What is cervical cancer?
The cervix is the lower, narrow part of the uterus that leads to the vagina. It comprises two parts - the endocervix (leading towards the uterus) and the ectocervix (leading towards the vagina).
Cervical cancer develops in the cervical mucosa. In most cases, the cancer originates in the epithelium of the cervical mucosa and is referred to as carcinoma. There are two types of cervical carcinoma:
- Squamous cell carcinomas (85% of cases), which develop in the ectocervix
- Adenocarcinomas (15% of cases), which develop in the endocervix
Cervical cancer is the 11th most common cancer in women with 2,900 new cases being reported in 2018. It is the 2nd most common cancer in young women.
Diagnosis of cervical cancer
Gustave Roussy is involved in the diagnosis and treatment of precancerous lesions, the diagnosis of cervical cancer following detection of a suspicious lesion on screening, and the management of patients whose diagnosis has been confirmed.
During the initial consultation, patients are asked about their personal and family medical history. The doctor will document any other family cases of cancer in particular, in order to highlight any hereditary predisposition to this disease.
A clinical examination is then performed comprising gynaecological examination and an examination of the abdomen and lymph nodes.
A cervical biopsy is immediately performed on the suspicious specimens to confirm diagnosis and specify the type, size and extent of the cancer.
Additional imaging techniques (pelvic MRI, PET scans) are often prescribed for cancer patients to assess the spread of the disease.
Decisions on cancer treatment pathways are taken during weekly multidisciplinary meetings. These meetings involve several doctors from different disciplines including medical oncologists, surgeons, radiotherapy oncologists, radiologists and anatomo-pathologists who work in conjunction with community doctors. Every major decision is discussed and an opinion given.
Cervical cancer treatments
Gustave Roussy offers a number of cervical cancer treatments :
Surgery is the primary treatment for localised forms of cervical cancer. It is sometimes preceded by uterovaginal brachytherapy.
In most cases, surgery and brachytherapy are sufficient to adequately treat the early forms of cancer.
In the event of limited spread, Gustave Roussy will offer fertility preservation treatment following a multidisciplinary discussion for each individual patient.
Radiation therapy is a highly effective treatment for cervical cancer.
Radiotherapy treatments are prescribed by doctors post-surgery depending on various prognostic factors (stage, lymph node invasion) highlighted by the surgical specimen. Radiation is emitted using a precise, external radiotherapy device that delivers converging radiation beams towards the pelvis.
Brachytherapy (or internal radiation therapy)
Uterovaginal brachytherapy is an internal radiotherapy technique delivering high-dose radiation to the specific area to be treated. This technique can be used to shrink the size of the tumour prior to surgical removal, for instance, or to completely destroy the tumour during concomitant radio-chemotherapy.
Locally advanced (non-metastatic) treatments
Concomitant radio-chemotherapy combines external radiotherapy, chemotherapy and brachytherapy. This treatment is the gold standard for tumours larger than 4 centimetres and for those that have spread beyond the uterus into the pelvis.
In most cases, cervical cancer treatment will leave a woman infertile.
The Gustave Roussy teams therefore focus on preserving patient fertility, where possible and when requested to do so. Indeed, the Institute has been involved in improving practices over the last two decades.
We raise this issue during the first consultation and accompany our patients throughout their fertility preservation journey.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy doctors may invite patients to participate in clinical trials. If a patient is eligible, clinical trial participation will be discussed during treatment by the referring oncologist. The patient will then be given access to advanced therapy medicinal products.
In almost 100% of cases, cervical cancer is linked to a viral infection caused by the human papillomavirus (HPV). HPV is a sexually transmitted virus that usually disappears spontaneously. However, there are many varieties of HPV, some of which are oncogenic. This means that when they persist and infect the cervical mucosa, they can cause changes in the epithelial cells known as dysplastic lesions or dysplasia. If they do not clear spontaneously or with local treatment, these lesions can become pre-cancerous. In certain rare instances, they may gradually develop into cancer.
There are two effective methods for preventing cervical cancer, namely regular Pap smears and testing for the presence of oncogenic HPV in the gynaecological region, and vaccination against the most common oncogenic HPVs.
Cervical cancer screening is available to all women between 25 and 65 years of age. The first Pap test should be carried out around the age of 25 and every 3 years thereafter. The recommendation from this year onwards is to perform HPV testing every 5 years and a follow-up smear test only in the event of a positive result.