Cervical Cancer (Cervical Cancer, Cervical Cancer)

General Information

It is the most common gynecological cancer in underdeveloped countries and the third most common gynecological cancer in developed countries after uterine and ovarian cancer. Cervical cancer is a treatable and preventable cancer. It is a cancer type with a very high chance of cure, especially when detected in the early stages.

Cervical Mouth

The cervix is ​​the name given to the lower part of the uterus where it meets the vagina. Although there is no clear boundary between the uterus and the uterus anatomically, cervical cancer differs significantly from uterine cancer in terms of both the causes of occurrence and treatment options.

There are two basic cell types in the cervix. While there is stratified squamous epithelium in the outer part of the cervix, there is a glandular epithelium (glandular epithelium) in the inner parts of the cervix towards the cervical canal. The border region where the stratified squamous epithelium transforms into glandular epithelium is called the transformation zone, and there are metaplastic cells that have not completed their transformation. Almost all of the cervical cancers develop from the metaplastic epithelium in the transformation zone.

Cervical cancer is most commonly seen as squamous cell carcinoma, while it is seen in the adenocarcinoma type originating from the gland epithelium with the second frequency. Adenosquamous cancers, clear cell cancers, carcinosarcomas and neuroendocrine type cancers can be seen less frequently. associated with. There are more than 200 types of HPV that can infect humans. Some of them are low-risk types and are responsible for warts in general, some are high-risk types and are responsible for cervical cancer, and the risk category of some is not yet known.

HPV is a virus transmitted by close skin contact. For this reason, the most common ways of transmission are sexual (vaginal, oral, anal intercourse).

HPV infection is very common. In fact, HPV is the most common sexually transmitted infection agent all over the world. Approximately 75% of sexually active women in Western societies are infected by at least one HPV type at some point in their lives.

After HPV infection, 85-90% Within 1-2 years, it is completely cleared from the body with the help of the immune system. In approximately 10-15% of patients, the infection can last longer than 2 years and this is called persistence of HPV. The group at risk for cervical cancer is individuals with HPV persistence. The main purpose of examining HPV DNA in cervical cancer screenings is to detect individuals with long-term HPV infection and to take necessary precautions before cancer occurs.

Other risk factors are:

• Cigarette consumption

• First sexual intercourse at an early age

• Multiple partners

• Low socio-economic status

• Immune system impairment (organ transplant patients, hematological malignancies or patients who have to use long-term immunosuppressants)

Cervical Cancer Symptoms

In general, cervical cancer develops slowly over years. Cellular changes usually begin in the cervix before it becomes cancerous. It does not give any signs and symptoms during this period, but it can be caught in routine controls and Smear/HPV DNA tests. In case of abnormality in the smear test or HPV test, your doctor may recommend that you perform a colposcopy and biopsy from the cervix. After the cancer has developed in the later stages, the signs and symptoms in the early stages may be faint and mild. The most common early symptoms are bleeding and spotting, especially during and after sexual intercourse. In the later stages, complaints such as groin pain, irregular bleeding that occurs both during intercourse and spontaneously, turbid watery discharge, blood in the urine can be seen.

Stages of Cervical Cancer

Cervical cancer The next step after diagnosis is to determine the stage of the disease. The stage of the disease roughly indicates how far the disease has spread. The stage of the disease is also important for determining the type of treatment.

When cervical cancer is diagnosed, a complete physical examination, rectal examination, and, if necessary, examination of neighboring organs such as rectoscopy and cystoscopy should be performed to determine the stage. Imaging methods are important in determining the stage of the disease. For this purpose, computed tomography (CT), magnetic resonance (MR) or positron emission tomography (PET/CT) examinations may be requested. The following factors are considered in determining the stage of cervical cancer

• The size of the tumor

• How deep it has invaded the cervix

• Whether adjacent structures such as the vagina, pelvic tissues, rectum and bladder are involved by tumor

• Whether there is spread to the lymph nodes

• Dissemination to distant organs

Treatment Methods in Cervical Cancer

Many treatments for cervical cancer option is available. Which method is best for you is decided by looking at the following factors

• Stage of the disease

• Your wish to have children in the future

• The presence of important accompanying diseases that you have

There are basically two different treatment options as surgical treatment and radiation therapy. You should definitely decide together with your doctor which option will be more suitable for you.

Surgical Treatment in Cervical Cancer

There are different techniques among surgical treatment options for cervical cancer. Factors such as the age of the patient, the stage of the disease, and the desire to bear a child are taken into account in the selection of the surgical technique. This is called fertility-sparing surgery. You should definitely check with your doctor whether you are suitable for fertility preservation in cervical cancer.

In patients whose ovaries are not removed, moving the ovaries out of the radiotherapy area in case of a possible radiotherapy after surgery is called ovarian transposition and is a method that helps prevent menopause due to radiotherapy.

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Patients who have undergone surgical treatment may sometimes need additional treatment after surgery. According to the results of the pathological examination of the parts taken after surgery:

• Some patients will not need any additional treatment and the rut They will come for follow-ups.

• Some patients will need radiotherapy and they will need radiotherapy in 3-4 days after surgery. weeks, it will be recommended to give radiotherapy

• In some patients, it may be possible to receive chemotherapy together with radiotherapy.

Chemoradiotherapy in Cervical Cancer

X-rays are delivered to the tumor in two ways:

• Brachytherapy (Internal beam): Radioactive radiation emitted from iridium rods placed in the cervix canal to tumoral tissues effect

• External Beam Radiotherapy: The X-ray source is a device opposite the body. Radioactive rays are applied focused on the tumor area.

Life after cervical cancer treatment

After the treatment of cervical cancer, patients should be followed closely. The purpose of this follow-up is to detect cancer at an early and treatable stage if it recurs. is in the form. If suspicious findings are detected during the follow-up, the frequency of follow-up can be changed.

When you come to follow-up, your doctor will firstly question your symptoms and complaints. Next comes a detailed physical examination. Physical examination includes examination of the whole body systemically, as well as the surgical site and genital areas. Vaginal examination is an integral part of the physical examination. Since cervical cancers most frequently recur on the top of the vagina, vaginal examination should be performed every time you come for control.

Smear examination may be beneficial in some cases, but it may not be a part of every examination, your doctor may request smear examination at less frequent intervals.

Vaginal ultrasonography examination can be performed as a part of the vaginal examination.

If you have complaints suggesting cancer recurrence during your control or if suspicious findings are found in the tests, your doctor may request more detailed examinations and imaging methods.

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