Cervical cancer is a type of malignant tumor that occurs in the lower part of the uterus , the region where it connects with the vagina and opens for the baby to come out at the end of pregnancy. In addition, according to the National Cancer Institute (Inca), cervical cancer is the third most common cancer in the female population, behind breast cancer and colorectal cancer .
However, today the diagnosis is made much earlier: in the 1990s, 70% of cases were diagnosed in their most advanced form. Currently, 44% are identified in the precursor lesion. Check now Cervical Cancer: Symptoms, Treatments and Causes:
News of the week:
- Squamous cell carcinomas occur in most cases and are usually caused by the presence of the HPV virus.
- Adenocarcinomas are less common cervical cancers , but they can also appear.
On some occasions, both types of cancer cells may be involved in a single case of cervical cancer .
Causes: Cervical cancer usually occurs when there is a genetic mutation in the cells in the region, which begin to multiply in an uncontrolled way.
Usually this mutation is related to the presence of some types of HPV virus. HPV is very common in women (it is estimated that 90% of them will come into contact with some strain of this virus throughout their lives), but only a few types of the virus are related to cases of cervical cancer, especially types 16 . and 18 (present in 70% of cases), but also types 31, 33, 35 or 39.
Approximately 291 million women worldwide carry HPV, but only 32% of them are infected with types 16, 18 or both. Usually the tumor develops from a precursor lesion, which can be caused by HPV. They are totally treatable and curable, and only when left untreated for many years can they develop into cancer.
These lesions have no symptoms, but are easily detected in Pap smears, colposcopy, and vulvoscopy. Talk to a gynecologist about these tests. In addition, the presence of HPV alone does not cause cervical cancer , it is necessary to have other risk factors for the disease to develop.
Risk Factors: Risk factors for cervical cancer involve:
- Early initiation of sexual life, which increases the risk of having HPV.
- Large numbers of sexual partners also increase the risk of getting HPV.
- Presence of other STDs such as gonorrhea, syphilis, chlamydia or HIV increases the risk of HPV.
- A weaker immune system, especially in people who have a health condition that interferes with their immunity, makes HPV more likely to manifest itself.
- Smoking can increase the incidence of squamous cell carcinoma.
- Prolonged use of the contraceptive pill (for more than 5 years).
- History of three or more pregnancies.
- IUD use.
- Family history of cervical cancer .
In addition, there are risk factors that increase the risk of cancers in general, such as:
- Low consumption of fruits and vegetables.
Symptoms of Cervical Cancer: Early cervical cancer or even pre- cancer do not usually have symptoms and are only detected by routine female exams.
More advanced cases of cervical cancer often cause:
- Vaginal bleeding, whether during intercourse, between periods, or after menopause.
- Abnormal vaginal discharge with a different color and odor than normal.
- Pain in the pelvis or during intercourse.
Even more advanced cases may show symptoms such as:
- Anemia due to abnormal bleeding.
- Pain in legs or back.
- Urinary or bowel problems.
- Unintentional weight loss.
Seeking Medical Help: The best way to detect cervical cancer earlyor any other common female health problem is by going to the gynecologist annually and having routine exams.
At the Medical Consultation: Specialists who can diagnose cervical cancer are:
- General practitioner.
Being prepared for the appointment can facilitate diagnosis and save time. That way, you can already arrive at the query with some information:
- A list of all symptoms and how long ago they appeared.
- Medical history, including other conditions the patient has and medications or supplements they take regularly
- If possible, ask someone to accompany you.
The doctor will likely ask you a series of questions, such as:
- What are your symptoms?
- When did you start introducing them?
- Have you had Pap smears since you have an active sex life? Have you ever had an abnormal test result?
- Have you ever been treated for a cervical problem ?
- Have you ever been diagnosed with an STD?
- Do you use medications that can suppress your immune system?
- Do you smoke or have you ever smoked? In what quantities?
- Do you think about being a mother in the future?
It is also important to take your questions to the consultation in writing, starting with the most important. This ensures that you will get answers to all relevant questions before the consultation is over. For cervical cancer , some basic questions include:
- What is the most likely cause of my symptoms?
- What kind of exams should I take?
- What treatments are available and what can I expect?
- What’s the prognosis?
- How long do I need to make routine appointments after treatment is finished?
Do not hesitate to ask other questions, should they occur at the time of the appointment.
Diagnosis of Cervical Cancer: Early stage cervical cancer is usually screened periodically by the gynecologist in routine consultations. To detect it or the lesions of HPV the most used exams are:
- Pap smear.
- Colposcopy and vulvoscopy, with biopsy if necessary.
- HPV test through DNA, which collects cells from the cervix and checks for the presence of the virus. This test is done on women over 30 or younger, provided they have an abnormal Pap smear.
Prevention exams are usually done after the woman begins to have an active sex life. Therefore, it is very important to start visiting the gynecologist regularly at this time, even so that he can also talk to the woman about contraceptive methods.
When cervical cancer is already ongoing, some tests can be done to identify the extent of the tumor:
- Biopsy of the region
- Computed tomography
- Positron emission tomography (PET-Scan).
Staging: Cervical cancer is divided into the following stages:
- Stage 0 or carcinoma in situ: when the cancer cells are still on the surface of the cervix .
- Stage I: when the cancer invades the cervix , but remains there, without going outside the uterus .
- Stage II: The cancer has grown outside the uterus but has not yet spread to the walls of the pelvis or vagina.
- Stage III: The cancer has spread to the vagina and pelvic wall and may be blocking the urethra.
- Stage IV: The cancer has spread to other parts of the body such as the bladder, rectum, lungs or liver.
Cervical Cancer Treatment: Treatment options for cervical cancer vary depending on the stage of the tumor. See the options below:
Surgery: In surgery doctors can remove tissue attacked by the cancer . There is also the option of removing the cervix and the entire uterus (simple hysterectomy) and also the vagina and lymph nodes in the region (radical hysterectomy).
The type of surgery is chosen according to the stage of the cancer (how many areas were attacked) and the woman’s desire to become pregnant, since the removal of the uterus prevents the possibility of having children.
Radiotherapy: Radiation therapy uses radiation to kill cancer cells. It can be done externally and/or internally. In the first technique, a ray is applied from outside the body, while in the internal, the radiotherapy material is placed inside the vagina for a few minutes.
Radiation therapy can cause menstruation to stop or menopause to start earlier in premenopausal women.
Women who want to become pregnant after treatment should talk to their doctor about ways to preserve fertility after treatment.
Chemotherapy: Chemotherapy may be given as an adjunct to radiation therapy or to shrink the tumor before surgery.
Treatment for precancerous lesions: When the doctor finds precancerous lesions on a woman’s cervix , options involve destroying that tissue in two ways:
- Cryotherapy: in it, tissue with malignant cells is destroyed by freezing. It can be done with local anesthesia
- Laser treatment: Laser can also be used to destroy tissue with malignant cells. The advantage is that it can be done in the doctor’s office with local anesthesia.
Immunotherapy: Immunotherapy for the treatment of cancer is, in a very simple way, a way to fight the problem by using the body’s own defense system to attack the cancer cells.
Living with/Prognosis: Cervical cancer when diagnosed in a non-invasive or stage I stage has a high chance of cure (between 80 and 90%). However, the chances decrease as the frame gets more advanced.
That’s why it’s very important to perform routine exams for cervical cancer , which allows an early detection of cancer or pre-cancer lesions.
The treatment can lead to some problems with fertility or the woman’s sexuality. It is important to talk to your doctor if you wish to have children after treatment, as some steps may be taken, such as freezing your eggs.
Hysterectomy can lead to problems such as vaginal dryness, weakness in the muscles of the pelvis, and even pain during intercourse due to shortening of the vagina. All these problems have solutions and can be discussed with your doctor.
Prevention: The best way to prevent cervical cancer is to prevent HPV infection . The most recommended preventive measure for HPV is the use of condoms. Most transmissions of this virus are sexual and by preventing skin contact between partners, condoms are one of the best ways to prevent the problem.
HPV Vaccine: The HPV vaccine is an interesting way to prevent the disease. There are two vaccines for HPV prevention approved and registered by the National Health Surveillance Agency (ANVISA) and which are commercially available: the quadrivalent HPV vaccine , which provides protection against HPV 6, 11, 16 and 18. The other option is the vaccine against Bivalent HPV, which confers protection against HPV 16 and 18.
According to the scientific literature, vaccines against HPV prevent approximately 70% of cases of cervical cancer , those caused by HPV 16 and 18. This does not, however, eliminate the need for women to undergo routine consultations with the gynecologist to carry out preventive exams.
Routine screening: Following up with routine gynecological exams after sexual intercourse is also important, as they allow for early detection of precancerous lesions and the cancer itself, which provides a better chance of recovery.
Prevention for other risk factors: There are some measures that help reduce the risk of getting cervical cancer:
- Do not smoke.
- Practice safe sex.