What is cancer of the cervix?
(See diagram below)
The cervix is the lower part of the uterus (womb). It is a pear-shaped organ located in the pelvis between the rectum and the bladder and has a canal that connects the vagina to the cavity of the uterus.
As with other organs it is made up of different tissues, the covering being the epithelium. New cells constantly replace the cells of the epithelium and as the newer cells start at the base move outwards, the older cells are discarded. It is these cells that are picked up by a Pap Smear.

When abnormal cells develop they can form a malignant tumour. These cells are only found within the epithelium the condition is known as a pre-cancerous lesion, but once they have penetrated through the basement membrane into the deeper tissue the condition is called cervical cancer. Cervical cancer cells can spread to the other organs e.g. the rectum and/or bladder or enter the lymphatic system/bloodstream and spread to the other organs.

What causes cancer of the cervix?
It is linked to contamination with the human papillomavirus (HPV).
Transmission can be by way of:
  • Sexual intercourse, just as any other sexually transmitted disease takes place.
  • It may be passed on from mother to child (vertical transmission) as the baby passes through the birth canal
  • Smoking increases the risk.
Conditions that lower immunity such as AIDS or some medicines used for transplant patients also increase the risk.
What are the symptoms of cervical cancer?
  • Pre-cancerous conditions do not generally cause pain or symptoms and can only be detected with a Pap Smear.
  • Symptoms usually only appear once the abnormal cervical cells become cancerous and invade the tissue below the epithelial surface.
  • The most common symptom is abnormal bleeding which appears between regular menstrual periods or during sexual intercourse.
  • Menstrual bleeding that lasts longer and is heavier than usual.
  • Bleeding after menopause.
  • Increased vaginal discharge with a strong unpleasant odour.
Note:
These symptoms could indicate other health problems and it is essential that a doctor makes a diagnosis.
How is cervical cancer or pre-cancerous conditions diagnosed?
  • The doctor does a gynaecological examination of the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum for any abnormality in shape and size.
  • A speculum is used to open the vagina in order to see the vaginal walls and the visible part of the cervix.
  • The doctor also takes a Pap Smear for examination in a laboratory.
Treatment of cervical cancer:
Treatment can involve surgery, radiation therapy and chemotherapy as decided on by the specialists. One method or a combination of methods may be used depending on what stage the disease has reached.
Early detection of the disease
Regular check-ups including Pap smears can prevent most cancers of the cervix especially if the woman is sexually active and over the age of 18.

If all women had regular gynaecological examinations and Pap Smears, most pre-cancerous conditions would be detected and treated before cancer develops.

It is not always necessary for women who have had a hysterectomy to have a Pap Smear every year and they should discuss with their doctor about when to have a Pap smear done.

When should one have a Pap Smear?
The best time to have a Pap Smear is 10 to 20 days after the start of menstruation, however, if the bleeding is heavy and prolonged, the doctor will do the smear regardless of bleeding.
For about two days before a Pap Smear the woman should refrain from using spermicidal foams, creams, etc. or vaginal medicines (except as prescribed by the doctor) as this may interfere with the detection of abnormal cells.
How is a Pap Smear done?
  1. A Pap Smear is a simple painless procedure.
  2. A wooden scraper (spatula) is used to collect cells from the cervix, cervical wall and vaginal wall.
  3. The cells are placed on a glass slide, fixed with a fixative spray and sent to a laboratory for examination.
  4. If the Pap Smear indicates abnormalities, the doctor will apply other methods to detect suitable areas for a biopsy i.e. removing a small amount of tissue for examination by a pathologist.
Where to get help and advice:
The Cancer Association of S.A. (CANSA) National Toll-Free Help-line no. 0800-226622
The Hospice Society of South Africa -– consult your telephone directory for the telephone number of the local hospice.
DIAGRAM OF FEMALE REPRODUCTIVE ORGANS
For information on other Women's Health issues, click on the links below:
Breast Cancer
Menopause
Osteoporosis
Cancer of the Ovaries
Cancer of the Vulva