Cervical cancer is the third most common cancer in women, following breast and bowel cancers. Cervical Cancer refers malignant tumor of cervix, the lowest part of the uterus (one of female genital organs), due to abnormal proliferation and growth.
However, it is possible to minimize prevalence of cervical cancer and rate of death (mortality) secondary to this cancer by using screening tests commonly.
Risk factors of the cervical cancer are as follows:
The most common symptom of the cervical cancer is vaginal bleeding at irregular intervals that are not related to periods. Although the bleeding can sometimes be heavy, it is usually in the form of “spotting”. It can be more evident after a sexual intercourse. Vaginal discharge with foul odor or blood in urine or stool can be seen in advanced stages of the disease.
Intact cervix starts manifesting changes related to infection 3 to 8 months of inoculation period after the cervix is exposed to HPV.
In the Pap test, a vaginal brush specimen is collected and normal and abnormal cells in the specimen are classified by pathologists. For suspected cases, colposcopy is indicated. If positive finding is revealed out by the colposcopic examination – optical magnification to visualize and inspect the cervix-, a biopsy specimen is collected during the colposcopy.
If abnormality is confined to superficial cells, as evidence by pathological examination of the biopsy specimen, cervix should be excised with conization. Conization (cone biopsy) is a diagnostic method, but it can be also sufficient for treatment.
If biopsy shows cervical cancer, it is necessary to determine spread of the disease for making evidence-based treatment decision. Size and spread of tumor and its relation with the urinary bladder on the anterior contour and with the bowel on the posterior contour can be clarified with vaginal and rectal exam, MRI and PET/CT. Ultrasound cannot clearly image status of the cervical cancer
Cervical cancer usually prefers regional spread. Lymphatic metastasis is more likely. Hematogenous dissemination (spread through blood circulation) is somewhat infrequent.
Surgery is usually preferred for cases that are confined to the uterus. The extent of the surgery is determined according to age of the patient, future conception plans, size of tumor and the extent of spread. There are many surgical techniques with varying extent depending on needs, including but not limited to conization of the cervix (uterus is left untouched) and large excision of parametrial tissues and the upper one third part of the vagina along with pelvic and para-aortic lymph node dissection.
If the cancer moves beyond the uterus and spreads to parametrial tissues, radiotherapy is the first-line treatment rather than surgery. Chemo-radiotherapy can be considered as first-line treatment option when volume of the cervical tumor enlarges.
For the patients with tumor-positive surgical margin or cancerous cells in lymph nodes as evidenced by postoperative pathological examination, chemo-radiotherapy is required.