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Friday, 17 March, 2000, 16:36 GMT
Cervical and Uterine Cancers
Completely different types of cancer affect different areas of the womb, or uterus.

Cancer: the facts
The best known, perhaps as a result of a nationwide screening programme, is cervical cancer, which affects the cervix, or neck, of the womb.

Many women, thanks to early detection, find they have abnormal cell changes in their wombs which cannot be classed as fully cancerous.

These "pre-cancerous changes" are far easier to treat, and the number of women presenting with the symptoms of cervical cancer has fallen over recent years.

However, equally common is uterine cancer, in its more usual form also called endometrial cancer - which affects the lining of the womb that grows, is shed, and regrows as part of a woman's monthly cycle.

Professor Hilary Thomas, who specialises in both cancers, and carries out work for the Cancer Research Campaign, said that the key to successfully treating both cervical and uterine cancer was early detection.

She said: "The number of patients who have full blown invasive cervical cancer has fallen from more than 3,000 in the 1970s and 1980s to less than 1,500 - and the figure is continuing to fall in the 1990s.

"Anybody who is sexually active should be having regular smears, and if they have a history of abnormal smears, they may need to go for more frequent smears.

"Cancer of the uterus, or the womb, is actually cancer of the body of the womb, which has a different kind of tissue in it from the neck of the womb.

"This is a disease which tends to affect elderly patients who have passed the menopause.

"Usually they will be advised to have a hysterectomy."

Click here to listen to Professor Hilary Thomas talk about uterine cancer

Click here to listen to Professor Hilary Thomas talk about cervical cancer

Another, far less common cancer of the womb is uterine sarcoma, which affects the powerful muscles of the womb.

This is far more similar to other cancers which affect muscles than to either uterine or cervical cancer.

Many cervical cancers are detected by the national screening programme.

Samples of cells from different areas around the womb neck are taken and looked at under a microscope for signs of abnormality.

If a smear is abnormal, the woman may be asked to take a repeat smear, or, particularly if there has been more than one abnormal smear, be sent to a specialist for further checks.

Smear success story: click here to find out how Carole Sharp found her cancer early

Once cancer is established however, the most common symptom is abnormal (ie non-menstrual) bleeding. This is a sign that the cancer has spread to surrounding tissue.

Menstrual bleeding may be heavier and last longer.

Abnormal bleeding, particularly after the menopause, can also be a sign of uterine cancer.

Women with certain symptoms should always consult a doctor. They are:

  • any sort of unusual vaginal discharge
  • pain in the pelvic area
  • painful or difficult urination

Once there is a suspicion of problems, there are various techniques used by doctors to try and locate the cause.

The first is a pelvic examination, which can be carried out by a family doctor, who will check the vagina, womb, ovaries, bladder and rectum for unusual lumps or changes.

Doctors may carry out another smear test, or Pap test, to gather cells to check for cervical cancer.

A technique called colposcopy, which uses a probe to look in more detail at the cervix, is sometimes used.

The extent of any cancer discovered may be confirmed by taking a deeper slice of tissue in a biopsy.

However, if uterine cancer is suspected, either a "pipelle biopsy", in which a thin tube is used to take a small sample of tissue, or a dilation and curettage (D and C) may be undertaken. The latter, involves scraping tissue from the lining of the womb for examination.

Scientists have identified a virus which they believe may have some role in the development of cervical cancer.

The human papillomavirus (HPV), which in some cases, is reponsible for genital warts, in found in many women who have developed cervical cancer.

However, most women who have the virus never go on to develop cervical cancer.

Smoking, as in so many other cancers, appears to increase the risk.

And women with HIV, the virus which causes Aids and weakens the immune system appear to be more prone.

The risk factors for uterine cancer are slightly more clearly understood.

In particular, those taking oestrogen-only hormone replacement therapies to alleviate menopausal symptoms are at higher risk. Most HRT formulations include other hormones such as progestin which appear to reduce that risk.

Overweight or obese women are thought to have more natural oestrogen in their bodies - another reason why they are more vulnerable.

Some other studies have suggested links between high blood pressure, diabetes and taking the anti-cancer drug Tamoxifen.

Women who suffer from a condition known as benign endometrial hyperplasia, in which the lining of the womb is naturally thicker, also are more likely to develop endometrial cancer.

If caught at their earliest pre-cancerous stage, abnormal cervical cells can be dealt with simply, using either freezing or heat to scour the cells from the cervix.

The action of the deep biopsy, called conization, can remove a cervical cancer if it has not spread.

Depending on the spread of the disease, and the age of the woman, a number of options are available, including surgery to remove abnormal tissue or the entire womb, including the cervix.

If there is evidence of spread, then the ovaries and nearby lymph nodes are sometimes removed as well.

If the cancer has spread beyond the wall of the womb, then radiotherapy and chemotherapy may be required to try to clear the disease.

In the case of uterine cancer, it is far more likely that a hysterectomy will have to be carried out, and the ovaries may also be taken out.

If it has not spread beyond the endometrium, then surgery will probably be enough, although other treatments may follow if there is evidence of spread.

It may be possible for the woman to take HRT following the operation, although this is only likely if the cancer has been caught early.

To learn more about survival rates for prostate cancer compared to other cancers, click here .

See also:

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