The cervix or cervix is the lower part of the uterus that forms the canal that leads to the vagina. The mucosa that covers the cervix is in continuity with the vagina and is called ectocervix, while the one that covers the cervical canal or canal that leads to the cavity of the cervix, is called the endocervix.
In this type of cancer, most tumors arise in the area where the ectocervix joins the endocervix, leading to squamous cell carcinomas.
Cervical Cancer occurs when normal cells in the cervix begin to transform and grow uncontrollably.
Causes of Cervical Cancer
There are some risk factors that are related to the incidence of cervical cancer. The most important that participates in the development of premalignant lesions is papillomavirus or Human Papillomavirus (HPV) infection. HPV is present in 99 percent of cases of cervical cancer.
HPV is transmitted from person to person through sexual intercourse and the risk of infection increases if sexual activity begins at an early age, the woman has many sexual partners, or maintains relationships with a man who has had many partners, and maintains a relationship Sexual with a man who has warts on the penis.
The risk increases between the end of adolescence and half of the 30 years. With 40 years the possibility of developing it continues to exist so that from the society they recommend continuing with cytology and check-ups for early detection.
Other factors that could cause this type of cancer are:
- Tobacco use: Women who smoke are twice as likely to develop cancer as non-smokers.
- Sexual promiscuity: Women with many sexual partners or who have sex with a man who has had many sexual partners are at greater risk.
- Early age of onset of sexual intercourse.
- Women who have a weakened immune system due to the use of medications used in other diseases, as well as treatment for HIV or other types of cancer.
- Women with genital herpes.
- Using oral contraceptives increases the chances of developing cervical cancer.
Symptoms of Cervical Cancer
Almost all women have no symptoms in the early stages of this type of cancer. The symptoms do not appear until the cancer has spread to other tissues and organs.
The manifestations that women can have are:
- Bloodstains or mild bleeding between or after periods.
- Pain when having sex.
- Have a longer and heavier than normal menstrual bleeding.
- Bleed after intercourse or during the pelvic exam at the gynecologist’s office.
- Increased vaginal secretion.
- Bleed after menopause.
The specialist points out that when these symptoms appear, and although they resemble others of not-so-serious pathologies, it is advisable to visit an oncologist to communicate it as soon as possible.
How to Prevent Cervical Cancer
Preventing this type of cancer is possible through the early detection of cell alterations in cytology and by administering the HPV vaccine .
There are currently two commercialized forms of the vaccine:
- Gardasil prevents the appearance of high-grade cervical dysplasias, cervical carcinomas, high-grade vulvar and vaginal dysplastic lesions and genital warts caused by HPV types 6, 11, 16 and 18. These last two types of HPV cause 70 percent of deaths from this tumor.
This vaccine is aimed at girls and women between 9 and 26 years old, being one hundred percent effective in those who have not had sex and, therefore, have not been exposed to the virus.
The European Medicines Agency (EMEA) established that its use was contraindicated in the case of patients with acute coronary syndrome, such as angina or myocardial infarction. Nor is it recommended in people with ischemic heart disease and/or peripheral arterial disease, and its combination with insulin should occur only in exceptional cases.
- Cervarix is also indicated for the prevention of premalignant cervical lesions and cervical cancer, causally related to HPV types 16 and 18 and also offers cross-protection against types 31, 33 and 45. It induces antibody levels in an order of magnitude greater than those found after a natural infection in women up to 55 years, although the level of antibodies in the blood is higher in the age ranges of between 10 and 14 years.
Among its particularities, it presents an innovative adjuvant system AS04, which gives great power and duration to immunization. It consists, like Gardasil, of three doses, purchased at the pharmacy.
Types of Cervical Cancer
Depending on the origin of the tumor there are two types of cervical cancer:
- Squamous Cell Carcinoma: Located in the ectocervix and the bottom of the vagina. This type occurs in 85 percent of cases.
- Adenocarcinoma: It originates in the cells located in the cervical canal, inside the cervix. It appears in 15 percent of situations.
Cervical Cancer Diagnosis
The Pap tests (Pap) can detect accurately and inexpensively by up to 90 percent of cervical cancers, even before symptoms appear. Consequently, the number of deaths from this disease has been reduced by more than 50 percent.
It is recommended that women get their first Pap when they begin to be sexually active or from 18 years and repeat it successively once a year. If the results are normal for 3 consecutive years, then the test can be spaced and carried out every 2 or 3 years, provided that the lifestyle is not changed. If all women undergo Pap periodically, deaths caused by this type of cancer could be eliminated. However, almost 40 percent of women in developed countries do not get tested regularly.
If a mass, an ulcer or other suspicious formation is found on the cervix during a pelvic examination, or if the results of the Pap indicate an abnormality or cancer, a biopsy should be performed (removal of a tissue sample for examination under a microscope ).
The tissue sample is obtained during a colposcopy, a therapeutic intervention in which a visualization tube with a magnifying lens (colposcope) is used to examine the internal cervix thoroughly and choose the ideal biopsy site.
Two kinds of biopsy are performed: punch biopsy, in which a tiny portion of the cervix that is visually selected with the colposcope is removed, and the endocervical curettage, in which the tissue of the neck canal is visually inaccessible is scraped. Both procedures are a bit painful and produce a small hemorrhage, although together they usually provide enough tissue for the pathologist to establish a diagnosis.
If this is not clear, conization is performed, in which a larger portion of tissue is removed. Usually, this biopsy is performed by electrosurgical excision in the doctor’s own office, if the hospital is well equipped.
Once the diagnosis has been established, the exact size and location of the cancer must be determined (i.e. staging is performed). The process begins with a physical examination of the pelvis and several tests (cystoscopy, chest x-ray, intravenous pyelography, sigmoidoscopy) to determine if cervical cancer has spread to other surrounding structures or to more distant parts of the body. Likewise, other tests may be performed, such as a CT scan, an enema with barium porridge and bone and liver radiographs, depending on the characteristics of each case.
Cervical Cancer Treatments
The choice of treatment will depend on the size of the tumor, the location, the condition of the patient and whether they want to have children.
Current options are surgery and radiotherapy and, sometimes, chemotherapy. The decision on treatment is usually decided by consensus among specialists (gynecologist, radiotherapist and medical oncologist). Surgery and radiotherapy are local treatments that only affect the area of the tumor, while chemotherapy affects the entire body.
Cervical Cancer Surgery
Depending on the stage of the disease and the extent of the tumor, the specialist can remove only the malignant tissue, the entire cervical neck, the uterus (preserving or not the ovaries and tubes) and regional lymph nodes.
- Conization: This method is a cone biopsy that is performed if the cancer is micro-invasive.
- Radical cervicectomy or trachelectomy: This surgery is used to remove the cervix and leave the uterus intact but dissecting from the pelvic lymph nodes. It can be used in young women who want to preserve fertility and whenever possible, depending on the size of the tumor. This procedure has gained acceptance as an alternative to hysterectomy in these situations.
- Hysterectomy: It can be simple (only the uterus and cervix is removed) or radical (includes the removal of the uterus and cervix, the upper part of the vagina, the tissue surrounding the cervix and the pelvic lymph nodes). In cases where the fallopian tubes and ovaries are removed (optional, depending on the age of the patient) it will be performed simultaneously with the hysterectomy.
- Pelvic exenteration: The uterus, vagina, lower colon, rectum and/or bladder are removed if the cancer has spread to these organs after radiotherapy.
Radiation therapy can be used alone, as a single treatment before surgery or in combination with chemotherapy.
This type of treatment can have side effects in women and depend on the dose and the part of the body where it is administered. The most common are tiredness, dry or flushed skin, loss of appetite, nausea, vomiting, urinary discomfort and diarrhea. These effects usually disappear once the treatment is over.
During treatment, it is advisable to avoid sexual relations that can be resumed.
It is usually administered to remove malignant cells intravenously so that it is transferred to the bloodstream in order to destroy the cells that may be left after surgery or radiotherapy.
The most common side effects are nausea, vomiting, diarrhea, fatigue, loss of appetite, low white blood cells or hemoglobin, bleeding or bruising, numbness or tingling in hands and feet, headache, hair loss and darkening of the skin and nails. These symptoms do not appear simultaneously and usually disappear at the end of therapy.
Other possible effects are that the patient may have an inability to become pregnant and premature menopause.
Treatment in pregnant women
In these situations, it is convenient to study starting treatment once the baby is born. From SEOM they indicate that the treatment of the tumor and the time to carry it out will depend on the stage of the disease, the stage of pregnancy and the wishes of the future mother.
Thanks to the increase in screening and the beginning of treatment in the early stages of cancer, mortality has been greatly reduced in the last fifty years in developed countries.
Currently, five-year survival at all stages of cancer is 71 percent and if detected at an early stage it has a five-year survival of 92 percent .
Sexual life of women
This type of tumor appears in relatively young women, so it can affect sexual life and fertility, so the treatment of sexual dysfunction should cover both physical and psychological aspects.