Cervical Cancer Treatment in South Africa

Cervical cancer is an abnormal growth of cancer cells that starts in the cervix. The cervix is the narrow part of the lower uterus. It is the entrance of the uterus, often referred to as the neck of the womb. Cervical cancer is the fourth most common type of cancer in women around the world. It is the fourth leading cause of death caused by cancer in women. However, the important thing to note is that cervical cancer is also one of the most preventable types of cancer and early diagnosis of the disease can improve the mortality rate amongst patients.

A dramatic reduction in cervical cancer occurrence is primarily due to the widespread use of advanced screening tests such as pap tests to detect cervical abnormalities and allow for early treatment.

Where does cervical cancer take place?

Under normal circumstances, the ectocervix is covered with flat, thin cells called squamous cells and the endocervix is made up of another kind of cells called columnar cells. The area where these cells meet is called the transformation (T) zone. The T zone is the most likely location for cervical cancer cells to develop.

Cervical Cancer Causes

A majority of cervical cancer cases occur because of a virus called human papillomavirus (HPV). HPV is a sexually transmitted virus. It can transfer through a sexual contact with an infected male partner.

There are many types of the HPV virus and not all types of HPV cause cervical cancer. Some of the HPV may cause genital warts. Some other cervical cancer risk factors include smoking, weak immune system, oral contraceptives, and multiple pregnancies.

Cervical Cancer Types

More than 90 percent of the cervical cancers are squamous cell carcinoma. The second most common type of cervical cancer is adenocarcinoma. Adenosquamous carcinomas or mixed carcinomas are some of the rare types of cervical cancer.

Cervical Cancer Symptoms

Usually, there are no early signs of cervical cancer, but several cervical cancer symptoms may appear as the tumor grows in size. Some of the common cervical cancer symptoms include the following:

• Bleeding between periods
• Bleeding during sexual intercourse
• Bleeding after menopause
• Smelly or blood-filled vaginal discharge
• Pelvic pain, back pain, and swollen legs
• Weight loss
• Fatigue 

Cervical Cancer Treatment

Cervical cancer that is confined to the cervix has good success rate if treated on time. The farther the cancer cells have metastasized, the lower the success rate tends to be. The selection of a cervical cancer treatment option depends on the stage, size, and depth of invasion of cancer, as well as the patient's age and overall health status. 

The most common cervical cancer treatment options include:

HPV vaccine

This is more of a preventive treatment option. Getting sexually-active women enrolled in an HPV vaccination program can substantially reduce cervical cancer rates.

Surgery

Cervical cancer surgery can be used to remove cancer cells from their place of origin and the surrounding tissues. The common types of surgery used for cervical cancer treatment include:

• Cryosurgery:

  In this method, an extremely cold metal probe is placed directly on the cervix, which kills the abnormal cells by freezing them.

• Laser surgery:

  In this surgery, a focused laser beam is directed through the vagina which vaporizes abnormal cells.

• Cervical conization:

  A surgical or laser knife or a thin wire heated with the help of electricity is used to remove cancerous tissue.

• Total hysterectomy:

  This is a more invasive treatment for cervical cancer, which removes both the body of the uterus and the cervix. But structures next to the uterus such as parametria and uterosacral ligaments, vagina, and pelvic lymph nodes are not removed.

There are different ways to conduct a hysterectomy, including abdominal hysterectomy (abdomen incision), vaginal hysterectomy (the uterus is removed through the vagina), laparoscopic hysterectomy (keyhole surgery by laparoscope) and robotic hysterectomy (laparoscopy attached to robotic arms).

Radical hysterectomy:

In this type of cervical cancer surgery, the surgeon removes the uterus along with the tissues next to the uterus. The upper part of the vagina next to the cervix can also be removed. However, the ovaries and the Fallopian tubes are not removed unless there is any other medical reason to do so.

Radical trachelectomy:

In this kind of surgery, the surgeon removes the cervix and the upper part of the vagina, but not the body of the uterus. This surgery allows women to be treated without losing their ability to have children. 

Radiation Therapy

This treatment for cervical cancer makes use of high energy X-rays or radioactive particles to destroy cancer cells. Radiation therapy may be given as external beam or as internal radiation (brachytherapy) to the pelvis.

Radiation therapy for cervical cancer can be used as a part of the main treatment or it can be used after surgery for cervical cancer removal. Patients are sometimes given radiation therapy with chemotherapy to further reduce the risk of cancer relapse.

Chemotherapy

This treatment makes use of anti-cancer medicines to kill cancer cells. The cytotoxic medicines used in chemotherapy enter the bloodstream and reach all areas of the body. This makes chemotherapy treatment useful for preventing cancer cells from dividing and growing in most parts of the body. Chemotherapy is often given in cycles, with each treatment period followed by a recovery time.

Cytotoxic drugs are effective in killing cancer cells but, it also damages some normal cells, which can lead to certain side effects. These side effects depend on the type and dosage of the drugs.

Recovery after cervical cancer treatment may take a long time, but you will be relieved that cancer has been removed. You will be required to make regular follow-up visits to the doctor for the first few years. The doctors will check your recovery and any signs of cancer coming back with the help of PAP smear and certain blood tests.

You will be advised to undergo a physical exam every three to six months initially and every six months for a few years. Since you no longer have the cervix, the cells samples for PAP smear test will be taken from the upper part of the vagina.

You must take the following steps to minimize your risk of cervical cancer recurrence:

• Stop smoking.
• Undergo screening at regular intervals.
• Eat well.
• Maintain a healthy weight.
• Stay physically active.
• Take medications or supplements as advised by the doctor.