Cervical cancer

Cervical cancer is the third most common type of cancer in the world. It is the second most common type for women, after breast cancer. Unfortunately, it’s the main cause of death for women in developing countries. Almost 200.000 women die every year from this disease.

What is it?

Cervical cancer is due to the abnormal growth of cells in the cervix. It typically develops from precancerous changes in the cervix. Specialists call these changes as dysplasia.

Then, the cancerous cells start invading or spreading to other parts of the body.

About 90% of cervical cancer cases are squamous cell carcinomas, 10% are adenocarcinoma, and a small number are other types.

What are the causes of cervical cancer

Various strains of the Human Papilloma Virus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. Gynecologists often spot HPV in a woman’s cervix, who has cancer. There are 80 types of HPV. The HPV infection is the most common reason of cervical cancer.

That doesn’t mean that all women infected from HPV will have cervical cancer in the future. Women, who don’t have a Papanicolaou test (Pap test) for cervical pre-cancer checking, may have higher risk of cervical cancer. Other risk factors are:

Early sexual activity.

Having sex at an early age increases your risk of HPV

Many sexual partners.

The greater your number of sexual partners — and the greater your partner’s number of sexual partners — the greater your chance of acquiring HPV

Pap test

Women who have never had a Pap test, or women who don’t do it as often as needed, have higher risk of cervical cancer. In many cases the test can detect pre-cancer alterations. There are three types of alterations CIN I, CIN II και CIN III.

Multiple pregnancies

Smoking

Poor nutrition in vitamins A &C

Oral contraceptives

A weakened immune system

AIDS: Women who have AIDS

What are the symptoms of cervical cancer?

The early stages of cervical cancer may be completely free of symptoms or pain. It is very important to attend all scheduled cervical screening tests. In this way we can detect cancer at an early stage.

Cervical cancer in early stages may not cause clinical symptoms. The first signs of discomfort begin when the cancer spreads out of your cervix and into surrounding tissue and organs. The main sign in this case is abnormal vaginal bleeding. A woman may also feel pain or have vaginal discharge.

For all these reasons, all women must do their tests regularly. With colposcopy a gynecologist can examine the cervix and take samples, if needed, to determine the abnormal cells. When found in early stages it is highly treatable and associated with long survival and good quality of life.

Possible symptoms of cervical cancer may be vaginal bleeding and pelvic pain. These symptoms may lead to cervical cancer, but the may also be caused by something else. The patient should see a doctor if she has any of these symptoms: Vaginal bleeding, a vaginal mass, pain in the pelvic area, moderate pain during sexual intercourse and vaginal discharge.

Prevention

In 1950 Georgios Papanikolaou invented the Pap smear in order to screen early cancerous cells in a woman’s cervix. He was a pioneer who saved million women’s lives of this fatal disease.

Every active or inactive sexually woman must do the Pap smear. According to American scientific societies, women from the age of 21 must do it, or within 3 years from the first intercourse and until the age of 75.

Depending on the case, women must do the Pap test screening regularly. But it must not exceed 2 years without doing it.

Cervical cancer vaccine.

Since 2002, an effort in vaccination for the prevention of cervical cancer has started. Vaccines seem to have an excellent effectiveness and no serious side effects. Clearly, we can achieve the greatest benefit when we plan the vaccination and complete it before the beginning of sexual intercourse.

For this purpose, they have included preventive vaccination for children. In any case, there is a benefit for all women of almost all ages. Thus doctors recommend  vaccination for ages up to 26 years.

For older women, the vaccine is the subject of discussion between a woman and her gynecologist. At this point we must emphasize that in no case, even after vaccination, women should stop having their Pap smears, in order to prevent damage from other types of the virus.

Finally, our future hope is the construction and application of a therapeutic vaccine for the women who have already come in contact with the virus or have developed lesions in the cervix due to HPV infection.

How is cervical cancer detected and diagnosed?

Cervical examination is necessary to detect and diagnose cancer. Gynecologists use the following testing methods can be used:

This test consists of collecting cells from the surface of the cervix and vagina. We use a piece of cotton, or a brush to gently scrape cellular material from the cervix and vagina. We observe the cells under a microscope to check if they are abnormal.

We examine the inside of the vagina and cervix  for any abnormal areas through a vaginal endoscope (colposcope, a thin, illuminated tube) which we insert through the vagina into the cervix. We take tissue samples for biopsy.

The finding of abnormal cells on the Pap test is an indication for a biopsy. A tissue sample is detached from the cervix and observed under a microscope. A biopsy in which the doctor removes only a small amount of tissue does not require special preparation or care of the patient. In contrast, a conical resection of the cervix (removal of a larger, conical sample of cervical tissue) requires hospitalization.

We examine the vagina, cervix, uterus, ovaries, and rectum. The doctor inserts one or two fingers of one hand wearing gloves and lubricating the vagina while he places the other hand above the lower abdomen to feel the size, shape and position of the uterus and ovaries. Finally, he inserts an endoscope into the vagina, which is examined along with the cervix for possible lesions as known because of the disease. At the same time, he obtains material for a Pap test. Also, he performs a finger examination of the rectum for any swelling or abnormal areas.

We use it to collect cells or tissue from the cervix using a scraper (spoon-shaped tool). We take tissue samples for biopsy. The doctor sometimes performs this procedure at the same time as the colposcopy.

Cure for cervical cancer

Treatment options and prognosis (probability of cure) depend on the stage of the cancer (if the cancer is extended to one part of the cervix, or covers the entire cervix, or has spread to the lymph nodes or other parts of the body), the histological type cancer, the size of the malignancy and the patient’s desire to have children. The treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. When cervical cancer is diagnosed at an early stage, or for cancer detected during the last trimester of pregnancy, treatment may be delayed until the baby is born.

There are several treatments available for patients with cervical cancer. Various options are available, some of which have been established while others are still in clinical trials. Before starting treatment, patients may consider participating in a clinical trial. A clinical study is a research process that aims to improve the treatments applied or to seek information on new treatments for cancer patients. When clinical trials suggest that a new treatment has more benefits than a standard treatment, the new treatment may replace it. We use three forms of therapeutic approach:

Surgery is one of the mainstay of treatment for cervical cancer. The following types of surgery are used:

It consists of removing a conical section of tissue from the cervix and fallopian tube. The scientists examine the tissue under a microscope for cancer cells. Conical resection can be used either for diagnosis or as a treatment.

Surgical removal of the uterus and cervix. If the uterus and cervix are removed through the vagina and the operation is called a total vaginal hysterectomy. When the uterus and cervix are removed through a large open incision in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are removed through a small abdominal incision using a laparoscope, doctors call the operation total laparoscopic hysterectomy.

Surgical removal of both ovaries and both fallopian tubes.

Surgical removal of the uterus, cervix and part of the vagina. The surgeon also removes the ovaries, pelvis and pelvic lymph nodes.

Surgical removal of the descending colon, rectum, and bladder along with the cervix, vagina, ovaries, and intrapelvic lymph nodes. The surgeon creates artificial openings (orifices) so that urine (cystostomy) and feces (colostomy) can be channeled out of the body into a collection bag. The woman may need plastic surgery in order to create an artificial vagina after this surgery.

The destruction of the pathological tissue through its cooling is attempted, in cases of in situ non-invasive carcinoma. Doctors also call this type of treatment cryotherapy

It uses a laser beam as an artificial “knife” to remove cancer.

A treatment that uses electricity passed through a thin wire loop as a “knife” to remove abnormal tissue.

Radiation therapy is a method of treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. There are two types of radiotherapy. External radiotherapy or teleotherapy uses a source machine located outside the body that emits radiation to the cancerous tissue. Internal radiotherapy or brachytherapy uses a radioactive substance embedded in needles, cables, heads or catheters that are placed directly in or near the cancer site. The method of radiation depends on the histological type and the stage of the cancer.

Chemotherapy uses drugs to inhibit the growth of cancer cells, causing them to either die or stop dividing. When doctors give orally or injected chemotherapy intravenously or intramuscularly, the drugs enter the bloodstream, approaching the cancer cells throughout the body (systemic chemotherapy). When the specialists apply chemotherapeutic drugs directly to the spine, to a body part such as the abdomen, or to an organ, they primarily affect the cancer cells in those areas. The type of chemotherapy depends on the type and stage of the cancer.