Cervical cancer: symptoms, causes and treatment
Cervical cancer is a worrying problem in Portugal, where it is higher than in the vast majority of other European countries. Moreover, in Europe, it is the eighth most frequent neoplasm in women.
This type of cancer develops in the cervix, which is the area where the uterus enters from the vagina. It mainly affects sexually active women between the ages of 30 and 45.
Cervical cancer can often be detected at an early stage and prevented by regular screening tests. If detected early, it is one of the most treatable cancers.
Cervical cancer: what to look for
The early stages of cervical cancer usually have no symptoms.
If there are symptoms, the most common is abnormal vaginal bleeding, which may occur during or after sex, between periods, or new bleeding after menopause.
Abnormal bleeding, however, does not mean that a woman has cancer, although it is reason enough to see a general practitioner.
If the physician suspects cervical cancer, the woman should be referred to an urgent gynecology consultation.
What causes cervical cancer?
Causes and risk factors
Cervical cancer is usually caused by infection with the human papillomavirus (HPV). Although there are more than 150 types of HPV, most of which are harmless, some have proteins that “turn off” certain tumor suppressor genes (genes that prevent tumors from growing).
When this happens, the cells lining the cervix can multiply and develop changes in additional genes, causing cancer in some cases.
However, HPV is not the only cause, especially because most women with HPV do not develop cervical cancer.
There are other associated risk factors, such as smoking and HIV infection, that make women exposed to HPV more likely to develop cervical cancer.
HPV is transmitted through sexual intercourse (vaginal, anal or oral). It is a virus that also causes genital warts, among other things.
The risk factors for cervical cancer are
- Having sex for the first time at a very young age (especially before age 18);
- Having more than one sexual partner;
- Having a high-risk sexual partner (carrier of HPV infection or having multiple sexual partners);
- Smoking (smokers have twice the risk of developing cervical cancer);
- Immunosuppression (due to disease or medication);
- Sexually transmitted diseases (chlamydia, genital herpes);
- Women who have had three or more full-term pregnancies, not only because of increased exposure to HPV infection during sex, but also because of possible weakening of the immune system during pregnancy;
- First pregnancy at a very young age (before 20 years);
- Prolonged use of oral contraceptives;
- Diet low in fruits and vegetables;
- Family history of cervical cancer.
Note that the younger a woman is when she first has sex and the more sexual partners she has had, the higher her risk of developing cervical cancer. Therefore, you should get routine screening more frequently.
The main ways to prevent cervical cancer are:
- Cervical cytology (Pap smear);
- HPV research;
- HPV vaccine.
Screening for cervical cancer is done with an easy test called a Pap smear, which examines the cells in the inner area of the cervix.
The best time to do it is after your period and before peak ovulation, which is the first phase of your cycle.
The Pap test involves taking cells from the cervix for laboratory examination, which can detect cancer or pre-malignant lesions (cervical dysplasia).
These routine Pap smears can detect cervical cancer with an accuracy of about 80%, even before symptoms appear.
According to the American Cancer Society (ACS) and American Society for Colposcopy and Cervical Pathology (ASCCP) indications are:
- Age less than 21 years, screening is not recommended;
- Between 21 and 29 years of age, cytology every 3 years is recommended;
- From age 30 to 65, HPV testing and cytology every 5 years preferred, or cytology at least every 3 years;
- At age 65, screening is not indicated if previous screenings have been negative and there are no risk factors.
There are several possible treatments for cervical cancer. The choice of treatment is mainly related to the stage of the disease.
Other factors that influence treatment include the exact location of the cancer in the cervix, the type of cancer (squamous cell or adenocarcinoma), the woman’s age and general health, and whether or not she wants to have children (fertility maintenance).
Among the various treatment options are the following:
Surgery (removal of the uterus or hysterectomy)
May be used to aid in diagnosis, to determine the extent of cancer spread, or for treatment itself (especially in the early stages).
Radiation therapy uses high-energy X-rays to eliminate malignant cells.
For some stages of the disease, the option is radiation therapy alone or surgery followed by radiation therapy. In other stages, radiation therapy is given in addition to chemotherapy, as it improves the treatment outcome.
Chemotherapy is usually recommended for cases where the cancer has spread to other organs and tissues (advanced stage). It may also be useful if the cervical cancer has recurred.
Targeted therapy consists of a set of antineoplastic drugs that act at the molecular level. They act differently than traditional chemotherapy drugs and also have different side effects.