Cervical cancer: Your risks, preventative measures, and treatment by stages
Cervical cancer is the most prevalent form of cancer affecting SA women. Yet too many women have questions: what is your risk, how does it develop, and how is it treated? Mediclinic pathologist Dr Izak Loftus explains.
Cervical cancer is one of South Africa’s biggest women’s health problems, affecting one in 41 women in the country according to the SA Journal of Obstetrics and Gynaecology. However, it is highly curable if diagnosed early.
Dr Izak Loftus, an anatomical pathologist at Mediclinic Vergelegen, says cervical cancer is still the most prevalent form of cancer affecting women in South Africa. “The majority of these cases are in the form of either squamous cell carcinoma or adenocarcinoma. Sexually transmitted infections like Human Papillomavirus (HPV) can act as precursors to these cancers.”
This is why early detection is so vital. “Regular checks are the best way to pick up early warning signs of cervical and other cancers,” he says.
The stage of cervical cancer is the most important factor in choosing treatment. However, other factors play a role too, including the location of the cancer within the cervix, the type of cancer, the patient’s age and broader health profile and whether she wants to have children.
HPV: the biggest culprit
The human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is also responsible for 99% of cases of cervical cancer, according to the Western Cape Department of Health.
While symptoms such as genital warts can occur with an HPV infection, very often it is asymptomatic or symptoms only occur when cancer is present.
The only way to ensure that a woman does not have any cancerous cells is to have regular pap smears as indicated by her GP or gynaecologist.
Understanding the stages of cervical cancer
Stage I: The cancer has spread from the cervix lining into the deeper tissue, but is still just located in the uterus and has not yet reached the lymph nodes.
Stage II: The cancer has spread beyond the cervix to the vagina or tissue near the cervix, but it is still contained within the pelvic area.
Stage III: The tumour has spread to the pelvic wall, and may already involve the lower third of the vagina or affect kidney functioning.
Stage IVA: The bladder or rectum and possibly other parts of the body including the lymph nodes are affected.
Stage IVB: More distant regions in the body are affected.
Some of the treatment options for early-stage cancer (stage 0 and I) include:
- Cryosurgery (freezing the cancer)
- Laser surgery
- Loop electrosurgical excision procedure (LEEP/LEETZ) – small wired loop tool utilising electricity for surgical removal of cancer
- Cold knife conization – removing a piece of cervical tissue containing abnormal cells using a scalpel or laser
- Cone biopsy – often a preferred procedure for women who want to have children after the cancer is treated; a small operation to remove a cone-shaped piece of tissue from your cervix
- Radical trachelectomy(removal of the cervix and upper vagina) – often preferred if the cancer has grown into blood or lymph vessels
- Simple hysterectomy (as the first treatment or if the cancer returns after other treatments)
- A radical hysterectomy along with removal of the pelvic lymph nodes – sometimes needed if the cancer has grown into blood or lymph vessels
- External beam radiation therapy (EBRT) to the pelvis plus brachytherapy including the above surgery — this is often reserved for more advanced stage I cancers
Some of the treatment options for more advanced cervical cancer (stage II to IV) include:
- Radical hysterectomy with removal of lymph nodes in the pelvis
- Radiation using both brachytherapy and external beam radiation therapy
Very advanced cancers, recurrent cancers or cervical cancer during pregnancy would require further tailoring of the treatment plan, as discussed with the patient’s oncologist and gynaecologist.
After cancer treatments, regular follow-ups remain essential, usually every three to six months for the first few years following the cancer treatment.
Regular screening remains essential
“For patients younger than 21, or within a year of becoming sexually active, I would recommend a pap smear,” says Dr Loftus. “A combination of the pap smear and HPV-testing is recommended from 30 years onward.”
Every patient is unique, and so your doctor may suggest a testing schedule outside of the norm. “We look at your age, how strong your immune system is, and of course the testing model you prefer. Your doctor is in the best position to decide on a screening frequency that works for you.”
During a pap smear test, the health care provider removes a sample of cells from the cervix to check for any signs of cervical cancer. The same sample can also be used to look for the genetic material (DNA) of the HPV within a sample of cells. The test can detect the type of HPV connected to cervical cancer. The sample used for this test is generally collected at the same time as a pap test.
Annually, there are over 5 700 new cases of HPV, according to the Western Cape Department of Health – and over 3 000 associated deaths each year. There is an effective vaccination [link to relevant Infohub article] available for young women (and men) who have not already been exposed to the risk of HPV through sexual intercourse. In April 2014 the South African National Department of Health implemented a school-based HPV vaccination programme for all girls nine years and older, but have admitted that the screening for, and management of, both pre-invasive and invasive cervical cancer needs to be increased.