Cervical cancer, its symptoms, causes, prevention methods, and the best centers for its treatment in Turkey by the best gynecological and obstetric surgeons in Istanbul.
Cervical cancer is one of the few cancers with a specific cause, which increases the possibility of preventing it. Regular gynecological examinations and cervical tests are among the most important steps a woman can take to prevent cancer of the cervix, as many complications can be avoided if we follow what will be mentioned later in the article.
According to the World Health Organization, cancer of the cervix is the fourth most common cancer among women, and in 2022, an estimated 570,000 cases were diagnosed worldwide.
What is cervical cancer?
Cervical cancer occurs as a result of abnormal proliferation of cells in the cervix. There are two main types of cancer of the cervix: squamous cell carcinoma and adenocarcinoma.
Squamous cell carcinomas account for about 80% to 90% of cases, while 10% to 20% are adenocarcinomas.
Overview of the Cervix
The cervix is the lower part of the uterus, which consists of two parts: the upper part, where the baby grows and is called the body of the uterus, and the lower part, which is called the cervix.
The cervix has several functions, including connecting the body of the uterus to the vagina (birth canal), where it forms a passage for sperm to pass into the body of the uterus and also forms a passage for the fetus to pass through at birth.
Another of its functions is that it secretes mucus that helps moisturize the female reproductive system.
Causes and risk factors of cervical cancer
Some types of human papillomavirus (HPV) are a cause of cancer of the cervix, which is one of the few known causes of cancer. In addition, there are many risk factors for developing it, and some of the risk factors include the following:
- Irregular gynecological examination: Women who have not had a Pap test (smear) regularly and periodically are at increased risk of developing cervical cancer.
- Human papillomavirus (HPV) infection: Some types of HPV are transmitted through sexual contact and can infect the cervix. Cervical infection with HPV is the main risk factor and cause of cervical cancer. However, a very small percentage of women with untreated HPV develop this cancer.
- Sexual history: A woman’s multiple sexual partners make her more susceptible to HPV and cancer of the cervix, and preventing sexually transmitted diseases reduces the risk of cancer of the cervix.
- Smoking: Cigarette smoking is associated with an increased risk of developing any cancer in general.
- HIV infection: Women with HIV have a higher than average risk of developing this type of cancer.
You can also read on our website about breast cancer and the latest treatment techniques for it in Turkey.
Cervical Cancer Symptoms
In the early stages of cervical cancer, there is no pain or other symptoms. To better understand the symptoms and what a patient may experience when they have cancer of the cervix, we will divide the symptoms of cancer of the cervix into early and late symptoms.
Early Cervical Cancer Symptoms
The first symptoms that may indicate the disease are likely to include the following:
- Watery or bloody vaginal discharge that may be thick and may have a bad odor.
- Vaginal bleeding after intercourse or exercise, between menstrual periods, or after menopause.
- Menstrual periods are heavier and last longer than usual.
Late Cervical Cancer Symptoms
If the cancer has spread to nearby tissues, symptoms may include the following:
- Difficult or painful urination, sometimes with blood in the urine.
- Diarrhea or pain or bleeding from the rectum when defecating.
- Fatigue and loss of weight and appetite.
- Back pain or swelling in the legs.
If abnormal bleeding, vaginal discharge, or other symptoms persist for more than two weeks without explanation, a complete gynecological examination, including a Pap smear, should be performed.
How is cervical cancer diagnosed?
Pelvic exams and Pap smears can help detect most cases of cervical cancer early.
To make an accurate diagnosis, your doctor will visually examine your cervix and take a tissue sample to study any obvious abnormalities for a biopsy to diagnose cancer.
If the biopsy confirms cancer, further tests are done to see if the cancer has spread. These tests may include liver and kidney function studies, blood and urine tests, and X-rays of your bladder, rectum, and bowel.
Read more about cancer diagnosis and treatment methods in Turkey.
Stages of cervical cancer
- Stage I: Cancer is only in the cervix.
- Stage II: Cancer has spread beyond the cervix but has not yet spread to the pelvic wall.
- Stage III: Cancer has spread to the lower third of the vagina or has spread to the pelvic wall and nearby lymph nodes.
- Stage IV: Cancer at this stage affects the bladder, rectum, or other parts of the body.
Are routine gynecological exams necessary?
There is no consensus in the medical community about whether a woman should have a pelvic exam in the years when she should not have a cervical cancer screening.
Some medical associations leave it to the doctor to decide whether to have a pelvic exam, but others discourage pelvic exams because of the discomfort they cause the patient.
Unfortunately, pelvic exams have never been shown to prevent cancers, especially for the cancers that worry women the most, such as ovarian cancer.
Sexually active women aged 25 or younger are advised to have an annual chlamydia screening test.
Cervical cancer treatment
Treatment for cancer of the cervix depends on many factors, including the stage of the cancer, the patient’s age, the woman’s general health, and her desire to have children in the future.
The three main treatments for cervical cancer are radiation therapy, chemotherapy, and surgery.
Radiation or chemotherapy may be used to treat cancer that has spread outside the pelvis (stage IV) or cancer that has recurred.
Radiation therapy
There are two types of radiation therapy:
- Either a device loaded with radioactive beads is placed in the vagina near the cancer and held in place for a certain period of time.
- Or the targeted areas are exposed to radiation over several sessions by a radiation therapist.
Chemotherapy
A variety of chemotherapy drugs are used. Sometimes, when surgery is used, radiation and chemotherapy are used before or after surgery.
You can read more about chemotherapy for cancer in Turkey.
Surgical treatment
Various types of surgical techniques are used to treat cervical cancer. Here are some of the most common surgical treatments for cervical cancer:
- Laser surgery: This surgery uses a laser beam to burn cells or to take a small piece of tissue for study.
- Cone biopsy: This is a surgical procedure in which a cone-shaped piece of tissue is removed from the cervix.
- Simple hysterectomy: This surgery involves removing the uterus but not the tissues surrounding the uterus. The vagina or lymph nodes in the pelvis are not removed.
- Radical hysterectomy and pelvic lymph node dissection: In this surgery, the uterus, surrounding tissue, a small section of the upper part of the vagina, and lymph nodes from the pelvis are removed.
In its early stages, cancer may be curable by removing the cancerous tissue. In advanced cases, a simple or radical hysterectomy is performed.
The latest methods of treating uterine cancer recently applied in Turkey
These treatments are either adjuvant to previous treatments or used in special cases or as a last resort if other treatments fail.
Sentinel Lymph Node Biopsy
This method can be used for any type of cancer, and its mechanism is that a biopsy or removal (during surgery) of the lymph nodes that are suspected to be affected before the other lymph nodes is performed, and if doctors do not find any sign of cancer in these nodes (or node), there is no need to remove the rest of the adjacent lymph nodes.
This procedure has a great benefit as it prevents complications resulting from extensive lymph node removal, especially edema in the legs.
Immunotherapy
Studies are still ongoing on the effectiveness of this treatment in treating cervical cancer.
Immunotherapy is a treatment that helps the body’s immune system fight off the rapid and random reproduction of cancer cells.
Most studies are based on Immune Checkpoint Inhibitors.
Targeted therapy
Targeted therapy is an advanced treatment method that is not available in all countries and is expensive.
Bevacizumab is a targeted drug that is currently used to treat advanced cervical cancer, and other targeted drugs, such as Cediranib (which blocks certain growth factors that help cancer cells grow), have also been shown to be helpful.
Cervical cancer vaccine
The cervical cancer vaccine, Gardasil®, is approved for girls and women aged 9 to 26 and prevents cervical cancer.
This vaccine, which also protects against genital warts (and has also been approved for this purpose for men), works by stimulating the body’s immune system to attack certain types of human papillomavirus (HPV), which have been linked to many cases of cervical cancer.
It is best to get the vaccine before starting sexual activity. The vaccine consists of a series of 3 doses; the second dose comes two months after the first, and the third dose comes six months after the first dose.
Can cervical cancer be prevented?
Women can take some measures to prevent cervical cancer.
Getting regular gynecological exams is one of the most important steps a woman can take to prevent cancer of the cervix.
The American College of Obstetricians and Gynecologists recommends the following guidelines for routine cervical screening:
- All women should start getting regular Pap smears when they are 21 years old, and the test should be repeated every 3 years.
- More tests may be needed if any abnormal cells are found or if HPV is present.
- Starting at age 30, women who have had 3 normal Pap test results in a row can be screened every 5 years with a Pap test and a high-risk HPV test. Another acceptable option is to be screened every 3 years with a Pap test only.
- Women with certain risk factors, such as prenatal exposure to diethylstilbestrol (DES), HIV infection, or a weakened immune system due to organ transplantation, chemotherapy, or chronic steroid use, should be screened annually.
- Women ages 65 to 70 or older who have had three consecutive negative (normal) Pap smears and no abnormal Pap test results in the past 20 years should stop getting cancer of the cervix screening. Women with a history of cervical cancer, prenatal exposure to DES, HIV infection, or a weakened immune system should continue getting screened as long as they are healthy.
- Women who have had a total hysterectomy (removal of the uterus and cervix) should also stop getting cancer of the cervix screening unless they have a history of or are at risk for cervical cancer.
Women who have had a hysterectomy without removing the cervix should continue to follow the guidelines above.
In the end, we find that cervical cancer is one of the most important cancers that affect the female reproductive system, and its early treatment and diagnosis are among the most important things to ensure a woman a healthy life, whether sexually, reproductively, or psychologically. The Bimaristan Center also advises women to undergo periodic examinations and maintain a daily health regimen to avoid contracting any cancer.
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