Cervical Cancer

500.00 women are diagnosed with cervical cancer each year globally. Cervical cancer is the second most prevalent type of cancer among women in the world, after breast cancer. It is striking that the incidence of this cancer has increased in developed countries.

What is it?

It is also referred to as cancer of the cervix or cervical cancer because the cervix connects the uterus to the vagina. It is common disease in women and strikingly, the incidence of this cancer has increased in developed countries. 500.000 women are diagnosed whit cervical cancer each year worldwide.

The cancer can be explained simply as follows: cells called the cancer precursors emerge when healthy cells of the cervix acquire a genetic mutation that turns them into abnormal cells. Cancer precursors are precancerous lesions and they may transform to cervix cancer when they are not detected at an early stage and are not treated. The main factor responsible for this change is HPV, known as human papilomavavirus. HPV is sexually transmitted virus causing genital warts. Women are recommended to have PAP smear tests every year after their first sexual intercourse. Changes that occur in the cervix can be detected with this test.

The PAP smear test, also known as the Papanicolaou test, allows the early diagnosis of abnormal cells in the cervix before transforming into precancerous lesions or into cervical cancer. The smear test is a very important test for women. In developed countries, the widespread use of the PAP smear test has reduced the cervical cancer incidence rates.

What are the risk factors?

The risk factors causing cell mutations in the cervix are as follows: 
• HPV infection
• Age
• Early sexual activity
• Multiple pregnancies
• Low socioeconomic status
• Sexual intercourse whit a promiscuous partner
• A known abnormal PAP smear test result
• Smoking
• Poor genital hygiene
• Use of oral contraceptives (birth control pills)
• Poor nutrition (A, C, E, lack of folic acid)
• HIV infection
• A history of sexually transmitted disease.

Who is at risk of contracting this type of cancer?

Although cervical cancer occurs most often in middle-aged and older women, it can occur at any age.

What are the symptoms?

Usually, the first symptoms is abnormal vaginal bleeding. The bleeding mostly occurs during and after intercourse. Vaginal discharge (which may have a foul odor), dysuria (pain during urination) and vaginal discomfort are the other symptoms.

The tumor grows by extending upwards into the endometrial cavity, downwards into the vagina and laterally into the pelvic wall. It may directly invade the bladder and rectum. The following symptoms may evolve: constipation, hematuria, fistula, and ureter obstruction with or without hydroureter or hydronephrosis, reflect local organ involvement. Moreover, patients may suffer from leg edema, pain and hydronephrosis depending on the cancer`s spread into the pelvic wall. The most common locations for distant metastasis include the extrapelvic lymph nodes, the liver, the lungs and the bone.

What diagnostic methods are used?

First finding: an abnormal PAP smear result may be obtained from the Papanicolaou test used at the routine gynecological examination. Detecting an early stage cervical cancer with a physical examination is highly unlikely.

PAP smear test: During a Pap test, the doctor brushes cells from the cervix and sends the sample to pathologist to be examined for abnormalities. This test is safe at pregnancy tests as well. It has been calculated that the reduction of deaths due to cervical cancer may be up to 70 per cent when regular PAP smear scanning is applied. Colposcopy allows for direct examination of the lesions that may be unnoticed otherwise. Thanks to this optical device, the cervix can be observed at a magnification rate of 6 to 40 times. In the event of detection of an abnormal lesion in the PAP smear test results, a colposcopy or a biopsy is performed if necessary.
An HPV DNA test is recommended when suspicious results are found. Patients with positive HPV DNA, are at a higher risk of having their lesions progress at a higher rate than in patients with negative HPV DNA testing. The HPV DNA scan can also be performed by using the liquid-based PAP test.

How is it treated?

There are two main groups of treatment of cervical cancers: surgery and radiotherapy. Radiotherapy is a treatment method that can be used at any stage of the cervical cancer development. Surgery is applied especially during early-stages of the cancer as then it is less invasive. Radiotherapy is preferred in advance, with the purpose of cleaning the primary tumor around the cervix and the potential invasion regions. The extent of surgical treatment varies depending on the size of the tumor. It can vary from small surgical techniques (listed below) to larger surgical techniques in which all the uterus, the cervix and the lymph nodes are removed.
LEEP (Loop electro surgical procedure): LEEP is a valuable mean of diagnosis and treatment of the cellular changers in the cervix. In this technique a wire loop is used as a surgeon’s knife which removes cells from the mouth of the cervix.
Cryotherapy: This technique involves freezing a section of the cervix and thereby killing cells.
Laser therapy: This technique may be used at every instance when the entire lesion is visible and where the lesion is clean as a result of cervix curettage.
Conization: This technique plays a very important role in the treatment of cervical cancer. A cone-shaped piece of cervical tissue is removed from the cervix by Conization.

Protection against cervical cancer

It is recommended that women begin screening for cervical cancer approximately 3 years after they begin to have vaginal intercourse. From the age of 30, women who have had 3 consecutive normal Papanicolaou test results may get screening every 2-3 years. Women at a high risk should continue screening every year. The following conditions are of high risk: Immunodeficiencies (the immune system’s ability to fight infectious disease is compromised), HIV infection and DES exposure. Women over the age of 65, with 3 consecutive Pap test results within the last 10 years, may choose to stop having cervical screening.

Who should get the HPV vaccination?

The main target for vaccination is young women who are not sexually active and are not infected with the HPV virus. The vaccine is used to ensure protection against cervical dysplasia, neoplasia,  cervical cancer, genital warts and precancerous anogenital lesions. Women should still continue to have PAP smear tests and  the cervical cancer screening tests, even when vaccinated against HPV. Barrier protection, such as the use of condoms is recommended as prevention from an HPV infection.