It is possible to prevent cervical cancer before it starts…
Cervix is lower part of the uterus that connects the uterine and vagina. There are two different types of cells in its lower part that is close to the vagina and in its upper part that is close to the uterus, and cancer starts at the point where these two layers are combined.
Cervical cancer is the third most common gynecological cancer, and is one of the leading causes of cancer-related death of women throughout the world. The date rate decreased by 70-80% thanks to the Pap test (smear test) used in the early diagnosis of this cancer. Cervix cancer is the only gynecological cancer that can be diagnosed and treated before it emerges with the scanning tests performed at regular intervals.
Cervix cancer manifests itself with cell level defects and progresses into invasive cancer within 10-20 years. In other words, there is precancerous period. This period is defined as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL). These cell changes recover on their own in time in most of the women or turn into cancer. It is possible to prevent cervical cancer before it starts by the simple surgical removal of the areas where cell defects identified with the Pap tests are present.
Cervix cancer is seen among women aged between 35 and 55. Precancerous lesions can be detected at all ages and they manifest themselves as cervix cancer between the ages of 40-50. Therefore, it is necessary to perform scanning test regularly in sexually active women after the age of 18 until 60-65. A virus called Human Papilloma Virus (HPV), which is transmitted sexually, is detected in all women with cervical cancer. HPV results in cervical cancer, external genital organ, anal and throat cancer, and the warts that emerge in the external genital organs. The same problems arise in men following the virus infection.
It does not necessarily mean that everyone who carries HPV virus will contract cervical cancer. There are some risk factors that cause cancer development in an individual. Carrying these risk factors does not necessarily mean contracting cancer; however, these people should be closely followed. The major risk factor is encountering high risk HPV types. All men and women can transmit this virus to each other since this virus is sexually transmitted. 80% of the women encounter this virus in some parts of their lives but they are not able to notice it as a complaint. Cervical cancer develops only in 1-3 out of 100 women who encountered this virus. The finding of carrying the virus that can be a patient compliant is the genital warts called as condyloma caused by the same virus. However, the absence of these warts does not indicate that the person does not carry HPV. Therefore, it is important to scan the cell defects with Pap test. This test is able to identify HPV type. There are more than 100 HPV types, and 70-80% of the cervical cancer cases are caused by type 16 and 18. Type 6 and 11 are responsible for the 90% of the genital warts. It is important to closely follow and treat the people who carry the high risk virus types in terms of preventing the cancer development. It is possible to provide protection against this virus with the vaccines developed for these types. There are 2 types of vaccines in the world. These include quadrivalent vaccine for HPV type 6,11,16,18 and bivalent vaccine for HPV type 16-18. These vaccines provide 100% protection against the virus types they contain.
Similar to some contagious diseases, those who contracted HPV infection cannot acquire natural immunity and cannot be protected against the other HPV disease. Protection can be achieved by vaccination. If precancerous lesions developed with HPV 16-18, these vaccines cannot treat the person. That is to say that the vaccines are not operative but protective.
Apart from being infected with high risk HPV types, the risk factors of the cervical cancer include:
- Engaging in sexual contact at early ages, having many sexual partners, not being protected during sexual intercourse. Majority of the HPV carriers cannot notice that they carry this virus since there is no apparent finding before cancer develops. Therefore, the only and certain way to be protected from HPV is abstaining from sexual intercourse with risky people.
- Smoking increases the risk.
- HIV and chlamydia infection increase the risk.
- Mother’s or sister’s being diagnosed with the cervical cancer.
- Not performing regular Pap test.
- Low socio-economical level, nutrition deprived of vegetables-fruits.
- Using contraception pills more than 5 years.
- Giving birth frequently.
Cervical cancer can be prevented
It is one of the most preventable cancer types since the risk factors of this cancer can be controlled by the person, scanning test is available and protection with vaccination is possible. Regular pelvic examination and Pap scanning test should be performed. Smoking should be quit, care must be taken to genital hygiene, condoms should be used during sexual intercourse and sexual intercourse with risky people should be avoided.
It is recommended to perform Pap (smear) test once a year in the cancerous region in sexually active women or women aged over 18. This test is performed by receiving a sample from cervix with a brush in a very simple and painless way in the gynecological examination. The cells are examined by the pathologists. After smear or liquid base preparation of the cell, they are examined by the pathologists. In the event that abnormal cells are detected, further examination and treatment is performed. It is very important to be careful at the 40-50 years interval, when the cancer is most frequently seen. If the results are found to be normal with the tests performed for three consecutive times at 60 years, scanning might be terminated by the doctor recommendation. Personal risk factors should be taken into account while making this decision.
The test enables the detection of cervical cancer or identification of precancerous stages. In case that abnormal cells are found in the test, HPV test or colposcopy is performed. HPV DNA test is performed similar to smear test and it enables detection of HPV presence and identification of the types. Thus, the patients with high risk are found. Colposcopy magnifies the cervix with a special microscope and makes it possible to examine the cervix and take biopsy from the suspected areas. The suspected areas are surgically removed during colposcopy and treated. It is determined whether another type of treatment is required or not in line with the pathological examination of the surgically removed piece.
The signs of cervical cancer
In general, precancerous lesions do not have symptoms. The symptoms begin to emerge when cancer begins to develop in the cells and spread to the neighboring tissues after covering the cervix. These symptoms include bloody and malodorous discharge, bleeding following sexual intercourse, bleeding seen outside of the menstrual cycle, pain in sexual intercourse or pain genital region or groin. It is important that the scanning tests detect these cells before these symptoms appear. Every woman should be careful about their health. If cancer developed, its extent, which is known as staging and its spread is ascertained with various inspections. This staging is of great importance to determine the right treatment. The course of the cancer and the treatment method to be applied is determined based on cancer type, location, stage, the speed of growing and spreading, the age and general condition of the patient. The response given to the treatment varies from one patient to another.
Upon making the final diagnosis, identifying cancer cell types and doing staging, a procedure is performed in order to eradicate the tumor by the surgical removal of the cancerous organs and tissues, lymph nodes or by radiotherapy. In some cases, chemotherapy is also used and the cells that moved to distant organs are eradicated. Each patient undergoes one of these treatment methods or a combination of them.
All these treatment types have serious and life constraining side effects. 5-year survival rate is around 70% taking all the stages of cervical cancer into account at the end of the treatments. It should not be disregarded that this rate will be much lower if the cancer is at and advanced stage. These data underline the importance of performing scanning tests and identifying and treating this disease before it starts.
Surgeon Adnan KAYA
Department of Gynecology and Obstetrics