Definition
Cervical cancer is the most common gynecological cancer worldwide and the second most frequently diagnosed cancer in women after breast cancer. The vast majority of diagnosed patients are seen in developing countries. Mortality related to cervical cancer and the frequency of this cancer are gradually decreasing in developed countries thanks to the success of screening programs. This decrease has largely been achieved by the routine use of the Papanicolaou smear (Pap smear) screening, which came into use in 1941.
The Pap smear test has the characteristics of an ideal screening method; it is inexpensive and can be applied easily. This test is the process of taking a smear sample from the surface of the cervix. This procedure, which is very simple and quite successful in terms of sensitivity and specificity for the early diagnosis of cervical cancer, plays an important role in the early detection of cervical cancer when performed at regular intervals. Early diagnosis is the most effective way to reduce mortality and the decrease in quality of life caused by cervical cancer and to prolong life expectancy. With the Pap smear test, 90% of cervical problems can be diagnosed at an early stage. While early diagnosis increases the chance of treatment to almost 100% in these cases, it also reduces deaths related to cervical cancer by 50%.
In developed countries, approximately two-thirds of women who develop cervical cancer are either women who have never been screened or women who have not undergone any screening program in the last 5 years. The average age of women who develop cervical cancer is quite young and has been determined as 52, and many of these patients are seen between the ages of 35-39 and 60-64. The most important identifiable risk factor for cervical cancer is HPV (Human Papilloma Virus). More than 100 types of HPV have been identified and categorized as low, medium, and high-risk types. Although this infection is very common (approximately 70%), most women can easily overcome this infection without leaving any sign of infection behind. However, women with certain risk factors may not be able to do this, and the infection may become permanent. This situation can be a cause of cervical cancer and may become a sexually transmitted disease. The long precancerous period of cervical cancer makes it ideal for screening programs. Therefore, today, a routine screening program for cervical cancer has been established and early diagnosis can be achieved.
Who Should Be Screened
The primary goal of screening is the accurate detection and timely treatment of precursor lesions of the cervix in order to prevent cervical cancer.
Cervical cancer can be diagnosed at an early stage. The presence of a precancerous stage of cervical cancer, the ability to detect patients during this period, and effective treatment are important characteristics specific to this disease and allow screening and early diagnosis. However, in developing countries, cervical cancer still continues to be a major problem due to the lack of regular screenings. Since cervical cancer is a disease that can be diagnosed and treated at an early stage, studies to be carried out in this field are important in terms of early diagnosis.
According to the screening recommendations of the American Cancer Society (ACS); cervical cancer screening should begin at age 21 in sexually active women. Women between the ages of 21-29 should have a Pap test every 3 years. In this age group, if there is an abnormal Pap test result, an HPV test is recommended. Women between the ages of 30-65 should have a Pap test and HPV test every 5 years. There is no consensus on until what age the test should be performed, but women aged 65 and over who have previously had regular cervical cancer screening tests and have not had any abnormal results should not be screened for cancer.
Whether the test should be performed in patients who have had their uterus removed depends on the reason for the surgery. If the cervix was left in place without complete removal of the uterus, screening must definitely continue. If the uterus was removed for a benign reason, there is no need to continue the screening program. If the uterus was removed due to any condition that is a precursor to cervical cancer, follow-up should be performed every 4-6 months until 3 negative smear results are obtained, and then annually.
Risk Factors for Cervical Cancer
As with many cancers, the exact cause of cervical cancer is not known. In fact, all women are at risk in terms of cervical cancer. However, individual risk factors increase this risk. Most of these risk factors are closely related to negative health behaviors. But most women do not know that these negative behavior patterns are directly related to cervical cancer.
Cervical cancer;
1) High-risk Human Papilloma Viruses (HPV): Some of the sexually transmitted HPV types are carcinogenic, and types 16-18 are accepted as cervical cancer risk factors.
2) Having the first sexual intercourse at a young age,
3) Smoking: Women who smoke have twice the risk of cervical cancer compared to women who do not smoke.
4) Excess weight
5) Giving birth to many children: Three or more births, birth trauma, hormonal changes, and immunosuppression may cause cervical cancer.
6) Low socioeconomic level: It is reported that cervical cancers are more common in developing countries due to low socioeconomic status; therefore, the disease is seen more often in women with low income levels.
7) Women with multiple sexual partners and women whose partners adopt a multiple-partner lifestyle
8) Birth Control Pills: The risk of cervical cancer increases in women who use birth control pills for more than 5 years.
9) Nutrition and Dietary Habits: Although some studies show that vitamins and minerals reduce the risk of cervical cancer, this has not yet been proven.
10) Sexually Transmitted Diseases: Sexually transmitted diseases have been the first considered and investigated factor among the causes of cervical cancer. Chlamydia, Trichomonas vaginalis, and genital herpes infections may strengthen the carcinogenic effect of high-risk HPV types.
11) Poor Genital Hygiene Habits: Failure to apply menstrual and perineal hygiene adequately and correctly may lead to cervical cancer. Vaginal douching is cleaning the vagina with a liquid solution or often with water. Vaginal douching increases the risk of pelvic inflammatory disease, ectopic pregnancy, decreased fertility, bacterial vaginosis, sexually transmitted infections, and cervical cancer.
12) Other Risk Factors: Having previously been diagnosed with another cancer, having a mother or sister with cervical cancer are counted among other risk factors.
Signs and Symptoms of Cervical Cancer
Precancerous lesions of cervical cancer usually do not cause symptoms. Symptoms begin when the cells turn into cancer and spread to the deeper parts of the cervix or neighboring organs. Success in the treatment of gynecological cancers varies according to the stage of the disease. The symptoms present in the patient are very important in the classification of these stages. The symptoms seen in cervical cancer are listed below.
1) Unusual vaginal discharge, increased vaginal discharge, sometimes containing blood
2) Abnormal vaginal bleeding
3) Bleeding after sexual intercourse
4) Bleeding after menopause
5) Spotting and bleeding between periods
6) Menstrual bleeding lasting longer and being heavier than normal
7) Bleeding after pelvic examination
8) Pain during sexual intercourse
9) Foul-smelling vaginal discharge in advanced stages
10) Lower back and groin pain
11) Anemia
12) Weight loss
13) Difficulty urinating
14) Leg edema
Prevention of Cervical Cancer
The negative effects of gynecological cancers, which are quite common in our country, on women's health are multidimensional. Despite this, developments in the diagnosis and treatment of gynecological cancers have increased life expectancy and improved the expectation of quality of life for patients in this group.
Today, the approach to cancer patients is handled within a very wide spectrum, starting from understanding the importance of early diagnosis, accepting the disease, improving self-care ability and developing the ability to continue life with the disease as in chronic illnesses, and extending to terminal patient care in the final stage of life.
Prevention is the key strategy for completely eliminating cervical cancer from the world. Knowing the factors thought to cause cervical cancer is important in terms of the precautions to be taken for protection against cervical cancer.
Treatment of Cervical Cancer
The choice of treatment in cervical cancer varies according to the degree of the precursor lesion in the cervix, the patient’s age, and general health status.
There are 2 important points to consider in treatment selection. The first is applying the treatment with the higher cure rate, and the second is that the treatment to be applied should be more effective on survival and quality of life. In precursor lesions, electrocoagulation and cryotherapy are used; in invasive lesions, radiotherapy, chemoradiotherapy, and surgical treatment methods are used. For women who are beyond reproductive health age or who do not want to have children, complete removal of the uterus (total hysterectomy) is the most definitive treatment method.
Op. Dr. Kerem OĞUZ
Obstetrics and Gynecology Specialist