What is cervical cancer?
Cancer is a disease in which certain cells of the body grow without control. The cervix is the lower part of the uterus that connects the uterine body to the vagina. The function of the uterus (or womb) is to allow embryo-fetal growth during pregnancy. The cervix, in turn, prevents the loss of the fetus during pregnancy and during labor, it dilates and forms the birth canal for fetal descent.
Cervical cancer is the only gynecological cancer that can be prevented by performing periodic screening Pap smears. In addition, the function of cytology is to detect cancer of the cervix in early stages, ensuring greater effectiveness of treatments.
What are the risk factors for the development of cervical cancer?
Cervical cancer usually occurs between 45 – 55 years of age and represents the 3rd most frequent cause of gynecological cancer. Today it is known that almost 100% of cases are associated with the human papillomavirus. It is transmitted from one person to another during sexual intercourse.
Cervical cancer can be prevented by performing cervical cytology.
Cervical cytology is a method both to prevent cancer of the cervix and to detect it in early stages. The goal of cytology is to detect pre-malignant cellular changes in the uterine cervix that could progress to cancer over time. The pre-malignant cellular changes that can be diagnosed by cytology include: ASCUS, AGUS, low-grade SIL, or high-grade SIL.
Cervical cytology consists of obtaining superficial cells of the uterine cervix through its gentle and delicate scraping. It is performed periodically in the office by placing a speculum in the vagina
The HPV test
What are the risk factors for the development of cervical cancer?
While it is difficult to find a specific cause of cervical cancer. These are some of the main factors that could increase the risk:
- Infection with the HPV virus: the possibilities of acquiring HPV are increased with:
- The beginning of sexual relations at an early age
- Multiple sexual partners
- Other risk factors include:
- Age: the highest incidence of this cancer is observed around 40-50 years. However, at younger ages, pre-malignant lesions that can cause cancer of the cervix throughout life are more frequent.
- Smoking: tobacco is a strong immunosuppressant. Its effect is further enhanced if the woman has some type of HPV in her blood.
- Immunosuppression: HIV (the virus that causes AIDS), diabetes.
- Take oral contraceptives for long periods of time (usually more than 5 years)
- Have 3 or more children
The fact of having any of the risk factors mentioned above does not imply that the woman will have cervical cancer in the future, but rather that it is necessary to discuss with her gynecologist.
How can cervical cancer be prevented?
- Vaccine against HPV
- Periodic gynecological checks to perform cervical cytology.
- More frequent gynecological tests if the result of the cytology is abnormal.
- No Smoking
- Using condoms during sex
- Limit the number of sexual partners
What are the symptoms of cervical cancer?
Cervical cancer is usually asymptomatic in the early stages. And that is precisely why cytology carried out periodically becomes so relevant. In advanced stages, the most common symptoms include:
- Abnormal genital bleeding:
- Postcoital (the most common)
- During the fertile age but outside the menstruation
- In the post-menopause
- Abnormal vaginal discharge
- Pelvic pain
After the abnormal result of a cytology, the gynecologist must perform a series of procedures with the aim of confirming or not the diagnosis and, if so, determine the extension of the disease:
- Colposcopy – Cervical biopsy.
- LEEP (Electro-Surgical Loop Excision Procedure).
- Cervical cone
- Computed axial tomography (CT): is performed routinely prior to any oncological treatment to determine the extension of the disease outside the affected organ: lymph nodes, abdominal organs or the thoracic cavity. It is usually done with oral and intravenous contrast.
- Magnetic resonance imaging (MRI): it is a useful complementary study for the diagnosis of the local extension of the disease.
- Cystography and rectoscopy: in selected cases with suspected advanced stages.
The final decision of the best treatment for each case is based on the following factors:
- The size of the tumor
- The extent of the disease
- Your wishes for future fertility
- Your global health status
- Your preferences
The vast majority of patients with cervical cancer are initially treated with surgery. Although surgery usually involves the removal of the uterus, in some cases it is possible to preserve it and treat the disease at the same time.
- LEEP – Cervical cone: For small tumors, these initial diagnostic procedures, could result therapeutic if the entire tumor is removed.
- Hysterectomy: involves the removal of the uterus (including the cervix).
- Radical hysterectomy: is the removal of the uterus and part of its surrounding structures. It is the classic surgical procedure for cervical cancer.
- Pelvic and abdominal lymphadenectomy: means the removal of the lymph nodes over the main arteries and veins of the abdomen and pelvis.
- Detection of the sentinel lymph node: consists of the injection with a tracer (Indocianin Green – ICG-) in the region of the tumor that serves to identify the sentinel node in the pelvis where the tumor would migrate, at the time of the surgical act. This lymph node (although they may be 2 or 3 in number) is identified, extracted and analyzed at the same time by a specialized pathologist. If malignant cells are identified, all pelvic lymph nodes are removed
This is a novel technique that we perform routinely in these women.
We are committed to the development of innovative surgical techniques for the treatment of gynecological cancer, including cervical tumors. In this sense, laparoscopic mini-invasive surgery represents the best example of technological development to ensure the best surgical results with faster and safer patient recovery. We perform these procedures in almost 100% of patients by using a laparoscopic mini-invasive approach.
After surgery, pathologists will carefully review the material sent to obtain a final diagnosis and determine the true extent of the disease. Then, all the best postoperative therapeutic options are considered based on factors that include:
- The intra-operative findings
- The final histological result
- The general conditions of each patient
- The preferences of the patient and their relatives
The decision can be simply observation and follow-up, or it can include radiotherapy and / or chemotherapy according to each case.
Follow-up and surveillance:
The oncological follow-up period begins after the initial cancer treatment. Its main objective is to detect early possible recurrence of the disease.
Beyond adopting the most effective follow-up rules, we also pay special attention and interest in maintaining and increasing the quality of life of our patients and achieving a rapid and effective re-insertion in their everyday life as before the diagnosis of their cancer.