Cervical cancer

Uterine cancer is a malignant tumor that affects the cells in the area of the cervix (lower part of the uterus, which is the connection to the vagina).

This article discusses cancer of the cervix, cervical cancer.
Cervical cancer usually develops slowly. It begins with a precancerous cell change called dysplasia. This precursor of cancer can be detected in a smear test (Pap test) and is 100% curable

Without treatment, these changes can turn into cervical cancer over the course of a few years. A majority of women diagnosed with cervical cancer have not had regular Pap tests.


Types of cervical cancer

In particular, two main groups of cervical cancer can be differentiated:

  1. Squamous cell carcinoma – occurs most often, begins at the superficial cells of the cervix. The Pap test usually detects the first cell changes that can develop into squamous cell carcinoma.
  2. Adenocarcinoma – this tumor is less common and arises in the glandular tissue of the cervix. In the Pap test, the precursor of this type of cancer is not easy to detect.

How does cervical cancer develop?

Almost all cervical cancers are caused by the human papillomavirus (HPV). HPV is a common virus that is transmitted through sexual intercourse. There are many different types of HPV. Some strains have the ability to cause cancer, while others lead to wart formation in the genital area. Still others do not cause discomfort.

HPV transmission can be years ago without anyone knowing about it. The virus remains in the body and can lead to cervical cancer years after infection. That is why it is important to carry out regular check-ups; The Pap test can detect changes in the cells before they turn into a tumor.

In young women and girls who have not yet had sexual intercourse, the likelihood of cervical cancer is very low.

Risk factors for cervical cancer

Risk factors, such as smoking, can increase the risk of developing cervical cancer in HPV-infected women.
Regular check-ups can reduce the risk of cervical cancer.
In the initial stage of cell change in the cervix, the tumor can be prevented by removing or killing the altered cells before it is too late.
Another form of prevention is vaccination against the papillomaviruses before the first sexual contact.

Symptoms of cervical cancer

In most cases, cervical cancer does not cause any discomfort at the initial stage.
The first signs of cervical cancer are:

Unusual bleeding
Women with cervical cancer may experience unusual, heavy or weak bleeding.

Heavy discharge Increasing discharge
is a symptom of cervical cancer.
It can be foul-smelling, watery, viscous or slimy.

Pelvic pain Pelvic
pain that is not related to the menstrual period may be a sign of cervical cancer. Many women describe the symptoms as dull or stabbing pain that sometimes lasts for hours.

Pain during urination If pain occurs during urination
, this may indicate advanced cervical cancer. This symptom usually occurs when the tumor has formed metastases in the bladder.

Bleeding outside the menstrual cycle, after sexual intercourse or after a gynecological examination is also typical.

The cause of this is the resulting irritation of the cervix. While a healthy cervix can lose small amounts of blood, many conditions can cause bleeding after certain activities, such as sexual intercourse.

Cervical cancer can spread to the bladder, colon, lungs and liver. Often, no symptoms occur until the tumor progresses and spreads. The symptoms of advanced cervical cancer are:

Diagnosis of cervical cancer

If cervical cancer is suspected, it is necessary to visit a gynecologist, he is the specialist in the treatment of diseases of the female reproductive organs.
If the Pap test shows irregularities of the cells of the cervix, a visit to the doctor is necessary.
In most cases, the irregularities do not mean that cervical cancer is present.
A sexually transmitted chlamydia infection is one of the main causes of vaginal bleeding.
The doctor may first prescribe a test for sexually transmitted infections before performing a Pap test.
For the chlamydia test, a small sample of tissue is taken from the cervix or a urine test is performed.

Colposcopy If the screening shows irregularities and test results or symptoms indicate that cervical cancer may be present, the gynecologist usually performs a colposcopy
. Colposcopy is a gynecological examination procedure that allows abnormalities in the cervix to be examined.
For this purpose, a small microscope with a light source (colposcope) is used. While examining the cervix, the gynecologist can also take a small sample of tissue (biopsy) and examine the presence of cancer cells under the microscope.

If the gynecologist cannot assess the cervix with the colposcope, a biopsy is sometimes necessary.
This is a small procedure for the removal of cervical cells, which is usually performed in the hospital under anesthesia.
Vaginal bleeding can occur up to 4 weeks after the procedure.

Further investigations
If the results of the biopsy indicate cervical cancer and there is a suspicion of spread of the tumor, further examinations may be necessary to provide more detailed information.
These include:

  • Examination of the pelvic area under general anesthesia to check the uterus, vagina, rectum and bladder.
  • Blood tests that can provide information about the condition of the liver, kidneys and bone marrow.
  • A CT scan is helpful in finding traces of malignant tumors and determining whether the cancer cells have spread.
  • Magnetic resonance (MRI) – with the help of strong magnetic fields and radio waves, detailed images of the inside of the body are created; These images can be used to check whether the tumor has spread.
  • PET, an imaging technique similar to MRI, except for the fact that it shows the functioning of the different parts of the body; This method of examination can also be used to see how the body responds to the treatment.

Cervical cancer has the following course of the disease:

  • Zero stage (precursor) – there are no cancer cells in the cervix yet, but there are biological changes that can later lead to cancer. This stage is called cervical
    Cervical Intraepithelial Neoplasia (CIN) may refer to:
  • First stage – the cancer is limited to the cervix;
  • Second stage – the tumor has spread to the upper part of the vagina or to the surrounding tissues;
  • Third stage – the tumor has spread to the lower vaginal region and/or the tissue structures of the pelvis;
  • Fourth stage – the tumor has spread to the intestine, lymph nodes, bladder and, in a very advanced stage, also to the lungs.

How is cervical cancer treated?

Forms of treatment include surgery, radiation therapy, chemotherapy, or a combination of these. The appropriate therapeutic measure depends on various factors, such as the stage of the disease and the general state of health of the patient.

The gynaecologist can inform the patient about the pros and cons of the individual forms of treatment, the chances of success, possible side effects and other aspects with regard to the treatment options in the various stages of the disease.
Treatment goals should also be discussed.

For example:
in some cases, treatment is aimed at curing the tumor. The cervical tumor can completely regress, especially in the early stages of the disease. Nevertheless, months or years later, a relapse is possible.
Sometimes treatment is used only to control the tumor.
If the therapy cannot cure the tumor either, growth and spread can be restricted. In this way, the symptoms are stopped for a while.
In more severe cases, treatment can relieve symptoms.

If the tumor has progressed, painkillers or other measures, for example, can be used to relieve pain and symptoms. Some therapies help to reduce the size of the tumor.

Surgical intervention for cervical cancer

Removal of the cervix and uterus (hysterectomy) is a common form of treatment. If the tumor is in initial development and has not spread, surgical treatment may be sufficient.
At an early stage, only the affected part of the cervix can be removed, the uterus is preserved. This means that the woman can still have children.

If the tumor has spread to other areas of the body, surgery may also be useful here, often supported by other therapies. For example, if the tumor has spread to the adjacent structures, surgical intervention may be an option.

In this way, the tumor is also removed from the bladder, intestines, lymph nodes, fallopian tubes and ovaries.

Even if the tumor is advanced and cannot be cured, some surgical techniques can help alleviate symptoms, such as occlusion of the intestine or urinary tract caused by the spread of the tumor.

Radiotherapy for cervical cancer

Radiotherapy uses high-energy beams of radiation that are concentrated on the tumor tissue.
In this way, the cancer cells are killed or their multiplication is prevented.
Radiotherapy alone can lead to a regression of the early-stage tumor and be an alternative to surgery. In advanced stages of the disease, it can be used in combination with other forms of treatment.

Chemotherapy for cervical cancer

This treatment with anticancer drugs causes the cancer cells to die or hinders their division. It can be used in conjunction with radiotherapy or surgery.

Vaccination against cervical cancer

There are currently two vaccines available to prevent cervical cancer. Both prevent infection by two types of papillomavirus, 16 and 18. These two types of HPV are responsible for about 70% of all cervical cancers. One of these, Gardasil®, is also effective against types 6 and 11, which cause genital warts.

Vaccination provides greater protection when administered before the woman’s sexual activity.
Vaccination with Gardasil® is carried out in three steps, with one dose administered every two months.

Prognosis, chances of survival and mortality

The chances of recovery are better if the tumor is diagnosed, as long as it is confined to the cervix and has not spread. In this case, 8-9 out of 10 women have good chances of recovery. If the tumor has already spread, the treatment has less chance of success, but a cure is possible.

The 2003 data in Italy shows that the number of survivors after one year is about 44% for women up to 95 years of age and 75% for women over 72 years of age.
The 5-year survival rate is even more dependent on age: it is 15% for women between 45 and 80 years of age and 75% for women over 37 years of age.

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