Causes and treatment options of cervical cancer in 8 questions
Cervical cancer is the second most common type of cancer among women worldwide. In our country, it ranks 9th among female cancers and approximately 1500 women are diagnosed with cervical cancer every year. Obstetrics and Gynecology Specialist Assoc. Dr. Korhan Kahraman tells.
1. What are the causes of cervical cancer, which women are at higher risk?
Human Papillomavirus (HPVCervical infection is the most important cause of cervical cancer. Since HPV is a sexually transmitted virus, it is directly related to the sexual lifestyle. The risk of HPV infection and the incidence of related diseases increase in early sexual intercourse (before the age of 21), polygamy, and intercourse with a man (polygamous) with a high risk of being a carrier for HPV.
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Some of the other risk factors for cervical cancer are; number of births (over 3), smoking, other infections of the cervix, weakness in the body’s defense system against microorganisms, low socio-economic level, early and long-term use of contraceptives are shown.
2. In what way does HPV cause cervical cancer?
Not all HPV types that cause cervical infections cause cancer. About 15 types of HPV are known to be associated with cancer. Especially HPV 16 and 18 are the types that turn into cancer most frequently. Any contact with skin and body fluids containing HPV can lead to the transmission of infection. It is passed on to approximately 2/3 of those who have sexual contact with an infected individual. However, there is no need to be overly concerned with every HPV infection.
Because; In the first 1 year following the HPV infection, 70% of the individuals, and in the second year, approximately 90%, the infection disappears spontaneously; that is, if the individual’s defense system works normally, the body destroys this virus.
Only about 10 percent of women with HPV infection develop persistent infection. High-risk, in other words, carcinogenic HPV transfers its genetic structure to the cells it invades, causing a series of interactions to begin.
The emergence of cancer with the transmission of HPV takes place over a period of 10-15 years, and before it appears, it manifests itself in the form of a number of “pre-cancer” lesions. The main purpose of cervical cancer screening programs is; To detect these precancerous changes and to prevent the development of cancer by eliminating them.
3. Is it possible to prevent cervical cancer?
The most important method of protection; Screening tests based on the examination of cells in swab samples taken from the cervix with the help of a small instrument (Pap smear test). In the countries where this test is applied, it is known that there is a 70 percent decrease in the incidence of cervical cancer and death rates due to this cancer.
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Despite this, this cancer still continues to threaten women’s health, especially in underdeveloped countries and some developing countries. Another important method of prevention is HPV vaccines, which are also applied in our country.
4. What is the latest situation in vaccines developed against cervical cancer?
Two different types of HPV vaccines are used today. The first of these; Quadruple vaccine developed against HPV 6, HPV 11, HPV 16 and HPV18 types. The HPV types covered by the quadruple vaccine are used against HPV 16 and HPV 18, which are responsible for approximately 70 percent of cervical cancers, as well as HPV 6 and HPV 11, which are responsible for approximately 90 percent of genital warts and are not associated with cancer. The second is the dual vaccine used for HPV 16 and HPV 18. Studies have shown that both vaccines prevent precursors of cervical cancer and cancer by 90 percent associated with the types they contain.
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This rate reaches the highest level in women who are not sexually active, that is, women who have never encountered HPV. It is useful to be vaccinated in childhood for the most successful effect. Recommended age for childhood is 11-12. It can also be done at the age of 9-10 depending on demand. Those who did not have it in childhood should definitely get vaccinated until the age of 26. Although there are different opinions, this age limit can be increased up to 45 in case of neglect.
5. When should women suspect cervical cancer?
Most cervical cancers do not show any symptoms in the early stages. The most common complaint in case of symptoms is vaginal bleeding. This bleeding can be in the form of spotting that occurs outside of menstruation in some women, or more typically in the form of bloody spots that are noticed during or immediately after intercourse.
Although bleeding in menopausal women often suggests cancers originating from the inner wall of the uterus, it should not be forgotten that cervical cancers can also cause this. In the advanced stage disease where the cancer starts to spread to the surrounding structures; Urinary or defecation difficulties, leg pain and water collection in the legs may occur.
6. How are cervical cancers treated?
There are two main methods of treatment. The first of these is surgical treatment. Although it differs in some special cases, the surgical method applied as standard in the early stage includes the removal of the uterus along with the surrounding structures and lymph nodes where the cancer is likely to spread. In addition to surgery, some of these patients may require radiotherapy alone or in combination with chemotherapy after surgery.
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The other form of treatment is; treating the patient with radiotherapy and often concurrent chemotherapy without surgery. The treatment option, in which radiotherapy is used primarily, is usually advanced stage patients where surgery cannot be applied.
7. Can women who are treated for cervical cancer become mothers?
An important difference between cervical cancers and other gynecological cancers is that this cancer is more common in women of reproductive age. For this reason, the treatment to be chosen for patients in this age group who have a desire to have children requires special attention. In patients in this age group, only the cervix and lymph nodes can be removed and the main body of the uterus can be protected, so that fertility can continue.
However, in order for this surgery to be performed, a meticulous evaluation must be made before the operation and it is necessary to determine whether the patient meets the criteria. Thanks to these surgeries performed in the appropriate patient group, many women can both get rid of the disease and have a baby.
8. Which method should be chosen in the surgery of cervical cancers?
Today, almost all intra-abdominal gynecological surgeries can be performed with the laparoscopic method. The important advantage of laparoscopy compared to open surgery; It is possible to perform surgery with a camera inserted into the abdomen and very small surgical instruments through millimetrical (5-12 mm) small holes by protecting the patient from large abdominal cuts. In addition, since all organs and structures can be seen in fine detail, better than open surgery, surgery can be performed with the desired precision.
In patients who underwent surgery with laparoscopy; less pain, a shorter discharge from the hospital and a quicker return to normal life. In addition, thanks to the robot technology that has been used recently, laparoscopic surgery is performed under a 3-dimensional vision, and thanks to the new instruments, it allows the surgeon to use his hands almost in the comfort of an open surgery. Robotic surgery recognizes that some of the complex aspects of surgery, such as cervical cancer, can be handled more easily and meticulously.
HPV testing is also recommended alongside the smear test.
All women after the age of 21 should participate in cervical cancer screening programs. Although there are different screening programs today, guiding institutions such as the American Association of Obstetricians and Gynecologists and the American Cancer Society, which are important professional organizations, have recently published statements covering their current recommendations.
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According to these guides; “Women aged 21-29 should be screened with a smear test once every three years, and women aged 30 and over should be screened with a double test in which HPV test is performed together with the smear test, which is repeated every 5 years.”
On the other hand, in cases where HPV testing cannot be performed, it is stated that screening with smear only once every 3 years is an acceptable approach. These determined scanning intervals may change in case of a pathological smear result (non-normal smear). It is recommended to continue screening until the age of 65-70 years. There is no official change in the cervical cancer screening program in our country yet, annual screening with smear continues. We also tell all women that they should not neglect the annual gynecological examination and that they should have a smear test regularly.