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Cervical Cancer and the importance of cervical smears


    Joachim Stanley writes about the importance of cervical screening for early detection of cervical cancer, following Jo’s Trust’s annual cervical cancer and cervical screening awareness week.

    By Joachim Stanley

I was very pleased to see that Jo’s Trust continued their work to increase awareness of cervical cancer and the importance of cervical screening, with their annual dedicated awareness week, which took place last week (22nd – 29th January 2017).

What is cervical cancer?

Cancer of the cervix develops at the entrance from the vagina to the womb.   There is understood to be an association between the disease and human papillomavirus, which appears to damage cell DNA, thereby producing mutations which may be a precursor to cancer.

Cancer Research UK report that 10-year survival rates for this type of cancer have improved from 46% – 63% over the last 40 years, with survival being highest amongst younger patients (15 – 39 years of age).

Symptoms of cervical cancer:

The most common early symptom of cervical cancer is unusual vaginal bleeding, which may occur after sexual intercourse, between normal period dates, and after menopause (of these, post-coital bleeding is most common). However, cervical cancer often does not cause any symptoms in its early stages, and may take years to develop.  Cancer is not a binary condition (you either have it or you don’t); rather, cell abnormalities accumulate over time, eventually culminating in a tumour.  Before cervical cancer occurs, cellular changes called cervical intraepithelial neoplasia frequently occur.     As stated, it can take years for these cellular changes to become frankly cancerous.

As the cancer spreads beyond the cervix, it may cause a variety of symptoms, including swollen legs, blood in urine, urinary incontinence and bone pain, severe back pain, loss of appetite, fatigue and weight loss.   Many of these symptoms are quite non-specific.

The importance of cervical smears

In order to ensure that any cellular changes which are present are detected, it is very important for female patients to attend all cervical smear tests. This is the focus of the Jo’s Trust annual campaign – ‘smear for smear’ – and last week was dedicated to informing women of the importance of cervical smears and how they can save lives by leading to early detection of potential cancerous changes.

If cervical screening tests yield abnormal results, then referral to a gynaecologist is usually required, and an examination of the cervix known as a colposcopy might be performed.   A biopsy (a procedure by which a tissue sample is obtained) may also be performed.   If positive, then further diagnostic tests including CT, PET and/or MRI scans may be requested and the results of these will guide the treatment plan.

Our experience

In the context of clinical negligence, cases involving cervical cancer can be brought following a failure to diagnose and/or treat cervical cancer sufficiently rapidly if this is due to a failing in medical care. In a recent case, a 37-year-old woman received a substantial sum in damages following a failure by her hospital to diagnose cervical cancer.  She had cervical smear tests which were incorrectly reported as negative. A later cervical smear test was taken which suggested there was low-grade cervical glandular intra-epithelial neoplasia.  She then underwent urgent colposcopy and biopsies were performed.  The findings were worrying, and a loop excision of the transformation zone was performed.  It was then found that the woman was suffering from cervical cancer.  She eventually required a total hysterectomy, and pelvic lymph dissection, both of which could have been avoided had the diagnosis been made earlier. She suffered from persisting pain in her abdomen, pelvis and legs and developed irritable bowel syndrome and depression.

Thankfully cases like this are rare, but the case shows the devastating consequences associated with cervical cancer, if left untreated. Regular cervical smear tests offer the opportunity for any potential changes, which may or may not be the earliest signs of developing cancer, to be picked up as early as possible, and are vital in therefore ensuring the best possible outcome for the patient if cancer is diagnosed. I was pleased to see that last week’s Jo’s Trust campaign received great support on social media and the message will hopefully have reached many women.

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