giant microscope (colposcopy) and taking a biopsy to prove a problem that needs treatment. The treatment is simple; it involves removing the abnormal area with a hot wire loop (LLETZ).
If there is already cancer, the treatment depends on the stage. A cone biopsy or simple hysterectomy can be done at a very early stage. Suppose it’s slightly bigger but still confined to the cervix; in that case, a radical hysterectomy involves taking the cervix, top of the vagina, side of the cervix, the uterus, and the lymph glands on the side of the pelvis.
If it’s above Stage 1, generally we will not operate but instead do a combination of radiation and chemotherapy. The chemotherapy is low-dose and doesn’t cause hair loss or many other side effects.
It’s always essential to discuss reproductive needs as this cancer affects young women and can affect their ability to have children.
After the diagnosis of cervical cancer and especially after radiotherapy, you must continue sexual activity. If cancer survivors don’t have a partner, we would advise that a vibrator is used. Radiation treatment causes the vagina to narrow and makes sex very uncomfortable, so it’s essential to continue sexual activity and keep the vagina open for examination and future sexual activity.
Treatment can also cause premature menopause. It’s not a hormone-dependent cancer so hormone replacement therapy can be used. It’s vital to remember that this is a treatable, curable cancer.
Prevention is better than cure
Cervical cancer is 100% preventable by vaccinating all adolescent girls and going for routine cervical screening, either by Pap smears or by HPV testing.
The Pap smear isn’t designed to find cancer but a pre-cancer that can be easily treated and thereby prevent cancer.
Dr Trudy Smith is a gynaecology oncologist at Wits Donald Gordon Medical Centre and a senior lecturer at the University of Witwatersrand. She has a keen interest in teaching postgraduates and undergraduates.
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