CERVICAL PRE-CANCER/CANCER
The incidence of cervical cancer in Australia has declined dramatically in the last two decades due to effective screening programs with PAP smears. The PAP smear is designed to detect pre-cancerous changes of the cervix so that a colposcopy may be performed to confirm any abnormailities on PAP. The colposcopic examination of the cervix is required, as the PAP smear is a screening test, which is not effective in determining the site and exact nature of the abnormality. The colposcopic examination will often include a small biopsy of the cervix which will be sent for pathological diagnosis.
If PAP smear screening and colposcopic examinations are followed to according to the NHMRC guidelines (http://www.health.gov.au/internet/screening/publishing.nsf/content/guide), then cervical cancers should be very rare. Appropriate treatment and follow-up of any precancerous areas of cervical tissue (lesions) will prevent progression to cancer.
The cervical cancer vaccine does not offer complete protection against cervical cancer, and PAP smears are still required, as are colposcopic examinations should an abnormality be detected on the PAP smear.
PAP smears are designed to detect abnormality of the cervix. It is not a test for cancers of the uterus or ovary.
With the decreased incidence of cervical cancer, we have also progressed dramatically with effective treatments of cervical cancers to achieve cure, which may include a combination of surgery, radiotherapy and chemotherapy. Selection of which treatment modality to employ is dependent on the stage of the cancer at presentation. Early stages of disease may be managed with a radical hysterectomy (removal of uterus, cervix and surrounding parametrial tissue around the cervix) and pelvic lymph node dissection. A radical hysterectomy requires a higher surgical effort, and has more side-effects than a simple hysterectomy. But it is required to get an adequate resection margin around the cancer and achieve a cure. Performing a radical hysterectomy in early stage disease is preferable to radiation and chemotherapy as it offer the same cure rates but with less side-effects. However, after the hysterectomy the tissue is examined under the microscope by a pathologist to determine the characteristics of the cancer. If there are high-risk features found by the pathologist, radiation therapy and/or chemotherapy can be used as an "insurance policy" after surgery.
Although a radical hysterectomy is traditionally performed via a large incision on the abdomen, Dr. Salfinger offers the procedure via a laparoscopic/keyhole procedure which will offer advantages of earlier recovery and likely reduced rates of discomfort during intercourse after surgery. The surgical procedure of radical hysterectomy via a keyhole approach has not been widely adopted because it is technically more difficult to perform and requires additional training. As a result, it is not yet classified as standard treatment for cervical cancer, which currently stands at a radical hysterectomy via a large abdominal incision. This will be further discussed at your consultation.
More advanced disease is usually treated with radiation and chemotherapy without surgery. This is not because the disease is not curable. This is often a difficult concept for patients to understand, as it is worrying surgery is not being performed to remove cancer. But the fact is that radiation and chemotherapy is more effective than surgery to achieve cure in these cases. The addition of hysterectomy prior to chemotherapy and radiation does not offer any benefits in cure rates, and may delay commencement of radiation and chemotherapy.
If PAP smear screening and colposcopic examinations are followed to according to the NHMRC guidelines (http://www.health.gov.au/internet/screening/publishing.nsf/content/guide), then cervical cancers should be very rare. Appropriate treatment and follow-up of any precancerous areas of cervical tissue (lesions) will prevent progression to cancer.
The cervical cancer vaccine does not offer complete protection against cervical cancer, and PAP smears are still required, as are colposcopic examinations should an abnormality be detected on the PAP smear.
PAP smears are designed to detect abnormality of the cervix. It is not a test for cancers of the uterus or ovary.
With the decreased incidence of cervical cancer, we have also progressed dramatically with effective treatments of cervical cancers to achieve cure, which may include a combination of surgery, radiotherapy and chemotherapy. Selection of which treatment modality to employ is dependent on the stage of the cancer at presentation. Early stages of disease may be managed with a radical hysterectomy (removal of uterus, cervix and surrounding parametrial tissue around the cervix) and pelvic lymph node dissection. A radical hysterectomy requires a higher surgical effort, and has more side-effects than a simple hysterectomy. But it is required to get an adequate resection margin around the cancer and achieve a cure. Performing a radical hysterectomy in early stage disease is preferable to radiation and chemotherapy as it offer the same cure rates but with less side-effects. However, after the hysterectomy the tissue is examined under the microscope by a pathologist to determine the characteristics of the cancer. If there are high-risk features found by the pathologist, radiation therapy and/or chemotherapy can be used as an "insurance policy" after surgery.
Although a radical hysterectomy is traditionally performed via a large incision on the abdomen, Dr. Salfinger offers the procedure via a laparoscopic/keyhole procedure which will offer advantages of earlier recovery and likely reduced rates of discomfort during intercourse after surgery. The surgical procedure of radical hysterectomy via a keyhole approach has not been widely adopted because it is technically more difficult to perform and requires additional training. As a result, it is not yet classified as standard treatment for cervical cancer, which currently stands at a radical hysterectomy via a large abdominal incision. This will be further discussed at your consultation.
More advanced disease is usually treated with radiation and chemotherapy without surgery. This is not because the disease is not curable. This is often a difficult concept for patients to understand, as it is worrying surgery is not being performed to remove cancer. But the fact is that radiation and chemotherapy is more effective than surgery to achieve cure in these cases. The addition of hysterectomy prior to chemotherapy and radiation does not offer any benefits in cure rates, and may delay commencement of radiation and chemotherapy.
FERTILITY PRESERVATION SURGERY FOR CERVICAL CANCER
Preserving the ovaries and/or the uterus is possible, and may not compromise your cure rates in certain situations. If fertility preservation is required, please discuss with Dr Salfinger, who will run through the pros and cons of each form of treatment. Cone biopsies without a hysterectomy is often adequate in Stage 1A1 cervical cancer. A laparoscopic radical trachelectomy (excision of the cervix and surrounding tissues completely and re-suturing the vagina to the lower segment of the uterus) may be offered if certain criterias are met, and has a take home pregnancy rate above 50%.