Gynecological Oncology

Cervical Ca

Cervical Ca


Vaginal bleeding is the most common symptom of cervical cancer. Vaginal bleeding can occur outside of menstrual periods, after sexual intercourse or in the postmenopausal period. Another common symptom is pain during sexual intercourse, which is defined as dyspareunia. Unusual excessive vaginal discharge, abnormal disruption of the menstrual cycle are some of the early symptoms of cervical cancer.

In the advanced stage, anemia may develop due to abnormal vaginal bleeding and may be added to the disease table. Persistent pain in the lower abdomen, legs and back may accompany the symptoms. Due to the mass formed, obstruction in the urinary tract may occur and may cause problems such as pain during urination or frequent urination. As with other cancers, involuntary weight loss may accompany these symptoms. Passage of urine or stool may occur due to new connections to the vagina. These connections between the leaky bladder or the large intestines and the vagina are called fistulas.


What are the causes of cervical (cervix) cancer?
Cervical cancer occurs as a result of mutations in the DNA of healthy cells in this region. Healthy cells divide in a certain cycle, continue their lives, and when the time comes, they leave their place to young cells. As a result of mutations, this cell cycle is disrupted and cells begin to multiply uncontrollably. Abnormal cell growth causes the formation of structures expressed as masses or tumors. These formations are expressed as cancer if they are malignant, such as growing aggressively and invading other body structures in the surrounding and distant areas.

Human papillomavirus (HPV) is found in approximately 99% of cervical cancers. HPV is a sexually transmitted virus and causes warts in the genital area. It spreads between individuals after skin contact during oral, vaginal or anal sexual intercourse. There are more than 100 different types of HPV, many of which are considered low risk and do not cause cervical cancer. The number of HPV types found to be associated with cancer is 20. More than 75% of cervical cancer cases are caused by HPV-16 and HPV-18, often referred to as high-risk HPV types. High-risk HPV strains can cause cervical cell abnormalities or cancer.

However, HPV is not the only cause of cervical cancer. Most women with HPV do not develop cervical cancer. Some other risk factors, such as smoking, HIV infection, and age at first sexual intercourse, make women exposed to HPV more likely to develop cervical cancer. In a person whose immune system is functioning normally, HPV infection can be eliminated by the body itself within a period of approximately 2 years.


What are the types of cervical (cervix) cancer?
Knowing the type of cervical cancer helps your doctor decide what treatment you need. There are 2 main types of cervical cancer: squamous cell cancer and adenocarcinoma. These are named according to the cancerous cell type.

Squamous cells are flat, skin-like cells that line the outer surface of the cervix. Between 70 and 80 of every 100 cervical cancers are squamous cell cancers.

Adenocarcinoma is a type of cancer that develops from columnar gland cells that produce mucus. Gland cells are scattered in the cervical canal. Adenocarcinoma is less common than squamous cell cancer; however, there has been an increase in the frequency of detection in recent years. More than 10% of women with cervical cancer have adenocarcinoma.

The third most common type of cervical cancer is adenosquamous cancer and includes both cell types. Small cell cancers are less common. Apart from these, there are other rare types of cancer in the cervix.


What are the risk factors for cervical (cervical cancer) cancer?
There are many risk factors associated with cervical cancer:

Human papillomavirus (HPV) infection constitutes the most important risk factor for cervical cancer.
Women who smoke have twice the risk of cervical cancer compared to nonsmokers.
In people with weak immune systems, the body is insufficient to destroy HPV infections and cancer cells. HIV virus or some drugs that impair immunity increase the risk of cervical cancer due to their weakening effects on body defense.
According to some studies, the risk of cervical cancer was found to be higher in women who showed evidence of chlamydia infection in blood tests and cervical mucus examination.
Women who do not consume enough fruits and vegetables in their diet may be at risk for cervical cancer.
Overweight and obese women have a higher risk of developing cervical adenocarcinoma.
Having a family history of cervical cancer is another risk factor.
DES is a hormonal drug given to some women between 1940 and 1971 to prevent miscarriages. Clear cell adenocarcinoma of the vagina or cervix has been found to occur more frequently than would normally be expected in women whose mothers used DES while pregnant.



How is cervical cancer diagnosed?
Cervical cancer may not cause significant complaints in patients at the initial stage. The first steps of the diagnostic approach after referral to physicians are taking the patient's medical history and performing a physical examination. The patient's age at first sexual intercourse, whether he felt pain during sexual intercourse, and whether he had bleeding after intercourse was questioned. Whether the person has had a sexually transmitted disease before, the number of sexual partners, whether HPV or HIV has been detected in the person before, tobacco use and whether he has been vaccinated against HPV, menstrual pattern and abnormal bleeding during these periods are other questions that need to be addressed. .

Physical examination is the examination of the external and internal parts of the genital structures of the person. The presence of suspicious lesions in the genital area examination is examined.

Cervical screening test is pap smear cytology examination. Failure to detect abnormal cells in the examination performed after sampling ensures the result to be interpreted as normal. Abnormal test results do not necessarily indicate that the person has cancer. Abnormal cells can be graded as atypical, mild, moderate, advanced, and carcinoma in situ.

Carcinoma in situ (CIS) is a general term for the early stage of cancer diseases. Cervical carcinoma in situ is defined as stage 0 cervical cancer. CIS is cancer that is found only on the surface of the cervix and has advanced deeply.

If your doctor suspects cervical cancer or if abnormal cells are found in the cervical screening test, he or she will order some tests for further diagnosis. A colposcopy is an instrument that allows your doctor to take a closer look at the cervix. It is not usually painful, but you may feel pain if a biopsy is needed:

Needle Biopsy
A biopsy with a needle from the transition zone where cancer cells and normal cells are located may be required to make the diagnosis.

Endocervical Curettage
It is the process of taking a sample from the cervix using a medical instrument called a spoon-shaped curette and another brush-like instrument.

If suspicious results are obtained in the samples taken with these procedures, further examinations can be applied:

Cone biopsy
In this procedure, which is performed under general anesthesia, a small cone-shaped section is removed from the cervix and examined in the laboratory. In this procedure, cell samples can be taken from the deeper parts of the cervix.

If cervical cancer is detected after these examinations, the staging of the disease can be done with various radiological examinations. X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are among the radiological examinations used for cervical cancer staging.


Staging is done according to the extent of the cancer's spread. Cervical cancer stages form the basis of treatment planning and there are 4 stages of this disease:

Stage 1 Cervical Cancer
The structure formed in stage 1 cervical cancer is still small, but it may have spread to the surrounding lymph nodes. At this stage of cervical cancer, discomfort cannot be detected in other parts of the body.

Stage 2 Cervical Cancer
Cancer tissue in the second stage of the disease is slightly larger than in the first stage of the disease. It may have spread outside the genitals and lymph nodes, but is detected as having not progressed further.

Stage 3 Cervical Cancer
At this stage of cervical cancer, the discomfort is seen as spreading to the lower parts of the vagina and outside of the inguinal region. Depending on the progression, it may cause obstruction in the urinary tract that continues out of the kidneys. Apart from these parts, there is no discomfort in other parts of the body.

Stage 4 Cervical Cancer
The disease is the last stage of the disease in which it spreads (metastasizes) from the genitals to other organs such as the lungs, bones and liver.


What are the treatment methods for cervical cancer?
Cervical cancer stage is the most important factor in the choice of treatment. However, other factors also affect treatment options, such as the exact location of the cancer in the cervix, the type of cancer, age, general health, and whether you want to have children. Cervical cancer treatment can be applied with a single method or a combination of several treatment options.

Surgery can be performed to remove the cancer. Radiotherapy, chemotherapy or radiochemotherapy, which is a combination of both, are other treatment methods applied according to the stage of the cancer and the condition of the patient.

The treatment approach in early stage cervical cancer is surgical interventions. Deciding which procedure will be applied can be decided according to the size and stage of the cancer and whether the person has a future pregnancy request:

Removing Only the Cancerous Area
In very small cervical cancer patients, it may be possible to remove the structure by cone biopsy. Except for the cervix tissue, which is removed in the form of a cone, other cervix areas are not intervened. This surgical intervention can be preferred especially in women who want to become pregnant in the future, if the degree of their disease allows.

Removal of the Cervical Neck (Trachelectomy)
The surgical procedure called radical trachelectomy refers to the removal of the cervix and some of the tissue surrounding this structure. After this procedure, which can be preferred in early stage cervical cancer patients, the person may become pregnant again in the future because the uterus is not intervened.

Removal of Cervical Neck and Uterine Tissue (Hysterectomy)
One of the preferred surgical methods in most early stage cervical cancer patients is hysterectomy surgery. With this surgery, in addition to a region of the patient's cervix, uterus (womb), and vagina, the surrounding lymph nodes are also removed. With hysterectomy, the person can completely get rid of this disease and the chance of its reoccurrence is eliminated, but it is impossible for the person to become pregnant in the postoperative period due to the removal of the reproductive organs.


In addition to surgical interventions, radiation therapy (radiotherapy) using high-energy rays can be applied in some patients. Radiotherapy is a treatment method that is generally used together with chemotherapy, especially in advanced cervical cancer patients. These treatment methods can also be used in order to reduce this risk in some patients if the disease is found to be highly likely to relapse.

Due to the damage to the reproductive cells and eggs after radiotherapy, the person may go through the menopause period following the treatment. For this reason, women who want pregnancy in the future should exchange ideas with their physicians about how reproductive cells can be stored outside the body.

Chemotherapy is a treatment method that aims to eliminate cancer cells by means of powerful chemical drugs. Chemotherapy drugs can be given orally or through a vein. In advanced cancer cases, chemotherapy treatment applied together with radiotherapy may increase the effectiveness of the treatments applied.

Apart from these processes, various drugs can be applied within the scope of targeted therapy by revealing various features in cancer cells. It is a treatment method that can be applied together with chemotherapy in patients with advanced cervical cancer.

Apart from these treatments, drug therapy that strengthens the fight against cancer by stimulating the person's own immune system is called immunotherapy. Cancer cells can make themselves invisible to the immune system through the various proteins they produce. Cancer cells can be detected and eliminated by the immune system with the application of immunotherapy, especially in advanced stages and in people who have not responded to other treatment methods.

In patients with cervical cancer detected in the early stages, the 5-year survival rate after appropriate treatment is 92%. For this reason, if you notice the symptoms of this disease, it is recommended to seek support by applying to health institutions.

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