Home Page>Cancer of the Cervix
Cancer of the CervixDr Kingsley’s comments While cancer of the cervix is the most common cancer in women in developing countries, there is an incidence of only about 25 in every 100,000 women in the UK, affecting 3% of all women. The peak age range is 30-60 years of age. There is a clear accepted association with the human papilloma virus, which I think may well be involved in all cases, although this can be difficult to prove. In a way, this is similar to my feeling that the shingles virus may be involved in many cases of multiple sclerosis and breast cancer, even though I can’t prove it either. Cancer of the cervix is also associated with cigarette smoking, and is more common in lower socio-economic groups. Signs and Symptoms. There are five main stages of cancer of the cervix described by doctors, which, as usual, indicate the severity of the condition. By far the most common first sign or symptom is vaginal bleeding between periods or after sexual intercourse, although a degree of abnormal vaginal discharge may be the first indication that makes a woman visit her doctor. Very often there are no symptoms or signs and cervical cancer is picked up on routine cervical screening. In more advanced cases, there may be more generalised features, such as low back pain, indicating spread to other tissues. There may be the usual weight loss that tends to occur in later stages of cancer, and, if they have become involved in the cancerous process, there may be bladder or rectal symptoms, such as cystitis or any of the symptoms described under the heading of cancer of the bladder or rectum. There are three names given to cancers of the cervix, namely squamous cell carcinoma, by far the most common, and adenocarcinoma or mixed adenosquamous carcinoma. Investigations. Once a suspicion has been raised of the possibility of cancer of the cervix, it may be possible to carry out a simple endoscopic examination, by inserting a camera through the cervix into the uterus itself, to see the extent of the cancer, and, of course, take a biopsy to confirm the diagnosis. It is more likely, however, that such an examination will be carried out under a light general anaesthetic, so that the surgeon can explore the area more fully, which would otherwise be rather painful. A rectal examination will also be carried out to try to identify any possible spread into that area. Apart from the usual blood tests and any specific cancer markers, a chest X-ray, local ultrasound and abdominal CT and/or MRI scans will be considered. Conventional Treatment. In the earliest stage, a simple cone biopsy (like a ring of tissue being cut out of the cervix) or treatment with a laser or another similar approach to effectively burn out the offending cells is the most likely approach. Sometimes a hysterectomy is recommended in a postmenopausal woman. In the middle of the severity ranges, radiotherapy and surgery are often combined. In young, otherwise medically fit women, hysterectomy will be recommended, occasionally one ovary being preserved if she is premenopausal. However, it is my experience that once the blood and nerve connections between the uterus and ovaries have been interrupted, the ovaries start to fail more quickly than would have been the case had an operation not been carried out. When I was in general practice in the 1970s, I noticed that many women who had their tubes tied for contraceptive purposes ended up having menstrual problems leading to a hysterectomy in due course. Most women who have a hysterectomy will have both ovaries removed at the time ‘just in case’, on the assumption that HRT will be able to sort out any problems of an early menopause. The latest studies showing the long-term dangers of HRT may well alter that approach. In the more severe cases, radiotherapy is the mainstay of treatment, and, clearly, the worse the condition when it is first diagnosed, the worse the prognosis. If the initial treatment seems to be effective, but the cancer comes back, chemotherapy and radiotherapy can be used, although radiotherapy is not likely to be tried if it was used in the first instance. Because of its local ‘burning’ effects, there can also be long-term damage to local tissues of the bladder, rectum and small bowel, although only a small number of these may need surgical correction. Unfortunately, surgeons do not like to operate on tissue that has been irradiated, because they don’t heal very well. An Explanation by Dr Kingsley Before Your Consultation about your (Cervix) Cervical Cancer Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having cancer of your cervix. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your cervical cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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