About Cervical Cancer:

Cancer of the cervix is the third most common gynecologic cancer diagnosis.  The prevalence of cervical cancer varies by geographic location.

Most cancers of the cervix begin in the transformation zone of the cervix. This is the area that is sampled during a papanicolaou (PAP) test. Almost all cervical cancers are caused by the human papilloma virus (HPV).

Prevention of cervical carcinoma can be achieved by primary or secondary measures. Primary prevention of cervical cancer is done through avoidance of HPV infection. Vaccines have been developed that can protect women from HPV infections. Secondary prevention refers to routine PAP smear screening. PAP tests may detect abnormal cells on cytology. This can be followed by a colposcopic examination where pathological diagnosis can be made. Pre-cancerous lesions may be treated using ablative or excisional procedures (LEEP) to prevent them from developing into invasive carcinoma. If untreated, abnormal cells may progress into cervical cancer over many years.

Types of Cervical Cancer:

There are three main types of cervical cancers:

• Squamous cell carcinoma
  • this is the most common type, accounting for approximately 70% of cases.
• Adenocarcinoma
  • this is the second most common type, accounting for 25% of cases.  Adenocarcinomas start in the gland cells of the cervix.
• Adenosquamous carcinomas
  • these are rare types of cervical cancers.

Symptoms:

The most common symptoms of cervical cancer are

• abnormal bleeding
• bleeding with sex
• pain with sex
• abnormal vaginal discharge

However, many patients do not have symptoms and as such, regular PAP tests are necessary to detect precancerous changes.

Diagnosis:

The diagnosis of cervical cancer is often made with a PAP test, colposcopy and biopsy. Colposcopy is a special type of exam of the cervix that utilizes a specialized microscope.

Once a patient is diagnosed with cervical cancer she will be assessed prior to deciding about the treatment plan.  The initial evaluation includes:

• Complete physical examination including abdominal, pelvic and rectovaginal examination
• Laboratory testing
• Imaging tests with CT scans of the Thorax or chest x-ray, CT scans of the abdomen & pelvis, pelvic MRI, and possibly a PET scan

Treatment:

Treatment options depend on the stage of the cancer.  Treatment of early-stage cervical cancer involves surgery. This may include a radical hysterectomy,  and removal of pelvic lymph nodes. More limited surgical procedures (such as a LEEP), simple hysterectomy, fertility sparing surgery with trachelectomy (removal of the cervix) and radiation with concurrent chemotherapy are also alternatives in select cases.  Often, surgery can be done through a minimally-invasive surgical approach. The team at UHN is one of the few in Canada to offer robotic trachelectomies. For advanced stages, a combination of radiation therapy and chemotherapy is often used.