Cervical cancer is a prevalent malignancy in the female reproductive system. It originates in the cervix, a vital part of the uterus. The uterus, comprising smooth muscle, consists of the body, located inside the female pelvis and serving as the site of pregnancy, and the cervix, partially situated in the vagina.
The cervix supports the developing pregnancy within the uterus by tightly closing the cervical canal. During labor, the cervical canal opens and dilates significantly. Apart from pregnancy, the narrow cervical canal serves as a pathway for sperm, guards against infections, aids in the expulsion of menstrual blood, and contributes to a woman's experience of orgasm through cervical contractions.
The most common site for cancer development is the transition zone, named for its location at the junction of two types of epithelium: glandular, lining the uterine cavity and cervical canal, and flat, covering the vaginal portion of the cervix and the vagina. From the vaginal part, the so-called shield can be identified.
The location of the transition zone varies depending on age and hormonal levels. In young girls and postmenopausal women, it lies internally within the cervical canal. During hormonal activity, it is situated on the shield of the vaginal part of the cervix near its external opening.
The shield may be coated with glandular epithelium, known as ectopy (commonly referred to as erosion, epithelial defect, or erythroplakia). This process is natural and does not necessitate treatment. Additionally, the term “erosion” is erroneous and should be avoided. In young women, a transition zone lies within the ectopy, where potentially cancerous changes may occur.
Cervical cancer
is the fourth most common cancer in women worldwide. About 570,000 women develop it annually, of whom about 60% die. The peak incidence occurs in women aged 50-60.
The main cause of cervical cancer is the human papillomavirus (HPV), which creates an environment conducive to the transformation of healthy cells into cancer cells. Infection with it is asymptomatic. Subtypes 16 and 18 are particularly dangerous.
The second equally dangerous factor is smoking (it increases the risk by 2 times). In addition, some infections of the reproductive organs are mentioned (chlamydia, gonorrhea, herpes virus, cytomegalovirus), multiple pregnancies and deliveries (more than 5), a diet poor in vitamin C, and long-term use of contraceptives.
The so-called indirect risk factors are:
It is worth mentioning that HPV can be infected not only through vaginal sex but also oral and anal sex. Additionally, skin-to-skin contact of the genitals may be sufficient to transmit the virus. It has also been shown that it is present in erotic accessories.
There is no familial predisposition to the occurrence of cervical cancer.
It is currently believed that the most significant risk factor for developing cervical cancer is HPV infection of the epithelial cells of the cervix. Much less frequently, the virus nests in the epithelium of the vagina or labia, leading to diseases of these areas. In the vast majority of cases, the woman's body eliminates the virus itself, but persistent infection occurs in a certain percentage of cases. It means that the virus permanently occupies the cells of the epithelium of the cervix, which can lead to changes in them – the so-called dysplasia, leading to disorders and functions and development, and sometimes to malignancy and the development of cancer.
HPV infection cannot be cured, just as there is no cure for the influenza virus. The patient should be monitored, and checks should be intensified in the case of chronic infection. In the case of dysplasia, appropriate treatment should be applied.
It follows that lifestyle has a huge impact on the risk of developing cervical cancer. Its appropriate modification, in combination with regular cytological and gynecological tests and protective vaccination, minimizes this risk.
A symptom of cervical cancer reported by premenopausal women is bleeding between periods. Patients quite often report heavier periods, menorrhagia, or bleeding after intercourse. In the case of a good preventive screening system, cervical cancer is most often diagnosed as asymptomatic. The lack of characteristic and significant symptoms of cervical cancer in the early stages of the disease, combined with the lack of regular preventive screening, often leads to silent and asymptomatic development of cancer into an advanced form, which has a much worse prognosis than early detected (preinvasive) cervical cancer.
It happens that patients report to the doctor with symptoms such as intestinal obstruction or kidney failure caused by blocked urine flow. These symptoms characterize the advanced form of cervical cancer. Very rarely, there are patients with a normal cytological test result and a lesion in the cervical region as the only symptom of cancer. Rare symptoms of cervical cancer include pelvic pain and foul-smelling vaginal discharge.
If the symptoms appear in the genital tract, the patient should see a gynecologist. This specialist deals with diagnostics and treatment of female urinary and reproductive system diseases. After a gynecological examination and interview with the patient, the gynecologist may recommend additional tests, such as ultrasound through the abdominal walls and the vagina – the so-called transvaginal examination (TV ultrasound), blood tests, and cytology.
To diagnose cervical cancer, a sample of the suspicious tissue is taken for testing to determine the type of cancer. The examination and collection of material are conducted using specula through the vagina and rectum. Additional tests are performed to determine the stage of the disease and select the appropriate treatment, such as chest X-rays, computed tomography, or MRI of the abdomen and pelvis to rule out metastases to other organs. Evaluating the patient's overall health and desire to maintain fertility is also crucial.
The choice of treatment depends on the cancer stage at diagnosis and the decision regarding having children. Surgery yields the best results. In the very early stages, particularly in young women aiming to preserve fertility, radical removal of the cervix and pelvic lymph nodes may be adequate, offering a 50% chance of pregnancy post-surgery.
However, the most common choice is the radical removal of the entire uterus, including the surrounding tissues (parametrium) and regional lymph nodes. If performed on a young woman, it's possible to move the ovaries outside the pelvis to prevent damage due to additional radiotherapy. The procedure is typically carried out via abdominal surgery (laparotomy), although laparoscopic or even transvaginal approaches are also possible.
Radiotherapy is used as an additional treatment after surgery, i.e., complementary treatment. After the tumor has been removed, the pelvis, where the affected uterus was located, is irradiated to destroy individual, invisible cancer cells.
It usually consists of two stages: external irradiation of the tumor—teleradiotherapy—and internal, by placing a radioactive element inside the tumor in the cervical canal (this does not damage healthy tissues around the tumor)—brachytherapy. The main complications that may occur during treatment are diarrhea, urethritis, and other gastrointestinal complaints, which respond very well to the applied symptomatic treatment.
Chemotherapy—mainly platinum derivatives—is important in the treatment of cervical cancer. It is used as an adjunct to radiotherapy. It enhances the effect of ionizing radiation on the tumor and improves the treatment results compared to radiotherapy alone.
Too many cases are diagnosed in advanced, inoperable stages, which is why the most common method of treating cervical cancer is radiochemotherapy. In very advanced stages of the disease, palliative radiochemotherapy or symptomatic treatment alone is used.
For women who are mindful of the risk factors, get regular preventive screenings, and receive HPV vaccinations, invasive cancer is uncommon. Typically, the disease is detected at the dysplasia or pre-cancerous stage. If cancer does develop, it is often identified early, which offers a 55–95% chance of recovery.
FIGO classification of cervical cancer stage (2009) distinguishes:
| I | Cancer is strictly limited to the cervix. |
| IA | Microinvasive cancer, diagnosed only microscopically based on material covering the entire neoplastic lesion. |
| IA1 | Depth of invasion of the stroma ≤ 3 mm from the basement membrane, diameter of the lesion ≥ 7 mm. |
| IA2 | Depth of invasion of the stroma ≤ 5 mm from the basement membrane, diameter of the lesion ≥ 7 mm. |
| IB | All cases of lesions larger than those defined in stage IA2, clinically visible or not. |
| IB1 | Clinically visible lesion ≤ 4 cm. |
| IB2 | Clinically visible lesion > 4 cm. |
| II | Cancer extends beyond the cervix without reaching the pelvic walls but invades the vagina only in the upper 2/3 of its length. |
| IIA | Invasion extends to the vault or vagina but does not exceed the upper 2/3 and does not invade the parametria. |
| IIA1 | Clinically visible lesion ≤ 4 cm. |
| IIA2 | Clinically visible lesion > 4 cm. |
| IIB | Infiltration of the parametria not reaching the pelvic bones (without vaginal invasion or with invasion). |
| III | Cancer extends to the pelvic walls (in a rectal examination, there is no free space between the infiltration and the pelvic bone), vaginal invasion involves the lower 1/3 of the length, all cases of hydronephrosis or a non-functioning kidney (regardless of the extent of the neoplastic process, confirmed in the combined examination) are also included in stage III of cancer advancement. |
| IIIA | Cancer invades the lower 1/3 of the vagina, no infiltration of the parametria to the bone is found. |
| IIIB | Infiltration of the parametria to the bone, presence of hydronephrosis, or a non-functioning kidney. |
| IV | Extension of cancer beyond the pelvic area or invasion of the bladder mucosa urinary or rectal. |
| IVA | Invasion of adjacent organs. |
| IVB | Distant metastases. |
It's important to understand that preventing cervical cancer involves two approaches. The first, known as primary prevention, focuses on shielding individuals from exposure to risk factors such as HPV infection. It includes getting vaccinated against the virus. The second approach, secondary prevention, is aimed at those who may already have been infected and focuses on identifying precancerous changes at an early stage through cervical cytology.
Vaccinations against cancer-causing strains of HPV are recommended for both girls and boys before they become sexually active, ideally between the ages of 9 and 13. The vaccination is administered in three doses. Vaccines are available that contain either two types of HPV (16, 18)—known as the bivalent vaccine—or four or nine oncogenic types of HPV, known as the 4-valent and 9-valent vaccines, respectively.
As part of the prevention of cervical cancer, specialists recommend that a cytological test be performed at least every three years if the previous results are standard and the woman is not at increased risk of developing cervical cancer. A previous abnormal cytological result is an indication to shorten the period between tests. Combining cytology with HPV testing allows you to increase the interval between tests to up to 5 years.
At what age should you have a cytological test? The first smear should be taken from a woman no later than 25.
A cytological test should also be performed by women who have already gone through menopause. Women after menopause who would like to skip the test should consult their doctor, who will consider the patient's situation, taking into account her health condition and factors predisposing to the development of neoplastic disease (cervical cancer).
Table of Contents
HPV (human papillomavirus) is a pathogen that can cause many different conditions, depending on its subtype. What are the symptoms… read more »
Human papillomavirus infection is one of the most common viral infections, mainly sexually transmitted. It can cause cancer. Check the… read more »
Pelvic inflammatory disease is associated with the female reproductive system. Many women suffer from pelvic pain without knowing the cause,… read more »
Vaginal discharge is a fluid or mucus that comes from the vagina. It is a normal bodily function that serves… read more »
Warts are skin lesions resulting from infection with the human papillomavirus (HPV). What are the symptoms? What is the diagnosis… read more »
Pelvic pain implies inconvenience within the lower region of the stomach, underneath the stomach button, and between the hips. This… read more »
Bacterial vaginosis is a common problem for women. Learn the risk factors so you can eliminate them and protect yourself… read more »
A gynecologist is a medical doctor who specializes in the health of the female reproductive system, which includes the uterus,… read more »
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