If you have abnormal smear, please don’t panic, as it doesn’t necessarily mean there’s something wrong! Your doctor will also perform a test for HPV and if this is also positive, will refer you for a microscopic examination of your cervix, or colposcopy. Sometimes, that is all that is needed. But if you do need further treatment, then in the majority of cases this will stop any changes already there from developing into cancer. Please remember that cancer of the cervix in the Western World is thankfully rare because of the screening techniques we now use, so simply having HPV does not mean you have cancer, there is a huge and wide spectrum of possibility in between.
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The human papillomavirus (HPV) infects epithelial cells (surface cells) on the oral or genital mucous membranes and parts of the skin, such as the hands or feet. Any contact of those areas with a person who has the virus could lead to transmission. It’s common among sexually active adults and there are many different varieties of HPV. More often than not, the body is able to fight off the virus so that it’s eliminated over a few years. However, this sometimes isn’t the case, especially if a person’s immune system is compromised, or if they smoke. When the virus persists, it can cause problems such as warts, or potentially even cancer, such as cervical cancer. This is why it’s so important to go and have regular smear tests, in particular as these are incredibly effective at detecting pre cancerous disease, before it’s had a chance to develop.
If your doctor decides that they need to remove abnormal cells, they’ll use one of the following techniques:
- cryotherapy, or freezing and eliminating the abnormal tissue
- a cone biopsy to remove part of the cervix
- a loop electrosurgical excision procedure or large loop excision of the transformation zone (LLETZ), which involves removing cells with a wire loop that carries an electrical charge
These procedures may affect your ability to conceive or reach full term in your pregnancy. This is because tissue removal from the cervix can change its structure. It may cause stenosis, or a narrowing of the opening of the cervix, which may present an obstacle to the sperm as they have to swim up the reproductive tract to reach the egg and fertilise it. Or it could present a problem during IUI or IVF if an embryo transfer is being attempted. The cervix may also weaken and whilst this will not cause infertility or difficulty becoming pregnant, it can lead to cervical insufficiency, which can cause your cervix to widen and thin before your pregnancy has come to term. It’s important to consider your fertility prior to any treatment and discuss the many and various options appropriate for you with a fertility specialist.
If you have had treatment to your cervix, your obstetrician may need to monitor this with extra ultrasounds, and may consider performing something called cervical cerclage, which is a tie around the cervix, to reduce the chance of cervical insufficiency.
Having the HPV vaccine before a person has sexual exposure, but even after, is now thought to significantly help prevent the development of cervical cancer, which has a strong association with HPV, and can subsequently help to preserve fertility. Barrier contraception is also important in terms of helping to prevent transmission of HPV, much like the other STDs, if you’re not trying for a baby.
Getting the HPV vaccine doesn't completely eliminate your risk of getting cervical cancer, however. The vaccine protects against two strains that cause about 70 percent of cervical cancers, so even if you're vaccinated, you can still contract other types, and you still need cervical screening.
If you’ve been diagnosed with cervical cancer, there are many treatment options. Cervical cancer treatment is very successful if you’re diagnosed in the early stages and the first thing to know is that the majority of treatment is very successful. The type of treatment used for cervical cancer depends on the stage at diagnosis. More advanced cancers usually require a combination of treatments that may involve surgery, chemo and radiotherapy.
We start off using the least invasive techniques. Cone biopsy removes a cone-shaped section of the cervix. It’s also called cone excision or cervical conization. It can be used to remove precancerous or cancerous cells. LLETZ is a more common procedure and more sparing to the cervical tissue. Further treatment may not be necessary.
Surgery for cervical cancer aims to remove all of the visible cancer. Sometimes nearby lymph nodes or other tissues are also removed, where the cancer has spread from the cervix. Your doctor may recommend surgery based on several factors. This includes how advanced your cancer is, whether you want to have children, and your overall health.
Hysterectomy is the surgical removal of the uterus and cervix. It greatly reduces the risk of recurrence when compared to more localized surgery. However, a woman cannot have children after a hysterectomy. It can be performed using three different ways: abdominal, vaginal and laparoscopic (or keyhole).
Trachylectomy is an alternative to a hysterectomy. The cervix and upper part of the vagina are removed. The uterus is left in place. It’s connected to the vagina with an artificial opening. Trachelectomies allow women to maintain the ability to have children. However, there is a high rate of miscarriage.
If radiation treatment is needed, there could be damage sustained to the vagina or ovaries and this can impact future fertility. This is why something called ovarian transposition, or hitching and suturing the ovaries to the pelvic side wall, is important before radiation, to try and preserve as much healthy tissue as possible for women who want o use their own eggs to become pregnant later.
Chemotherapy uses drugs to kill cancer cells. Drugs may be administered before surgery to shrink tumors. They can also be used afterwards to get rid of remaining microscopic cancerous cells.
Being diagnosed with cancer is awful and seeking help from a counselor to offer emotional support and help you to focus on a plan, is absolutely vital. Thankfully, there are also many support groups and charities out there who campaign hard to raise awareness of cervical disease and are an incredible source of help for many. They include The Eve Appeal and Jo’s Cervical Cancer Trust. Being armed with some awareness on this subject will go a long way in helping you understand your options to be able to make empowered decisions.
Find out more and keep up-to-date with Dr Larisa on her official website at https://www.drlarisacorda.com/.