Cervical cancer ranks 10th among all cancers in women and 3rd among genital organ cancers in Turkey. Its incidence is 4.5 per 100 thousand women.
The cause of cervical cancer and risky women
Today, we know the cause of cervical cancer. The cause that causes this cancer is a virus called HPV (human papillomavirus = Human papillomavirus). There are hundreds of types of this virus, but only 18 types are responsible for cervical cancer and we call them high-risk HPV types. The most common of these types is HPV type 16. In second place, it varies from country to country; while it is type 18 in some countries, it is type 51 in our country. However, all over the world, types 16 and 18 are considered higher risk types than others.
HPV causes infection in the cervix, and most of these infections are temporary, especially in young women. However, some of the infection may be permanent, especially in women who smoke, people with weakened immune systems, and those with other sexually transmitted infections. When HPV infection is permanent, it first causes superficial changes in the cervix, and when these changes are mild, they usually disappear. More advanced changes may, after a certain period of time, progress deeper into the tissue and lead to cancer. This period is quite a long time. The average time from HPV exposure to cancer is 20 years. The superficial disease before this cancer develops is called precancerous lesions (cervical intraepithelial neoplasia = CIN, or SIL; squamous intraepithelial lesion). First, these changes then form cancer.
The main transmission route of HPV is sexual activity. HPV virus is not found in people who have never had sexual contact. It is transmitted through all kinds of sexual activities. The risk of contracting HPV infection is higher in those who start sexual activity at an early age, in women who are polygamous or in those who are monogamous and have polygamous male partners, in smokers, in those taking birth control pills, and in those with other sexually transmitted infections.
Cervical cancer screening
Cervical cancer is a cancer that can be screened for. In other words, by performing these scans on women who have no complaints, women at risk are identified and the necessary precautions are taken. By taking r, there is a risk of getting cancer or the chance of catching it at an early stage. There are two tests for this; one is smear (cytology) and the other is HPV test. These tests start at a certain age and continue at regular intervals until the age of 65-70. In the United States (USA), screening begins with a smear test at the age of 21 (in those who are sexually active) and is repeated every 3 years. When you reach the age of 30, an HPV test can be done. HPV testing under the age of thirty is not approved in the USA. HPV tests are performed every 5 years. In Turkey, cervical cancer screenings are performed free of charge in health centers, family physicians or KETEM (Cancer Early Diagnosis Centers). Two tests are taken from women: smear and HPV test. If HPV is negative, the smear is not checked and the woman is called for a retest after 5 years. In women who are HPV positive, both the type of HPV and the smear test are checked. If HPV types 16 and/or 18 are positive, they are referred to a Gynecologist for Colposcopy, even if the smear results are normal. If the other types are positive and the smear result is abnormal, the patient is referred to the Obstetrician. However, in cases where HPV types other than 16 and 18 are positive and the smear result is normal, both tests are repeated one year later.
Cervical cancer diagnosis
Cervical cancer. Diagnosis is made by biopsy. Some patients may present with abnormal bleeding, bleeding or discharge after sexual intercourse. If there is a visible lesion in these patients, a biopsy can be taken and a diagnosis can be made.
Colposcopic examination is necessary for women who have a positive screening result and are referred to a gynecologist. Colposcopic examination is the examination of the cervix by magnifying it further with a system called colposcope. It is a painless method. During this examination, abnormal areas in the cervix are identified and biopsies are taken from these places. No diagnosis can be made without taking a biopsy.
According to the colposcopic biopsy results, the patient may be diagnosed with superficial lesions called CIN or cancer.
Biopsies may sometimes be insufficient to diagnose cancer. In this case, it is necessary to remove larger tissue. For this, LEEP (loop electrosurgical excisional procedure) or conization may be required. With these procedures, larger tissue is removed and the depth of the lesion is visualized more clearly.
Determination of the extent (stage) of cervical cancer
Determination of the stage is done by pelvic examination and imaging techniques (MRI or CT). If there is a visible mass during the examination, its size and whether it extends to the vagina or side walls are checked. This situation is also evaluated with other imaging techniques and it is evaluated whether there is growth elsewhere, especially in the kidneys. Because when cervical cancer spreads towards the side walls, it can cause obstruction in the urinary tract and ultimately enlargement of the kidneys.
Treatment
Determining the stage of the tumor is very important in choosing treatment. While cancer cases that have not spread beyond the cervix are treated with surgery, radiotherapy and chemotherapy are more appropriate in cases that have extended to the side walls. When choosing treatment, the woman's fertility and desire for children are also important, especially in early stage disease. If the tumor is smaller than 2 cm, only the cervix can be removed, the uterus can be preserved and pregnancy can occur. In cases where fertility is not possible at an advanced age, the uterus must be removed. In addition to removing the uterus, in some cases the lymph nodes are also removed to investigate whether there is a tumor there.
Protection against cervical cancer
Since HPV is the causative agent in cervical cancer, some of the HPV types have been detected in recent years. Vaccines have been developed against it. The most effective period of the vaccine is 11-12 years of age. If it cannot be done during this period, it can be done until the age of 26. Although the vaccine is not very effective after this age, there is no harm in administering it. Apart from vaccination, it may be recommended to use a condom in case of sexual intercourse with new partners, but it is not one hundred percent protective.
Read: 0
