Cervical Cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix which is the lower part of the uterus that connects to the vagina.

Human papillomavirus (HPV) infection can play a role in causing most cervical cancers. When exposed to HPV, a woman’s immune system can usually prevent the virus from doing harm. In a small group of women, the virus can survive for years contributing to the process that causes some cells on the surface of the cervix to become cancer cells. Smoking is also a risk factor for developing cervical cancer.

Current recommendations to reduce the risk of developing cervical cancer include regular screening tests and receiving a vaccine that protects against HPV infection.

Signs and symptoms of Cervical Cancer

Early stage cervical cancer generally produces no signs or symptoms, but as the disease advances, you may experience:

Vaginal bleeding after intercourse, between periods, or after menopause
Watery, bloody vaginal discharge that may be heavy and have a foul odor
Pelvic pain or pain during intercourse

The type of cervical cancer that you have helps determine your prognosis and treatment. The main types of cervical cancer are:

Squamous cell carcinoma– This type of cervical cancer begins in the thin flat cells lining the outer part of the cervix. Most cervical cancers are squamous cell carcinomas.
Adenocarcinoma– This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.

HDR Brachytherapy for Cervical Cancer

Treatments for cervical cancer include surgery, radiation therapy, chemotherapy or a combination of these modalities. Treatment recommendations will be made by your physician team after the proper evaluations have been made. However, cervical cancer is often treated with combined chemotherapy and radiation therapy. Radiation therapy will likely include external beam radiation therapy and brachytherapy.

High-dose rate brachytherapy is a type of internal radiation therapy that delivers radiation from implants placed close to or inside the tumors in the body. This allows a higher dose of radiation to directly reach the area where the tumor is, or was prior to surgery.

Because the cervix is located close to the bladder and rectum, it is important for radiation treatment to be tightly focused on the cervix to avoid any serious side effects.

At UVA, we treat cervical cancer using a “tandem and ovoid” (T&O) applicator which reaches both cervix and uterus. On the initial treatment which is done under anesthesia, a plastic hollow tube called a “Smit Sleeve” is fitted into the cervix and sutured in place. The tandem is a long, thin metal tube that is passed through this Smit sleeve into the uterus. The ovoids are circular hollow capsules placed in the vagina against the cervix. Then flat “balloons” are placed anterior and posterior to the applicators to provide extra protection to the bladder and rectum. A CT scan is performed to ensure proper placement and aide with planning process. Once everything is placed, the applicator is connected to a machine that automatically loads a radiation source into the applicator for a predetermined time. Once the time is up, the machine removes the source and then the applicator is removed from your vaginal area. Your physician will decide how many treatments you will require, but usually it is 5 treatments total. The initial treatment with Smit sleeve placement is under anesthesia and the remaining treatments are performed without anesthesia.

If you have had surgery, radiation treatment may be used afterwards to help reduce the risk of recurrence in the areas of the vaginal cuff or pelvis. If brachytherapy is recommended, a treatment device called a vaginal cylinder is utilized to deliver the treatment. It is similar to a large tampon with a central channel. The cylinder is placed into the vaginal area then connected to the HDR treatment machine via a tube where the radioactive source is located. Once the source has been connected, the radioactive source will travel quickly into the central channel of the cylinder to deliver a high dose of radiation to the top of the vagina. After completed, the vaginal cylinder is disconnected and removed from the patient. The number of treatments will be determined by your physician although it is usually 3-5 treatments total.

What to expect after treatment

General feeling of fatigue
Slight vaginal discharge or bleeding
Cramping
Vaginal discomfort
Diarrhea

Although everyone is different, these side effects usually resolve within a few days to weeks following the treatment.