Cervical cancer

Diagnosis cervical cancer”

Cervical cancer is a type of malignancy that develops in the cells of the cervix, the lower part of the uterus that connects the uterine cavity to the vagina. This type of cancer is often associated with the human papilloma virus (HPV), which is primarily transmitted through sexual contact. Early detection through screening tests such as the PAP test can greatly increase the chances of successful treatment.

Types of cervical cancer

There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat cells on the outer surface of the cervix and accounts for about 90% of cases. Adenocarcinoma affects the glandular cells that line the inner canal of the cervix and is less common.

Symptoms of cervical cancer

The early stages of cervical cancer often do not cause symptoms, highlighting the importance of regular screening examinations. When symptoms do occur, they may include abnormal bleeding or discharge from the vagina, pain during sexual intercourse, and pain in the pelvic area. In more advanced stages, there may be changes in urination, leg pain and swelling.

Diagnosis of cervical cancer

• Early stages of cervical cancer usually have no symptoms. Symptoms of advanced cervical cancer include abnormal vaginal bleeding, pelvic pain, vaginal discharge, and pain during sex.
• The diagnosis of cervical cancer is usually based on the results of clinical examination, colposcopy and biopsy.
• Further tests help determine how advanced the cancer is. For this, an examination under anaesthesia, an X-ray pyelogram and/or an intravenous pyelogram may be ordered. Advanced imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) may also be used as diagnostic tools.
• Cervical cancer is 'staged' according to the size of the tumour, the involvement of lymph nodes and whether it has spread to other parts of the body. This information is used to determine the best treatment.

Cervical cancer treatment options

• Treatment for cervical cancer depends on the size, location, and stage of the tumor.
• Patients should be fully informed and involved in decisions about treatment options.
• Surgery is the foundation in the treatment of cervical cancer in its early stages. More advanced disease can be treated with chemoradiotherapy, chemotherapy, radiotherapy or targeted therapies.

Non-invasive cervical intraepithelial neoplasia

- In non-invasive cervical intraepithelial neoplasia (CIN ), cells in the cervix show abnormal changes, which may progress to cervical cancer in the future. Some patients with CIN do not need treatment, but others will undergo a procedure (e.g., loop electrosurgical excision or conization) to remove the area where abnormal cells are found.

Early-stage cervical cancer

- Women with early stage invasive disease are usually referred for surgery to remove the cancerous growths. Hysterectomy with or without removal of pelvic lymph nodes is offered.
- Patients who are considered to be at high risk of cancer recurrence may receive adjuvant chemo- and radiotherapy after surgery.
- Fertility preserving surgery options may be available for women who want to have children in the future ( e.g. a trachelectomy may be performed instead of a hysterectomy to preserve the uterus).

Locally advanced cervical cancer

- Locally advanced disease is usually treated with cisplatin-based chemoradiotherapy.
- Some patients may be offered neoadjuvant chemotherapy to shrink the tumour, followed by surgery.

Metastatic cervical cancer

- Metastatic disease is usually treated with chemotherapy (paclitaxel and cisplatin) in combination with a newer targeted therapy called bevacizumab.
- Palliative radiotherapy can be used to treat certain symptoms arising from metastases.

Recurrent cervical cancer

- Treatment of recurrent disease depends on the degree of recurrence.
- If the tumour reappears as a recurrence at one site in the pelvis, radiotherapy or pelvic exenteration may be performed.
-Recurrent tumors in distant organs are considered metastatic cancer and can be treated with chemotherapy with or without targeted therapy.

Follow-up after treatment

• The schedule of follow-ups varies from region to region and practice to practice; you should usually see your doctor every 3-6 months for the first 2 years after treatment, every 6-12 months after 3 years, and annually after 5 years.
• At each visit, your doctor will examine you and perform a pelvic examination. You may also be given a CT (computed tomography) scan or PET scan.

Post-treatment follow-up

1. Cervical cancer is the fourth most common cancer in women worldwide, with about 660,000 new cases and about 350,000 deaths in 2022.
2. The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects large inequalities caused by lack of access to national HPV vaccination, cervical screening and treatment services, and social and economic factors.
3. Cervical cancer is caused by persistent (persistent, long-lasting) infection with the human papillomavirus (HPV). Women living with HIV are 6 times more likely to develop cervical cancer than women without HIV.
4. Prophylactic HPV vaccination, screening and treatment of precancerous lesions are effective strategies to prevent cervical cancer.
5. Cervical cancer can be cured if diagnosed at an early stage and treated promptly.
6. Countries around the world are working to accelerate the elimination of cervical cancer in the coming decades with three agreed targets to be met by 2030.