Cervical cancer

CERVICAL CANCER is the 4th most common female cancer in the world, with over 250,000 deaths and over 500,000 new cases worldwide. In St Vincent and the Grenadines 70 women died between 2000 and 2008.

It consists of two (2) types of cancer, squamous and glandular.

Squamous is the most common and usually occurs in older women, glandular is less frequent, but higher incidence in younger women.

The introduction of the screening programme has decreased deaths by 60 percent in the UK by picking up early cervical abnormalities which are treated in colposcopy clinics. This trend should also be seen in St Vincent and the Grenadines.

Symptoms

A patient can have no symptoms at all, however symptomatic women can have a watery bloody discharge and bleeding which can be post-menopausal, in-between periods and after sexual intercourse, or lower tummy and back pain in advanced disease.

Diagnosis

• Diagnosis is made by taking a medical history and a complete gynaecological exam (speculum) and taking biopsies of the cervix if one sees a lesion on the cervix.

• When the biopsy is positive for cancer the patient will need an examination under anaesthesia and imaging in the form of an MRI for clinical staging.

• Diagnosis can be made after referral for an abnormal smear to colposcopy and subsequent excision (removal) of part of the cervix (LLETZ) if it shows microscopic disease (cancer)

• After a diagnosis of cancer, a multi-disciplinary meeting is held to determine the best treatment option for the patient.

Treatment

• LLETZ is curative if excision is complete, but this is usually repeated in some cases.

• Surgical treatment consists of a simple hysterectomy if microscopic disease is present for stage 1A1, but if greater than this then a radical hysterectomy is performed. Radical Hysterectomy is traditionally

done via an open technique with lymph node dissection, the trend for improving the level and standard of care is now offering these patients Laparoscopic Hysterectomy, Laparoscopic Radical Hysterectomy with lymph node dissection (minimal access surgery), this is associated with improved recovery times and less blood loss and quicker return to normality.

• If fertility is an issue then a small portion of patients can be offered a trachelectomy where the cervix only is removed, the patient can have her lymph nodes removed via laparoscopic surgery at a later date, this gives the patient the ability to become pregnant at a later date.

• Radiotherapy is offered to late stage cancer patients and sometimes chemotherapy.

Prevention

• Introduction of the HPV vaccine has been shown to decrease the incidence and this is vital to improve the quality of life for our young women, as the HPV vaccine gives immunity to the high risk HPV viruses which cause cervical cancer, in addition it will decrease the incidence of warts and other low and high grade abnormalities of the cervix.

In conclusion, cervical cancer prevention is vital and is evidenced internationally by the introduction of the HPV Vaccine and cervical screening.

Further specialist input and speciality clinics improve outcomes, and these are available on the island.

Dr John Barker Bsc MBBS MRCOG, Dip (Risk Management). Obstetrician/ Gynaecologist at Arnos Vale Medical Centre, Consultant Obstetrician/ Gynaecologist UK. He has completed the Advanced Training Skills Module in Gynaecological Oncology in the UK and runs gynaecological oncology clinics for diagnosis and management of suspected and confirmed female genital cancers.