Cervix is the area where the uppermost point of the vagina meets the lower part of the uterus (womb). Cancers occurring in this area, namely cervical cancer, are one of the leading causes of cancer deaths in women all over the world. While 350 thousand new cases are detected every year in developing countries, this number is less than one hundred thousand in developed countries. This is due to the lack of effective screening programs in developing countries aimed at detecting and treating cervical lesions before they progress to invasive cancer, that is, in the pre-invasive period.
Early diagnosis of cervical cancer is of great importance for women's health in our country, where there is no effective and widespread screening program.
Thanks to the pap smear test, which allows the detection of pre-cancerous changes in the cervix, death rates from cervical cancer have decreased by 50-70% in the last 50 years.
Cancerous changes start from the squamocolumnar junction (transformation junction) and occur one after another in the cervix epithelium. Changes occur over the years, which is important in the early diagnosis of cervical cancer.
The terms cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL) are used for these precancerous changes. In most women, these precancerous changes disappear or remain unchanged, although when treated, almost all cervical cancers will be prevented.
Cervical cancer occurs on average between the ages of 35 and 55, but it occurs in people over the age of 65. Since there is a risk of cancer development in women, all women who are sexually active or over the age of 18 should be screened regularly until they are at least 70 years old. A sexually transmitted virus called Human Papilloma Virus (HPV) has been detected in almost all cervical cancer lesions. For this reason, it is thought that vaccines developed against this virus will be effective in preventing cervical cancer.
Main risk factors for Cervical Cancer:
* Infection of the cervix with high-risk Human Papilloma Virus (HPV): Every 4th person between the ages of 15-49 It is reported that 3 of them had HPV infection at some point in their lives. Infection may not cause symptoms for years, it always progresses. It may not cause genital warts, but this does not mean that the person does not carry the virus. Infection may not always progress to cancer, but high-risk oncogenic HPV types cause changes that may later lead to cancer. For this reason, frequent follow-up is recommended for people with HPV.
* Having sexual intercourse at an early age (before the age of 20), having multiple sexual partners, or having sex with people who have many sexual partners: Most cancers occur before they develop. Since it often causes no symptoms, people who are HPV carriers are usually unaware of their condition. Therefore, the only and definitive way to protect yourself from HPV is monogamy or not having sex with people who are likely to be HPV carriers. Condoms do not provide protection against HPV.
* Smoking: The risk is 2 times increased compared to a non-smoker.
* Other risk factors: diseases that weaken the immune system, clamidia infection , low socioeconomic level, not having regular pap smear tests..
Pre-cancerous lesions usually do not cause symptoms, but symptoms appear when the cells turn into cancer and begin to spread to the deep parts of the cervix and neighboring organs. In the early stages of cervical cancer, bloody and foul-smelling vaginal discharge, pain during or after sexual intercourse, and heavy and prolonged menstrual bleeding may be observed. These findings may be due to reasons other than cervical cancer, but they should not be ignored and should be taken into consideration and consult a doctor to avoid delaying treatment.
The best way to detect cervical cancer at an early stage is to have regular pap smear tests. . Pap smear test is the process of taking cells from the endocervical canal as a swab with the help of a brush during the gynecological examination, and the pathologist evaluates whether these cells are suspicious under the microscope. If the test is positive, that is, it contains abnormal cells, the doctor may recommend HPV DNA test or colposcopy.
Since the Pap smear test is a screening test, colposcopy, biopsy and endocervical curettage (ECC) are used for definitive diagnosis in the presence of abnormal results. further testing will be required. Colposcopy, cervix It is a method of examining in more detail by a special magnifying glass with n light. During colposcopic examination, biopsies can be taken from suspicious areas by applying 5% acetic acid and Lugol solutions to the cervix surface, and the biopsies taken are evaluated by the pathologist. or removed by techniques such as laser. These treatments are always effective in destroying precancerous lesions and preventing cancer. However, regular pap smear screening should still be continued to monitor whether abnormal changes recur.
The histopathological type of cervical cancers is 80-85% squamous cell cancers. Adenocarcinomas are seen in 15-20%. Other histological types are rare.
The 5-year survival rate for cervical cancer is 72%. The course and treatment of cervical cancer are determined by factors such as the histopathological type and degree of cancer, the stage of the disease, the patient's age, general condition, and how quickly the disease spreads. For this purpose, examinations such as blood count, lung radiography, intravenous pyelography, cystoscopy and rectoscopy are performed.
Usually, radical surgical treatment, radiotherapy or a combination of these is performed. In some cases, Chemotherapy can be added to the treatment.
Radiotherapy: It can be applied primary or postoperatively. RT has a place in every stage of cervical cancer. An external or intracavitary high-energy beam is sent to the area where the tumor is located.
Chemotherapy is a systemic drug treatment used to kill cancer cells that have spread to other parts of the body. The side effects of treatment for cervical cancer vary depending on the type of surgery performed, whether RT is received, the drugs used in LT, and the duration of treatment.
The probability of tumor recurrence within the first 2 years after cervical cancer treatment is 74%. 'Stop. Therefore, after treatment, patients should be checked with gynecological examination and smear every 2-4 months. At the end of the 1st year, lung x-ray and Computed Tomography are taken.
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