The incidence of cervical cancer in Australia has declined dramatically in the last two decades due to effective screening programs with Pap smears. The Pap smear (also called ‘cervical smear’) is designed to detect pre-cancerous changes of the cervix, so a colposcopy may be performed to confirm any abnormalities detected by the smear.
There are rarely any symptoms for early changes in cervical cells; however, if they develop into cervical cancer, the common symptoms include longer and heavier period, bleeding between periods, bleeding after menopause, bleeding after sexual intercourse, pain during sexual intercourse, unusual vaginal discharge, lower back pain, extreme fatigue, and leg pain or swelling.
A colposcopic examination of the cervix is usually required because the Pap smear is a screening test. The Pap smear does not show the site and exact nature of the abnormality. At WOMEN Centre, the colposcopic examination is performed using a specially designed examination chair and completed in a few minutes. It will often include a small biopsy of the cervix that will be sent for pathological diagnosis.
If cervical screening with Pap smears and colposcopic examinations are performed in accordance with the National Health and Medical Research Council’s (NHMRC) guidelines, then cervical cancers should be very rare. Appropriate treatment and follow-up of any precancerous areas of cervical tissue (lesions) will prevent progression to cancer.
The cervical cancer vaccine does not offer complete protection against cervical cancer; Pap smears are still required as well as colposcopic examinations should an abnormality be detected on the smear.
A cervical smear is designed to detect abnormalities of the cervix. It is not a test for cancers of the uterus or ovary.
Treatment and Surgery
Together with the decreased incidence of cervical cancer, there have also been dramatic advances in its treatment that may include a combination of surgery, radiotherapy and chemotherapy. Selection of which treatment modality to employ is dependent on the stage of the cancer at presentation.
Early stages of disease may be managed with a radical hysterectomy (removal of uterus, cervix and surrounding parametrial tissue around the cervix) and pelvic lymph node dissection. A radical hysterectomy requires more complex surgery and may have more side effects than a simple hysterectomy, but it is required in order to obtain an adequate resection margin around the cancer and achieve a cure. Performing a radical hysterectomy in early stage disease is preferable to radiation and chemotherapy as it offers the same cure rates but with less side effects.
Although a radical hysterectomy is traditionally performed via laparotomy (traditional open abdominal surgery) via a large incision in the abdomen, our gynaecologic oncologist offers the procedure via laparoscopy (keyhole surgery). The surgical procedure of radical hysterectomy via a laparoscopic approach has not been widely adopted because it is technically more difficult to perform and requires additional training. As a result, it is not yet classified as standard treatment for cervical cancer, which currently stands at a radical hysterectomy via laparotomy. This will be further discussed with the patient during consultation.
More information here on laparoscopy.
More information here on the consideration of open or keyhole surgery.
Chemotherapy and / or Radiation Therapy
After the hysterectomy, a pathologist will examine the tissue to determine the characteristics of the cancer. If there are high-risk features found, radiation therapy and / or chemotherapy may be recommended to minimise the risk of the cancer recurring after surgery.
More advanced disease is usually treated with radiation therapy and chemotherapy without surgery. This is not because the disease is not curable. This is often a difficult concept for patients to understand as they may worry that surgery is not being performed to remove their cancer. The reason is that radiation therapy and chemotherapy are more effective than surgery to achieve a cure in these cases. Performing hysterectomy prior to chemotherapy and radiation does not improve cure rates, and it may delay commencement of radiation therapy and chemotherapy.
After Surgery and Treatment
Our gynaecologic oncologist will discuss the best follow-up regime that is tailored to suit each individual patient. The recommended follow-up regime will have the benefit of early detection of any pre-cancers of the vagina. It is particularly important to be alert of any new symptoms rather than just relying on follow-up visits so any recurrence is detected early which allows for fast, effective treatment of the recurrence. For patients living outside Perth’s metropolitan area, arrangements can be made for on-going follow-up with their local general practitioner or gynaecologist.
If the patient has had chemotherapy or radiation after surgery, follow-up may be shared between our gynaecologic oncologist and the medical oncologist or radiation oncologist.
Fertility Preservation Surgery
Preserving the ovaries and / or the uterus may be possible in certain situations and may not compromise the chance of a cure. If fertility preservation is required, the patient can discuss with our gynaecologic oncologist who will explain the advantages and disadvantages of each form of treatment.
Cone biopsy without a hysterectomy is often adequate treatment for Stage 1A1 cervical cancer. A laparoscopic radical trachelectomy (complete excision of the cervix and surrounding tissues and re-suturing of the vagina to the lower segment of the uterus) may be offered if certain criteria are met, and it has a successful pregnancy rate of above 50%.