Cervical Screening Awareness Week – Why it’s so important
June 15th through to June 21st is Cervical Screening Awareness Week. Dr Mary McCormack, a consultant clinical oncologist who specialises in gynaecological cancer, has written a short article about cervical cancer and why screening for it is so important.
Cervical cancer is the fourth most common cancer in women worldwide with over 500,000 cases diagnosed each year. It is most common in central and south American, sub-Saharan Africa, and south East Asia. In the UK in 2012, 3064 women were diagnosed with the disease and 919 died from it. Overall almost 2 in 5 women diagnosed with locally advanced disease (cancer that has spread beyond the cervix) will relapse and die from their cancer.
However, cervical cancer is essentially a preventable disease in those parts of the world where there is a screening program. The cervical smear test can detect abnormalities in the cells of the cervix before they develop into a cancer. In such cases a simple surgical procedure (cone biopsy) can effectively remove these cells and prevent the development of a cancer: hence the reason it is so important for women to attend for regular screening. In the UK it is estimated that the screening programme saves 5000 lives per year. However, any women with new symptoms such as- bleeding between periods, after sex or after the menopause, any unusual vaginal discharge or discomfort during sex should seek medical advice from their GP or their gynaecologist.
The treatment of cervical cancer depends upon the stage (the extent) of the disease. The very earliest stages can be treated with an operation. The type of operation will vary from a full hysterectomy (removing the entire womb and cervix) in those who have completed their family to a trachelectomy (just removing the cervix and leaving the womb) in younger women wishing to retain their fertility.
In those women where the cancer has spread out beyond the cervix the treatment of choice is radiotherapy and chemotherapy. Radiotherapy is a localised treatment and can be divided into external and internal treatment. External treatment is delivered in small daily doses (Monday- Friday) and it is painless. Patients lie on their back on a couch as if they were having a CT scan. The treatment takes a few minutes each day. Once a week (providing the kidneys are working well) a chemotherapy drug called cisplatin is administered into a vein in the hand via a drip. This drug makes the radiotherapy treatment more effective and clinical trials have shown that women who have both cisplatin and radiotherapy live longer. All treatment has side effects but these can be easily managed with appropriate care and medication. The internal radiation treatment (brachytherapy) is usually delivered in 3-4 sessions via placing a tube in the womb usually under a general anaesthetic. At the end of each session (can last up to 2 hours) the tube is removed and the patient goes home.
Despite our best efforts the cancer can recur in up to 4 in 10 women and when this happens it may no longer be curable but it may be treatable with a combination of chemotherapy and newer targeted drugs (Bevacizumab). There has been little progress in the treatment of cervical cancer over the last 2 decades but currently there is an international trial (INTERLACE) investigating the use of additional chemotherapy given before the standard cisplatin and radiotherapy. However, the single most significant advance in the treatment of this disease has been the development of the HPV vaccine which, if adopted worldwide, could render this disease very rare indeed.
Finally for any woman diagnosed with cervical cancer it is essential to be treated by a team of individuals with expertise in this disease. Such a team should comprise a specialist gynaecologist (gynaecological oncologist), an oncologist with expertise in chemotherapy and radiotherapy, an expert radiologist (to interpret the scans) a pathologist (to report on the biopsies), and of course a specialist nurse and a psychologist to provide holistic care throughout the cancer journey and beyond. Multidisciplinary team working is at the core of my approach to gynaecological cancer treatment both within HCA and in my NHS practice.