Frequently Asked Questions About Cervical Cancer

Cervical cancer is cancer of the lower part of the uterus (cervix), called the cervix. The cervix is ​​the part of the uterus that opens into the vagina and expands during birth. Cervical cancer is the deadliest cancer among women and continues to be common in developing countries. The 5-year survival of women with cervical cancer detected at an early stage after diagnosis is as high as 92%. The main reason for the improvement in cervical cancer results is the Pap smear test, which provides early detection of pre-cancerous cells. Although cervical cancer is diagnosed in approximately 20% of women over the age of 65, it will affect women more in their 30s, 40s and 50s.

Cervical Cancer occurs as a result of long-lasting, persistent high-risk HPV infection. . HPV infection is quite common; Most sexually active people are infected. However, most HPV infections do not cause symptoms and do not progress to cervical cancer. Approximately 13 types of HPV have been identified as high risk and capable of causing cervical cancer. HPV 16 and 18 are the two most common high-risk HPV types associated with cervical cancer in Turkey.

It is easy to reduce the risk of cervical cancer with Pap smear and HPV test. In the Pap test, a sample of cervical cells is taken and it is determined whether there are any abnormalities in them. Abnormal Pap smear results may require further testing, such as a cervical biopsy, which may reveal either precancerous changes or cancer. Most cervical cancers occur in women who have never had a Pap smear. In these cases, while precancerous cells had time to progress to cancer before being detected and treated, the cancer was not detected because a Pap smear was not taken. HPV tests allow advanced monitoring for cancer risk by determining whether any high-risk HPV types are present.

What are the Risk Factors?
The factor in almost all cases of cervical cancer is now known as HPV. Most people infected with HPV do not experience serious problems, but a very small percentage may develop cancer. HPV; It increases the likelihood of many types of cancer, such as mouth, throat, vagina, vulva and cervix cancer.

Women with the following characteristics are more likely to develop cervical cancer:

• Women diagnosed with HPV

• Women who have not received the HPV vaccine

• Women who have not had regular Pap smears for precancerous lesions

• Abnormal Pap Women with smear results or a history of diagnosis of precancerous cervical cell changes

• Women with a previous history of cervical cancer

• HPV women who have multiple sexual partners, which puts them at increased risk of infection partner also has a risk of HPV infection)

• Women who have their first sexual intercourse at an early age

• An autoimmune condition, HIV infection or Women with any condition that weakens the immune system. A weak immune system increases the risk of developing cervical cancer by increasing the likelihood of HPV infection in women.

• Women who smoke

What are the symptoms of the disease?

There are typically no symptoms in the early stages of cervical cancer. The earliest finding will likely be an abnormal Pap smear result detected during a routine gynecological examination. Cervical cancer develops quite slowly, so the symptom-free period can last years. The stage where abnormal cells are detected in the Pap smear is one hundred percent treatable. Advanced cervical cancers are generally most common in women who do not have regular Pap smear tests or who receive abnormal Pap smear results and do not continue follow-up.
As cervical cancer develops, the following symptoms will appear in women:

• Abnormal vaginal bleeding, such as bleeding between menstruation, bleeding after sexual intercourse, or post-menopausal bleeding.

• Vaginal discharge that is watery, pink, pale and persistent

• Menstrual periods that bleed more and last longer than normal

Very advanced cases of cervical cancer that has spread to the bladder, intestines, lungs or liver have the following symptoms: It will show:

• Back pain

• Bone pain and fractures

• Fatigue , exhaustion

Urine and feces leakage from the vagina

• Leg pain

• Loss of appetite

• Pelvic pain

• Swollen feet

• Weight loss

Diagnosis and Treatment of Cancer

The first step is to confirm the diagnosis of cervical cancer and determine its stage. Diagnosing cervical cancer requires taking a biopsy of the cervix so that the pathologist can evaluate it under a microscope. This biopsy can be performed under office conditions or operating room conditions. Your doctor will evaluate which option will be best for you. Cervical cancer staging is a standardized way to describe the spread of cancer throughout the body and whether it has spread to a body part other than the cervix. Cervical cancer staging is based on pelvic and rectal examination in addition to radiological study and possible other diagnostic tests. Your gynecological oncologist will recommend treatment depending on the stage of cancer, your current health condition, and, if appropriate, your desire to have children.

What Are the Treatment Options?
Treatment options for cervical cancer are based on the stage of the cancer. Cervical cancer caught in the early stages is relatively easy to treat.

ı) Surgery Treatment
Patients with small, early-stage cancer undergo hysterectomy (uterine and It can be treated surgically by removing the cervix. Different types of hysterectomies may be recommended depending on the spread of cervical cancer. Surgery can be performed using classical open surgery or least invasive methods such as laparoscopy or robotic surgery. The choice of surgery type depends on many factors such as the experience and preference of the surgeon, the size of the cancer and your anatomical structure. This decision is discussed in detail with your doctor.

ıı) Fertility-Preserving Surgical Treatment Options
Any surgery on the cervix carries a risk for your future pregnancies, and your doctor will provide detailed information about this. Additionally, sparing part of the cervix or uterus is associated with an increased risk of cancer recurrence. The individual circumstances of each patient are evaluated and the surgical procedure that is right for him/her is selected. The best information should be given to make a decision.

• Cervical conization: In this surgery, the cervix is ​​removed in the form of a cone. It can be used to determine how advanced the cancer is or to treat very early cancers and precancerous cervical changes.

• Radical trachelectomy: This surgery is used for patients with early-stage cervical cancer. In patients, the cervix and surrounding tissues are removed, but the uterus is left in place for possible future pregnancy.

• Simple Hysterectomy: In this surgery, only the cervix and uterus are removed. This procedure is only suitable for patients with very early stage cervical cancer that can be detected microscopically.

• Radical Hysterectomy: In this surgery, the soft tissue around the uterus and cervix called cervix parametrium is performed. It is removed along with the tissues. A small portion of the vaginal dome is also removed. It is the most common procedure performed in cervical cancer patients with tumors smaller than 4 centimeters. This surgery usually requires a catheter to remain in the bladder for 7 to 14 days. Radical hysterectomy is a more complicated and comprehensive procedure than simple hysterectomy.

• Pelvic lymph node dissection: Lymph node dissection determines whether the cancer has spread outside the cervix through the lymph node. It allows us to understand. Lymph channels serve as a sewage system for organs by draining lymph fluid to the lymph nodes.

iii) Application of Radiotherapy, Chemotherapy or Both Treatment Methods Together
Cervical cancer can also be treated using radiotherapy, chemotherapy, or both to kill cancer cells and prevent them from spreading. Depending on the stage of the cancer, radiotherapy can be applied externally (using a machine from outside the body), internally (using a mechanism that provides direct radiation into or near the cancer), or both. Chemotherapy uses drugs to kill cancer cells. Chemotherapy drugs enter the circulatory system by being administered orally or injected intramuscularly or intravenously, and thus act on the cancerous area in the body.

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