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Cervical cancer
Definition
Tumours of the cervix can first of all be divided, like the vast majority of tumours, into benign (that is "non-cancerous") and malignant ("cancerous"). The group of benign tumours in the location of the cervix includes the so-called endocervical polyp, and the most common malignant tumour is carcinoma. Despite all efforts on the part of gynaecology - by which we mean regular gynaecological screening, which includes six-monthly preventive check-ups and subsequent cytological analysis of a smear of cells from the cervix - cervical carcinoma remains one of the most serious tumours in women and contributes significantly to overall mortality.
Age at risk
The most affected group are women aged 45 to 55. Unfortunately, the age limit keeps falling, so it is not unusual to encounter it in younger women as well.
Risk factors for cervical cancer
There are several risk factors for this type of disease.
It is essentially a sexually transmitted disease, so a large number of sexual partners (promiscuity) must be put at the forefront of all risks - and this applies to both women and men! If a woman has only one partner, but one with risky sexual behaviour (both at present and in the past), the risk is just as great as if she behaved that way herself.
Another risk factor is a young age at first sexual intercourse. As already described above, cervical carcinoma is caused by human papillomaviruses. If the infection they cause persists (meaning that the infection is not treated, or treatment is neglected, for example because the patient ignores the doctor's instructions), the risk of malignancy is again increased.
There are also a number of congenital diseases in which the body's immune barrier is impaired. A healthy body still has a certain percentage chance of helping itself and eliminating the infection.
Smoking can be placed in the last group of risks - as with many other malignancies.
Most of these risk factors are associated with a lower socio-economic class, but of course they need not be a complete exception even in a developed society.
Prevention of cervical cancer
The most effective prevention is to avoid all risk factors (where this is of course possible). Immunodeficiency states of the body, especially congenital diseases, are hard for a person to influence, but the attending doctor, who is familiar with the patient's condition, certainly takes care that the patient is not exposed to greater danger than results from the original illness.
If you avoid the risks, the next point of concern is a regular gynaecological examination. Ideally every six months, at the latest at an interval of one year. The gynaecologist routinely takes a smear of cells from the cervix (using a brush or a small spatula), which is sent for histological examination. It is the most sensitive examination, which with regular check-ups can detect changes on the cervix even in the very early stages of the disease, and this allows timely therapeutic treatment. Precancerous changes can sometimes precede the development of carcinoma by up to twenty years.
Today, effective vaccination is also available. Two vaccines are available on the market. But it must be realised that both act only against the basic types of papillomavirus, specifically HPV 6, 11, 16 and 18. Although these are most often involved in the development of the tumour, they are certainly not the only factors that cause it. The positive is that vaccines can reduce CIN to a lower grade. Of course they do not protect against other sexually transmitted diseases. The age suitable for vaccination is given as 10 – 25 years, but there are studies showing a positive effect even in women over 25. In any case, consultation with a gynaecologist is necessary.
Symptoms and signs of cervical cancer
It must be stressed that not all types of tumour can show themselves specifically. Bleeding outside the menstrual cycle and a changed vaginal discharge, reported to be white, certainly deserve attention (note that a changed vaginal discharge does not necessarily mean the worst variant straight away; in most cases it is present in genital infections, typically candidiasis, where the discharge is also white with a curd-like consistency, and in other fungal infections). In any case, it should always be a reason to visit the gynaecologist.
Pain during sexual intercourse is another symptom that could mean that something may be wrong with the cervix. Difficulty urinating can be listed as the last symptom.
Treatment of cervical cancer
Thanks to Pap screening, most precancerous lesions are diagnosed in time (the vast majority are detected already at the stage of initial lesions, in the so-called pre-invasive phase, when there are cell changes on the cervix but it is not yet carcinoma). Advanced stages are often present in women who have never been for a gynaecological examination or who put it off for a very long time (a typical reason: something is not right, but I would rather not go to the doctor so that he does not tell me I have cancer). Treatment is mainly surgical, and secondly radiological. Surgery is chosen for lower stages of the disease, radiotherapy for advanced tumours that can no longer be operated on (for example because of growth into the surrounding area, metastasis, etc.). For less invasive carcinomas and precancerous lesions, surgery uses a procedure called conisation or trachelectomy with reconstruction of the cervix. Both of these procedures preserve fertility. They are the most effective methods of treatment. If the tumour is advanced (this is decided by the gynaecologist, often in consultation with another specialist, often another gynaecologist or an oncologist), radical procedures are chosen, such as hysterectomy (removal of the womb) with preservation or removal of the ovaries, or a more radical operation, total hysterectomy with removal of the pelvic lymph nodes.
Complications of cervical cancer
In untreated carcinomas, metastasis occurs, mainly via the lymph nodes.
If the carcinoma is not treated, or is discovered very late, at a stage of higher differentiation ("maturity"), the complications are pelvic inflammatory disease, pyelonephritis (inflammation of the renal pelvis) and obstruction of the urinary tract.