Diagnosis and Treatment

Staging of the disease is by a careful examination under anaesthesia to determine the extent of local spread, with a cystoscopy (an endoscopic examination of the bladder) to exclude spread into the bladder, and, where warranted, a sigmoidoscopy (an endoscopic examination of the lower bowel) to exclude spread into the bowel. Most units will also perform an MRI scan to look at local disease and also to identify any enlargement of the draining lymph nodes (glands on the side wall of the pelvis to where the cancer cells will spread first).

Treatment of the disease is by surgery, chemotherapy and radiotherapy. These are administered alone, or in combination, and the main determining factor is the stage of the disease. For early stage disease surgery is usually recommended. The standard operation is a radical hysterectomy (also known as Wertheim's hysterectomy). Radiotherapy is given for later stages and when there is spread to the lymph glands (usually identified by the pathologist after the glands are removed at surgery). Increasingly, oncologists are using chemotherapy in combination with radiotherapy for advanced stage disease.

It should be emphasised that treatment of cervical cancer should be tailored to the needs of the individual, after a full and frank discussion with the patient and her relatives. All cervical cancer treatment (apart from cases of early microscopic invasion) should be delivered in recognized cancer centers by a team including a specialist gynaecological cancer surgeon, a clinical oncologist and a specialist nurse. They should be part of a large team, including a radiologist and pathologist with a major interest in gynaecological cancer.

Development of specialist teams has been recognized as the way forward to deliver an improved quality of care. This is also important, as, with a reduction in the number of cases of cervical cancer, fewer units will maintain the expertise to offer optimal treatment.

Cancer of the cervix is becoming a rare disease in the UK. This is largely attributable to the success of the cervical screening program. The main emphasis is now in the prevention of cervical cancer - by the detection and treatment of cervical cancer at its pre-invasive stage.