What is cervical cancer?

Cervical cancer is a malignant tumor that develops in the cells of the cervix, the lower part of the uterus that connects to the vagina. It is one of the most common types of cancer in women worldwide and is associated with a significant mortality rate, especially in countries with limited medical care resources. Cervical cancer often develops slowly, starting with precancerous changes that later progress to cancer. In the early stages, symptoms may be unexpressed, so regular screening examinations are essential for timely diagnosis.

In most cases, cervical cancer is closely related to human papillomavirus (HPV) infection, which is spread through sexual contact. HPV is a very common virus, and most sexually active people will have an HPV infection at some point in their lives. However, not all HPV infections lead to cancer, as the immune system is often able to eliminate the virus on its own. HPV infection can cause cell changes in the cervix that, if left untreated, can progress to cancer over several years. Cervical cancer can be invasive and spread to nearby tissues and organs, so early diagnosis and treatment are essential for patients' survival and quality of life.

Causes of cervical cancer

HPV infection

Human papillomavirus (HPV) is the main cause of cervical cancer. There are more than 100 types of HPV, but only a few are high-risk types associated with the development of cancer. HPV types 16 and 18 are most commonly associated with cervical cancer. HPV is spread primarily through sexual contact, and the infection is usually asymptomatic, so many people do not know they are infected. To reduce the risk of infection, vaccination and safe sex are the main forms of prevention. HPV vaccines are also effective against other types of the virus that can cause genital warts and other cancers.

Other risk factors

In addition to HPV infection, there are several other risk factors that can contribute to the development of cervical cancer:

• Early sexual activity: the early initiation of sexual life increases the risk of HPV infection, because younger cells are more sensitive to changes caused by the virus.
• Multiple sexual partners: increases the chance of exposure to different types of HPV, especially high-risk types.
• Smoking: tobacco use is associated with various types of cancer, including cervical cancer. Tobacco toxins can damage cervical cells and reduce the body's ability to fight HPV infection.
• Long-term oral contraception: research suggests that long-term use of birth control pills may slightly increase the risk of cancer, possibly related to hormonal changes that affect the cells of the cervix.

Symptoms and signs

Cervical cancer is often asymptomatic in its early stages. However, as the tumor progresses, several symptoms may appear:

• Abnormal vaginal bleeding: Bleeding between periods, after intercourse, or after menopause may be the first signs that there has been a change in the cells of the cervix.
• Abnormal vaginal discharge: watery, pink, or foul-smelling may indicate the presence of infection or cancer cells.
• Pain during intercourse: may indicate the spread of the tumor to the adjacent tissues.
• Pelvic pain: continuous or recurring pain in the pelvic area may be due to tumor pressure on adjacent organs.
• Changes in urination: pain or burning when urinating, as well as the need to urinate more often, may be related to the spread of the tumor to the urinary tract.

If any of these symptoms appear, it is essential to consult a doctor immediately, as early diagnosis and treatment greatly increase the chances of survival.

Diagnostics

Screening

Screening is an important part of cervical cancer prevention. The Pap test and the HPV test are the two most commonly used methods to detect changes in the cervix. A Pap test detects precancerous or cancerous cell changes, while an HPV test detects whether high-risk HPV types are present. Regular screening tests can detect changes at an early stage when they are easily treatable.

Screening intervals: Women are advised to start Pap tests around age 21 and continue every three years if the results are normal. Women between the ages of 30 and 65 can have a Pap test combined with an HPV test every five years. If the screening results are positive, additional tests are performed to confirm the diagnosis.

Additional examinations

Additional tests may include:

• Colposcopy: this procedure allows the doctor to view the cervix under magnification using a special instrument to better assess cellular changes.
• Biopsy: taking cell samples from the cervix can determine whether the changes are malignant. A biopsy can be a minor procedure performed on an outpatient basis.
• Image diagnostics: an x-ray, MRI or CT scan is used to determine the spread of the tumor and plan further treatment.

Treatment options

Surgical treatment

Surgical intervention is a frequently used treatment method for cervical cancer, especially in the early stages. The most common surgical methods are:

• Conization: conical excision of the affected tissue from the cervix. It is suitable in the early stages when the changes are localized.
• Hysterectomy: removal of the uterus and sometimes adjacent tissues and organs. It may be necessary if the cancer has spread widely.
• Radical trachelectomy: removal of the cervix while preserving the uterus, which may be an option for women who want to preserve their fertility. this procedure is suitable in the early stages, when there is no extensive spread of the tumor.

Radiotherapy and chemotherapy

Radiation therapy and chemotherapy are used to kill cancer cells or shrink a tumor:

• Radiotherapy: uses high-energy rays to kill cancer cells. It can be internal (brachytherapy) or external. It is often used in combination with chemotherapy.

Latest treatment methods

Prevention

Vaccination against HPV

HPV vaccination is an effective way to prevent cervical cancer. Vaccines such as Gardasil and Cervarix protect against the most common high-risk types of HPV and are most effective when given before sexual activity begins. Vaccination is recommended for both girls and boys to reduce the prevalence of HPV in the population. Getting vaccines at an early age helps strengthen the immune system against HPV viruses, reducing the chance of developing cancer in the future.

The importance of regular screening

Regular screening is essential for early detection and prevention of cervical cancer. Screening tests allow the detection of cell changes that can turn into cancer, thus ensuring timely treatment and avoiding the progression of the disease. Screening is especially important for women who have multiple risk factors because it allows for early identification of potential problems and necessary corrective actions.

Life after cervical cancer

Psychological support

After a diagnosis of cervical cancer, patients often need psychological support to cope with emotional stress and uncertainty about the future. Support groups, psychotherapy, and counseling can help patients and their families adjust to life after cancer treatment. It is also essential to raise awareness and reduce the stigma associated with cervical cancer so that patients feel supported and accepted.

Long-term health monitoring

After completing treatment, it is important for patients to see their doctor regularly for follow-up and early detection of relapse. Long-term monitoring includes regular checkups, Pap tests, and imaging to make sure the cancer doesn't come back and to identify and treat any complications. It is also important to monitor general health, including diet, physical activity, and lifestyle changes that may affect the patient's quality of life.

Review of social and economic impacts

Cervical cancer can have a significant impact on women's lives, especially in low- and middle-income countries, where access to medical care and preventive measures is limited. This can lead to economic hardship and social stigmas that can affect women's opportunities in social and economic life. It may be difficult for women to return to work or society after treatment, and it is therefore essential to provide support mechanisms to facilitate their reintegration.

Conclusions

Prevention, early diagnosis and effective treatment of cervical cancer are essential in maintaining women's health and improving survival. Vaccination against HPV and regular screening examinations are the main preventive measures that can significantly reduce the morbidity and mortality from this disease. In addition, the latest treatments and psychological support can help improve patients' quality of life after diagnosis. With widespread awareness and affordable medical care, it is possible to significantly reduce the burden of cervical cancer on society.