Episode 81: Cervical Cancer - Leeches or Hot Irons? - Anatomy Of Illness

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Lately, you have been experiencing some spotting between your periods,

(00:03):
just a little bit of blood when you wipe. But you've just brushed it off. It isn't that bad.
You've blamed this on stress, as you have been really stressed lately. You have exams coming up,
you just moved house, and your team just got into the semi-finals. You got the letter in the mail
over a month ago, telling you that you need to have your first screening. You initially were
going to ignore it, but your mother nagged you, saying you never know, and if all you do is skip

(00:27):
it, it will be too late when you do. So last week, you went in. You thought it was a waste of time.
You could have been studying, working, or even at practice. But you went to the appointment anyway.
Today, you hear your phone ring. It's the clinic.
They say you need to make an appointment. It's about your lab results.

(00:58):
Hello and Welcome to Anatomy Of Illness. Today's episode is about cervical cancer.
Before we get into the condition, we are going to start with the history. So why do we know cervical
cancer exists? Before we jump into the history, just a reminder that our Kickstarter pre-launch
page for the second season is up and running. So be sure to sign up for notifications, so you can

(01:18):
be among the first to know when we launch. But anyway, onto the history. For this, we begin in
the year 1500 BC with the Ebers Papyrus. Now in this, it describes several different forms of
cancers, including cancers of the uterus. Although these are not cancers of the cervix, in our
definition, many do believe that several cancers were lumped in with this sort of description.

(01:39):
Anyway, the ancient Egyptians believed that cancer was an incurable disease and that it was,
in fact, a curse from the gods. Now we are going to jump forward to Hippocrates in between 460 to
370 BC. This is where we move away from cancer being a punishment from God or the gods. Cancer
was now caused by an overabundance of black bile. Uterine cancer and cervical cancer were still

(02:04):
being lumped together at this time, and Hippocrates would have his own treatments of this condition.
For this, he would use local fumigations and herbal irrigations. However, in his opinion,
the disease was so destructive, they were better left uncured and untreated. Aetius in 600 AD would
claim that these cancers could be mitigated and alleviated by using baths, poultices and

(02:26):
irrigations that used various herbs. Now we are going to jump forward to the early 15th century
with an interesting document. This being the Medieval Women's Guide to Health. In this
document, it would claim that a certain “cancer and festering of the wombs were the result from
old injuries that had not healed well.” Moving on to 1575. This is when Ambroise Pare would perform

(02:50):
the first cervical amputation and now jumping forward again into 1813. We would see another
sensible treatment used for cervical cancer. This was done by J.M. Langenbeck. He was the first to
perform a vaginal hysterectomy. But don't worry, we would see other less sensical treatments. This
would be in 1837. We would see another interesting treatment used by Duparcque. This would be the use

(03:13):
of leeches applied to the cervix for bloodletting and purging purposes. Other physicians at the time
also chose red hot irons or caustic agents as their preferred method of treatment. Sounds lovely.
In 1842, Rigoni-Stern, who was an Italian physician, would look at the death records for
the city of Verona between the years 1760 to 1839. In this, he would have his own epidemiological

(03:37):
discovery about cervical cancer. He found that there was a higher prevalence in the deaths from
cancer of the cervix among women who were married or widowed. But in Jewish women, the incidence was
low. In unmarried women, it was rare. And in nuns, well, they had none. Yeah, there were no recorded
cases of nuns having cervical cancer in those death records. This was the first known reference

(03:58):
to sexual activity being a risk factor for cervical cancer. In 1878, we would see a hysterectomy
reappear. This time, however, an abdominal hysterectomy. This was done by W.A. Freund,
and he was lovely enough to do it using anesthetic and also took antiseptic measures. By 1885,
he would have treated 95 patients with this procedure. In 1898, Marie Curie would discover

(04:24):
radium. But why is it relevant? Well, this would be used in future treatments, such as radium
therapy, and was also important for X-rays. Between 1899 and 1912, Ernest Wertheim would
perform 500 radical hysterectomies and would publish his results. There was an almost one
in three mortality rate, and many of the survivors would be left with after-surgery complications.

(04:48):
Thankfully, with radium therapy, the mortality rate would be reduced. But we still did not have
a method of screening for cervical cancer. No way of detecting it until it got to later stages.
That is, until the year 1941. This is where we would have George Nicholas Papanicolaou,
an anatomist, and Herbert Traut publishing a paper on using a vaginal smear as a way of diagnosing

(05:11):
cervical cancer. And this test would be known as the Pap test, or the Pap smear. Little more catchy
than the Traut test. Now we move forward a couple of decades to the 1970s and 1980s. This is when we
would see the discovery by Harald Zur Hausen and his group that cervical cancer was associated with
a HPV infection. If you are enjoying this episode and think someone else might, you should share it

(05:33):
with them as it helps us grow. So what is cervical cancer? Cervical cancer is a cancer that begins on
the surface of the cervix. This is what occurs when the cells in your cervix change into pre-cancerous
cells, then eventually into cancerous cells. What are the types of cervical cancer? When it comes
to cervical cancer, there are two main types. These are squamous cell carcinoma and adenocarcinoma.

(05:54):
Squamous cell carcinoma is the most common, accounting for between 80% to 90% of cases.
Squamous cell carcinomas are cancers that originate in the squamous cells. These are the thin, flat
cells lining the outer part of the cervix. Adenocarcinomas, this type occurs in between
10% to 20% of cases. This cancer is found in the cervical canal, in the column-shaped gland cells

(06:17):
lining this. In some cases, there can be a mix of both types of cancer. So what actually causes
cervical cancer? Cervical cancer is most often associated with human papilloma virus infection,
or HPV. HPV is a sexually transmitted virus. Now, having this virus does not immediately mean you
are going to develop cervical cancer, as not everyone who has it will develop cancer. In many,

(06:41):
this virus will go away on its own. However, in others, this can cause cell changes which
lead to cancer. What are the risk factors for cervical cancer? There are several risk factors
that increase the risk of developing cervical cancer. These include early sexual activity.
Having sex at a younger age increases your risk of exposure to HPV. Of course, HPV causing
cervical cancer in some people. Having other sexually transmitted infections, or STIs. This

(07:07):
increases the risk of HPV, which is what most often leads to cervical cancer, as STIs normally
caused by unprotected sex, and HPV passed through unprotected sex. There are other STIs that however
increase the risk as well. These include chlamydia, gonorrhea, herpes, HIV/AIDS, and syphilis.
Yeah, none of them are fun. Don't get them if you can avoid it. Increased number of sexual partners.

(07:30):
The more sexual partners you have, along with your partner also having high numbers of sexual
partners, the more likely you are to get HPV. This is why we wrap it before we tap it. Yes,
protected sex is important. A weakened immune system. If you have a weakened immune system,
you may have an increased risk of developing cervical cancer if you have HPV. Smoking tobacco.

(07:52):
When you smoke tobacco, it increases your risk of cervical cancer. In those who smoke,
when they get a HPV infection, these infections will last longer and are also less likely to go
away. Exposure to miscarriage prevention medicine. In the 1950s, there was a medication used to
prevent miscarriages. This was diethylstilbestrol, also known as DES. So if you were given this

(08:12):
medication during your pregnancy to prevent a miscarriage, you may be at an increased risk of
a specific type of cervical cancer called clear cell adenocarcinoma. It was used between 1939
to 1971, most prominent in the 1950s. How do we go about diagnosing cervical cancer?
When it comes to cervical cancer, a lot of the testing in many countries is actually screening

(08:34):
tests that are offered from the age of 21. These are known as pap smears or pap tests.
During this test, they scrape and brush the cells from your cervix. This is collected and sent to a
lab. In the laboratory, they check the cells to see if any look different and unusual. This test
can detect cells that are cancerous or have the potential to become cancerous. So the cells that

(08:54):
have changes that have an increased risk of becoming cancerous are known as precancerous
cells. In some countries, they may do a cervical screening test instead. This is known as a more
advanced version as it has the ability to detect more. This is done every five years instead of the
more frequent testing with pap smears. Another of the screening tests is the HPV DNA test. This also

(09:15):
involves taking cells from the area and testing those cells to see if there is an infection with
any of the types of HPV, especially those that are likely to cause cervical cancer. If these tests
show signs of cervical cancer or precancerous cells, then further diagnostic tests are done.
These include punch biopsies. This is a test that uses a tool to take small samples of the

(09:37):
cervical tissue. Endocervical curettage. This procedure uses a small spoon-shaped tool which
is known as a curette or a thin brush to scrape a tissue sample from the cervix. If these results
are also concerning, they may do further diagnostic tests. These additional tests include
electric wire loop. This procedure uses a thin low voltage wire which takes a small sample of

(10:00):
the tissue. This procedure is normally done using a numbing agent. It may also be called a loop
electro-surgical excision procedure or a LEEP cone procedure or colonization. This procedure
takes the deeper layers of your cervical cells for testing. Now this is normally done in a hospital
under some form of anesthetic as it can be uncomfortable. Now if all of the prior tests

(10:22):
show concerning results, it is likely you will be diagnosed with cervical cancer and then staging
tests will be done. Staging tests help to show the severity of your cancer. These staging tests
can include visual examination of your bladder and rectum. If a doctor is concerned that your cancer
has spread to these areas, then they may suggest using special scopes to examine these areas.

(10:42):
Imaging tests. These tests show the size and location of the cancer. Depending on your specific
case, a doctor may recommend one or a combination of imaging tests including MRIs, ultrasounds,
CTs or PET scans. We will get right into the symptoms and presentation right after this little break.

(11:09):
This podcast is supported by listeners like you on Buy Me A Coffee. What symptoms might you have
if you had cervical cancer? When it comes to cervical cancer, in the early stages it is
unlikely to cause symptoms. But the symptoms it can cause in the first stage of cervical cancer
include vaginal bleeding after intercourse, between periods or after you've been through

(11:30):
menopause. Menstrual bleeding that is heavier than usual and lasts longer than usual. Experiencing
pain during intercourse. Having vaginal discharge that is watery or bloody. This discharge may also
be heavy and have a foul odour. In the more advanced stages, cervical cancer can cause
further symptoms. These are based on where it has spread. These symptoms include difficult or painful

(11:51):
urination. You may also have blood in your urine, weight loss, loss of appetite and fatigue, a
general feeling of being unwell, pelvic or abdominal pain, dull back ache or swelling in
the legs, diarrhoea, bleeding from your rectum or pain when pooping. You should always check when
you wipe. Just saying, it's a great way to tell early when there is something going wrong with

(12:12):
your butt. Sorry, it had to be said. What should a doctor be aware of when it comes to cervical
cancer? When it comes to cervical cancer, some of the risks for this condition are able to be
reduced. As a doctor, there are several ways you can help promote risk reduction. These include
encouraging quitting when it comes to smoking. Smoking increases the risk of cervical cancer
if you get infected with HPV. So quitting or not starting is a good way to decrease the risk.

(12:35):
If you are able to support patients through the quitting process, that is amazing, very helpful
and very good for the general health. Promoting the HPV vaccine. The HPV vaccine helps to prevent
HPV infections, so this can help to reduce the risk of developing HPV related cancers like
cervical cancers, among several other cancers. Encouraging practicing safe sex. Encouraging

(12:57):
the use of condoms during intercourse helps to prevent sexually transmitted infections like HPV,
which helps to reduce the risk of cervical cancer. Encouraging routine pap smears or cervical
screenings. Pap smears or cervical screening tests. These tests monitor the cervical health
and allow for the detection of precancerous and cancerous conditions. Also allowing for

(13:18):
the treatment of these if they show up on the results. So encouraging all of this really helps
when it comes to patient health and cervical health. How do we treat cervical cancer? Well,
when it comes to the treatment of cervical cancer, there are several factors that come into play.
These include what stage your cancer is at, your own personal health outside of cancer,
and your personal preferences. With treatment, it may involve surgery, chemotherapy, radiation,

(13:40):
or even a combination of these. The surgical options for cervical cancer are predominantly
for those who have smaller cancers, which are still localized to the cervix. When it comes to
these surgical options, it will really depend on the size of the cancer, its stage, and whether or
not you plan to become pregnant in the future. So the surgical treatment options for cervical
cancer include surgery to cut out the cancer only. So if your cervical cancer is very small,

(14:04):
you may be able to have it removed by having a cone biopsy done. This is the procedure that
removes a cone-shaped piece of your cervical tissue and leaves the rest of the cervix intact.
This procedure may allow for you to become pregnant in the future if there are no other
factors impeding. Surgery to remove the cervix. This is known as a trachelectomy. So a radical
trachelectomy is a surgical option that removes the entire cervix plus some of the surrounding

(14:29):
tissue, but not the uterus. So you still have the ability to become pregnant again if nothing impedes.
Hysterectomy. This is a surgery that is done to remove the cervix, the uterus,
part of the vagina, and some of the nearby lymph nodes. In most cases, this is the procedure that
is done when surgery is an option. This surgery helps to prevent the cancer from coming back,

(14:49):
but it also prevents pregnancy. Surgery is not the only option. There is also radiation therapy.
Radiation therapy is normally used in combination with another form of therapy. This is often used
with both chemotherapy or with surgery. If it is used with chemotherapy, this is often due to the
cancer growing past the cervix, so it has spread. If it is used with surgery, this is due to there

(15:11):
being an increased risk of the cancer coming back. There are two methods that can be used.
These are external radiation. This is called external beam radiation. This is where a beam
of radiation is directed at the affected part of the body. So this is targeted towards the tumor.
Internal radiation. This is called brachytherapy. This is where they insert a device inside of the

(15:31):
vagina. This device is filled with radiation and can only be used for a few minutes at a time.
These devices can be used in combination. Radiation therapy can cause menopause if you
have not started menopause already. So there may be an option to freeze your eggs if you
want to consider having children in the future. There is also chemotherapy. These are medications
that are used to kill cancer cells. It is used in cases where the cancer has spread beyond the

(15:53):
cervix. Chemotherapy may also be used before surgery to reduce the size of the tumor.
There are also other options for the treatment of cervical cancer like targeted therapy. These use
medicines to block specific chemicals that the cancer cell makes. This causes the cancer cells
to die. This is normally combined with chemotherapy and used in advanced cervical cancer.

(16:14):
Immunotherapy. This uses medication to help the immune system to kill the cancer cells.
This is used in the advanced stages where no other treatment has really worked.
Are there any famous people who have or have had cervical cancer?
Yes, there are several famous people who have had cervical cancer. One of these being Eva Peron,
a former first lady of Argentina. Now, what happened to Eva Peron is both incredibly sad

(16:37):
and incredibly interesting. But why is this? Well, two words, informed consent. In the case of Eva
Peron, she was diagnosed with advanced cervical cancer at the age of 31. Because of this,
she would undergo a hysterectomy in an attempt to treat the cancer. Later that year,
her cancer would come back and it had metastasized, so it had spread. Eva Peron

(16:57):
would be the first Argentinian to receive chemotherapy, but the chemotherapy was
not successful. And she would pass away in 1952 at the age of 33, just two years after
being diagnosed. But why does the words informed consent matter in the case of Eva Peron? Well,
simply put, Eva Peron did not know she had cancer. She was never told what was going on in her body.

(17:19):
All of her decisions were being made for her, this being claimed as a way to prevent her from becoming
depressed. Now, the concept of informed consent would not actually exist until 1957, so after she
had passed, with a legal case being the first to ever mention it. But the idea of becoming sicker
and sicker and sicker with no explanation, with everyone around you knowing what is happening to

(17:40):
your body, that feels like my own personal horror story, and I'm sure it was a horror story for her.
Another famous person you may know who has had cervical cancer is Pam Grier. She is an actress,
singer, and martial artist. You may know her for her many roles, such as Miami Vice or even in the

recent movie Pet Sematary (17:57):
Bloodlines. Back in 1988, when Grier was just 39 years old, she was given
the diagnosis of stage four cervical cancer, and she was told she has 18 months to live.

Now, doing the maths, Pet Sematary (18:08):
Bloodlines came out in 2023, which is more than 18 months from
1988, meaning the aggressive treatment worked, and she is still kicking it, in her 70s as an
action star. If you would like to watch a documentary, I recommend you check out Jade:
The Reality Star Who Changed Britain. This documentary is about Jade Goody. She was on
the TV show Big Brother, and in 2009, at the age of 27, she died of cervical cancer. After being

(18:34):
diagnosed, she kept her story in the public eye to raise awareness and to encourage people to get
tested, which at the time, her story did increase testing. However, this was only a temporary
increase. So if you have a cervix, go ahead and get it tested. Yes, it is uncomfortable. Yes,
it sucks. But you know what is worse? Dying young. This is a very treatable cancer in the early

(18:56):
stages. But anyway, moving on. If you would like to check out a foundation for those in the US,
there is the Cervical Cancer Foundation. They aim to raise awareness about HPV, provide services
for detection and prevention of cervical cancer, as well as provide education surrounding this
condition. For those in the UK, there is Jo's Cervical Cancer Trust. They provide information

(19:16):
and support for those who need it in the UK. And for those in Australia, there is the Australian
Cervical Cancer Foundation. They are dedicated to preventing cervical cancer and to supporting
those who are experiencing cervical cancer and cervical abnormalities. They also raise awareness
around topics surrounding cervical health and cervical cancer. If you want to check out the
sources, social media links or any other links, you can head to anatomyofillness.com. If you

(19:38):
enjoyed this episode and would like to hear more, subscribe to be notified about our latest episodes.
If you would like to join our community, you can join us on Discord or Instagram. Otherwise,
stick around for the next episode. Did you know HPV also causes other cancers,

(20:06):
including cancers in men? Sorry guys, you're not off scot-free. The cancers we see HPV causing
include cancers of the vulva, the vagina, penile cancers and anal cancers. These cancers also
have other causes but a large percentage of them are caused by HPV.

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Episode 81: Cervical Cancer - Leeches or Hot Irons?

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