Cervical Cancer: Symptoms, Types, and Treatment

Cervical cancer is one of the most common types of cancer in women. Every year in our country, thousands of women are diagnosed with cervical cancer, and thousands of women lose their lives due to cervical cancer. It is possible to prevent deaths due to cervical cancer with vaccination and screening.

What is Cervical Cancer?

Cervical cancer is one of the most common types of cancer among women. Thousands of women in our country are diagnosed with cervical cancer each year, and thousands lose their lives due to it. Vaccination and screening can prevent deaths related to cervical cancer.

What are the Symptoms of Cervical Cancer?

Cervical cancer may not show any symptoms in the early stages. Symptoms that may be seen as the disease progresses include:

• Abnormal vaginal bleeding (during or after sexual intercourse, between menstrual periods, after menopause)
• Changes in vaginal discharge
• Pain during sexual intercourse
• Pain in the lower abdomen or pelvis

People with conditions related to the uterus, such as endometriosis, may also experience similar symptoms to cervical cancer. These individuals should have necessary screenings if there is an increase in the number, frequency, or severity of symptoms.

Types of Cervical Cancer

There are different subtypes of cervical cancer. The type of cervical cancer a patient has is important in terms of the course and treatment of the disease. The types of cervical cancer include:

• Squamous Cell Carcinoma: Develops in the part of the cervix that opens into the vagina. This type accounts for most cervical cancers.
• Adenocarcinoma: Originates from the glandular cells in the cervical canal.

In some cases, both types of cancer may develop in a patient. Although rare, cancer can also originate from other cells in the cervix.

Prevention Methods for Cervical Cancer

Nearly all cervical cancer cases are related to HPV. Therefore, preventing HPV infection can also help prevent cervical cancer. There are HPV vaccines developed for this purpose. Vaccination of individuals, especially those aged 9-26, significantly reduces the likelihood of developing cervical cancer in the future. In addition to cervical cancer, HPV can also lead to cancers such as throat cancer, penile cancer, and anal cancer. Therefore, not only women but also men should be vaccinated. The HPV vaccine used in our country is known as the quadrivalent vaccine and is developed against four subtypes of HPV that cause cancer. It is administered in three doses. The HPV vaccine is not included in the National Vaccination Program. Therefore, individuals who want to vaccinate themselves or their children need to obtain the vaccine from a pharmacy and get vaccinated at healthcare facilities.

Women should have cervical screening tests every five years until the age of 65, even if they do not have any complaints. These tests play an important role in the early diagnosis and treatment of cancer. Just as in breast and colon cancer, screening is important in cervical cancer as well.

Diagnosis and Treatment Methods for Cervical Cancer

The diagnosis of cervical cancer can be made based on the symptoms present in a person, as well as through screening tests. The cervical cancer screening program is conducted in our country, as in developed countries worldwide. This screening includes Pap Smear and HPV DNA tests for sexually active women aged 30-65. The main two tests used in screening are:

• Pap Smear Test: A short procedure where cells are collected from the cervix using a special brush. This test can detect abnormal, cancerous cells in the cervix.
• HPV DNA Test: Cells are also collected from the cervix in this test to determine if they are infected with HPV.

People with suspicious results for cancer in the screening tests undergo further examination to establish a definitive diagnosis. A biopsy may be required for diagnosis in people suspected of having cervical cancer. The doctor examines the cervix closely for possible abnormalities using an instrument called a colposcope and takes a tissue sample from this area. The definitive diagnosis is made by examining the taken sample in pathology.

After diagnosing cervical cancer, imaging methods can be used to determine the stage of cancer. The treatment of cervical cancer varies depending on the stage of the disease and the patient's age and general health condition. The treatment methods that can be used for cervical cancer are as follows:

• Surgery: Surgery is primarily preferred for the treatment of early-stage cervical cancer. Different methods include removing only the tumor tissue, removing the entire cervix (trachelectomy), or removing both the cervix and uterus (hysterectomy). Removing only the tumor tissue or performing a trachelectomy allows the patient to conceive in the future. Hysterectomy can be applied to patients who do not plan to conceive.
• Radiotherapy: Radiotherapy, which is based on the principle of high-energy rays killing cancer cells, can be used to treat locally advanced cervical cancer along with chemotherapy.
• Chemotherapy: Chemotherapy involves administering various drugs to kill cancer cells orally or intravenously. Low-dose chemotherapy in locally advanced disease can enhance the effect of radiotherapy, so the two methods can be used together. In advanced cervical cancer patients, chemotherapy can be administered in high doses to alleviate the effects of the disease.
• Targeted Therapy: Known as targeted therapy, this method involves identifying the weak points of cancer cells and applying treatment targeting these points. This method is generally applied in conjunction with chemotherapy.
• Immunotherapy: Immunotherapy enables the immune system to recognize and destroy cancer cells by identifying the special protein produced by cancer cells. Immunotherapy can be used in patients who cannot be successfully treated with other treatment methods.
• Supportive (Palliative) Care: In advanced cancer patients, palliative care aims to alleviate symptoms such as pain that may arise due to the disease. The goal of palliative care is more to improve the patient's overall quality of life rather than treatment.

Risk Factors for Cervical Cancer

Cervical cancer forms when the DNA of cells in the cervix undergoes mutations. Healthy cells divide at a certain rate and die when the time comes. However, these control mechanisms are lost in cancer cells. Cancer cells divide rapidly and uncontrollably, forming masses known as tumors. The disease progresses as cancer cells spread to surrounding tissues or different parts of the body.

Approximately 99% of cervical cancer cases are related to HPV. In some people infected with HPV, the virus remains in the cells for years and at some point, leads to cancer development. However, not everyone infected with HPV will develop cervical cancer, indicating that environmental factors and lifestyle also play a role in cancer development. Factors that increase the risk of cervical cancer include:

• Multiple Sexual Partners
• Early Age Sexual Activity
• Sexually Transmitted Infections
• Weakened Immune System
• Smoking