Cervical Cancer

The cervix is the neck portion of the uterus adjacent to the vagina. Cervical cancer develops from abnormal cells on the surface of the cervix and is one of the most common cancers in women. Cervical dysplasia refers to precancerous changes in surface cells. Abnormal cells can turn into cancer. There are four stages of cancer, depending on the extent of its spread. As cancer spreads, it requires more intensive treatment.

The exact cause of cervical cancer is not fully understood.

There are two types of cervical cancer:

• Squamous Cell Carcinoma (Epidermoid Cancer): This is the most common type, accounting for approximately 80-85% of cervical cancers. Researchers suggest that this cancer is caused by sexually transmitted diseases, one of which is genital warts caused by the human papillomavirus (HPV). The cancerous tumor grows on or into the surface of the cervix. Cancer usually develops on the surface and can be diagnosed early through a smear test.

• Adenocarcinoma: This develops from the glandular tissues in the cervix.

Risk factors for cervical cancer include:

• An abnormal Pap smear test result.
• Your partner has or had a human papillomavirus infection.
• Having multiple sexual partners or starting sexual activity before age 18.
• Not using condoms during intercourse with a new partner.
• A history of genital or vaginal cancer.
• Your partner's previous partner had cervical cancer or abnormal cervical cells.
• Your partner has or had cancer of the penis.
• Smoking.
• Having a weakened immune system.
• If your mother took the hormone DES (diethylstilbestrol) during pregnancy, your risk is higher.

Cervical cancer usually does not present symptoms in its early stages. Bleeding between menstrual periods or after intercourse can be a sign of cervical cancer. Most women do not experience any complaints. Cancer is often detected during routine annual Pap smear screenings or examinations. Therefore, women should have an examination and Pap smear test annually after becoming sexually active.

Patients with cervical cancer typically experience unexpected abnormal vaginal bleeding or bloody discharge, and pain may occur in advanced stages.

A smear test is necessary for diagnosis. Your doctor will collect a sample from the cervix using a spatula or brush, which is then spread on a glass slide for cellular examination by a pathologist.

The cells observed in a Pap smear can be:

• Normal
• Abnormal
• Precancerous
• Cancerous

If a mild abnormality is observed, it may resolve on its own or with treatment, but follow-up is necessary to ensure it returns to normal.

If a significant abnormality is detected in the Pap smear, a colposcopy may be performed using a device called a colposcope. This special microscope allows the doctor to observe the cervix and vagina. During this examination, small tissue samples can be taken from suspicious areas, and an endocervical curettage may be done to sample the cervical canal. These samples are sent to a pathology laboratory for a definitive diagnosis.

Early precancerous changes can be easily treated through laser treatment, cryotherapy (freezing), cauterization, or surgical removal of the affected area. In more advanced cases, a cone biopsy or even a hysterectomy (removal of the uterus) may be performed.

If detected early, treatment for cervical cancer can preserve a woman's ability to have children. The treatment for advanced-stage cancer varies based on the patient’s age, general health, and the extent of cancer spread.

If invasive cancer is small and confined to the cervix, the uterus, cervix, upper vagina, and surrounding tissues may be removed surgically. Depending on the patient’s age, the ovaries may or may not be removed. If tumor spread is detected, radiation therapy may follow surgery.

If the cancer is advanced or the surgery poses risks to the patient’s overall condition, radiation therapy may be administered, potentially in combination with chemotherapy.

If cancer is detected and treated early, a complete recovery can be achieved. However, if it is not detected early and treatment is delayed, cancer may spread to lymph nodes and surrounding pelvic organs. If the tumor grows and extends beyond the cervix, treatment success diminishes.

• Consult your doctor about bathing, sexual intercourse, and tampon use.
• Get regular check-ups and Pap smear tests to detect early recurrences.
• If your ovaries have lost function due to treatment, your doctor may start estrogen replacement therapy.

Several precautions can be taken to prevent cervical cancer.

• Ideally, a woman should refrain from sexual intercourse until at least 18-20 years of age.
• Minimize the number of partners to reduce risk. The number of partners your partner has had is also important.
• The ideal scenario is monogamy.
• Use condoms during intercourse.
• Quit smoking.
• Pay attention to personal hygiene.
• Women with sexual activity should regularly undergo gynecological examinations and have annual Pap smear tests.
• Bloody vaginal discharges, bleeding between periods, or after intercourse, and pain during intercourse should be thoroughly investigated and treated appropriately