Carcinoma of the cervix is the commonest form of female genital
cancer seen in Ghana and indeed most developing countries. Even though it
is common, it is thought to be preventable. Its treatment poses a major
challenge, demanding the services of a gynaecological oncologist and the
surgical procedure, Wertheim's hysterectomy, for operable cases.
In developed countries, the incidence of this disease has fallen
considerably owing to regular screening procedures using the Pap smear.
In Ghana, the absence of an effective screening system results in most
cases presenting late and thus requiring treatment with radiation.
Surgery involves the removal of the central tumour as well as the
lymphatics draining the area including the obturator, internal iliac, the
external iliac, common iliac and the para-aortic nodes. Since it is an
extensive surgery, it is recommended that this is carried out only by
specialists who have been trained for it.
CAUSES
· Human papilloma virus
· Associated risk factors
· Sexual promiscuity
· Multiple child births
· Infections with Herpes Simplex Hominis type II, HIV
· Smoking
· Low socio-economic status
· Family history
SYMPTOMS
· Asymptomatic (diagnosed on routine screening or assessment during
antenatal care, family planning etc.)
· Symptomatic
Abnormal vaginal bleeding
In between regular menstrual periods
· After sexual intercourse
· Post menopausal bleeding
· Increased vaginal discharge
COMMON MALIGNANCIES
· Lower abdominal pain
· Pain during sexual intercourse
· Weight loss
· Urinary symptoms e.g. dysuria, frequency, incontinence
· Rectal pain
SIGNS
· Early cases-erosion of cervix or changes of chronic cervicitis
· Ulcerative or fungating cervical lesion on speculum examination
INVESTIGATIONS
· Cervical biopsy
· FBC and sickling status
· Renal function tests
· Blood urea and electrolytes
· Serum Creatinine
· Serum uric acid
· Chest radiograph
· Intravenous urography
· CT Scan and or Magnetic Resonance Imaging (to detect aortic nodes
and metastases to the lungs and liver)
· Examination under Anaesthesia. This is used to find whether the
parametria or utero-sacrals are involved. At the same examination
cystoscopy and proctoscopy with or without biopsy may be done to
allow visualisation of vesical or rectal mucosa.
TREATMENT
Treatment objectives
· To treat central tumour
· To treat areas of tumour spread with the aim of eradicating the disease
Non-pharmacological treatment
The treatment modalities for carcinoma of the cervix are:
· Surgery
· Radiotherapy
· A combination of surgery and radiotherapy
Early disease
· Primary surgery
· Conisation of the cervix or simple hysterectomy
Overt disease
· Radical surgery
COMMON MALIGNANCIES
· Total abdominal hysterectomy
· Bilateral salpingo-oophorectomy
· Excision of 1/3 to ½ of the vagina
· Pelvic lymphadenectomy and para-aortic node dissection
Advanced disease
· Radiotherapy (with or without chemotherapy)
Pharmacological treatment
(Evidence Rating: A)
· Adjuvant chemotherapy (Section on referral below)
REFER
All patients must be referred to a specialist for evaluation to decide on
mode of treatment. The treatment of carcinoma of the cervix is best done in
hospital under specialist care.
