cervical cancer

Cervical cancer

Cervical cancer is the world's second most common type of cancer. In Finland cervical cancer has become rarer due to screening. Cervical cancer develops through precursors and therefore cancer can be prevented by screening. Precursors can be detected by a cell sample of the cervix and treated before the cancer can develop.

A national cervical cancer screening Programme, which began in 1960, has reduced the incidence of cervical cancer to one fifth. At present, approximately 160 cervical cancer is diagnosed each year in Finland. Cervical cancer is now the most common in women of 30 -44 to childbearing potential and a fair third of all cases are found in this age group. The disease is rare in children under 25 years of age.

Cervical cancer develops through precursors and therefore cancer can be prevented by screening. Precursors can be detected by a cell sample of the cervix and treated before the cancer can develop. The onset of cancer is a prolonged infection caused by the human papilloma virus (HPV). As a result of prolonged HPV infection, the normal surface cell of the cervix begins to slowly change and develop into a malignant cancer. The development of normal surface cell cancer usually takes years, according to studies from 7 to 15 years.

The majority of cervical cancer sufferers will be cured if the disease is diagnosed in the early stages. In advanced tumours, the prognosis is not as good. Especially in younger women, it is usually still a local cancer, so that fertility can also be preserved.

The uterus is a pear-shaped body in the lower abdomen between the bladder and the rectum. The uterus consists of two parts: the upper uterine trunk and the lower cervix. The cervix protrusts into the vagina. The placenta opens from the middle to the mouth of the cervix, which begins with the cervical canal that is consuming the uterine cavity. The uterine wall forms the largest part of the muscle layer. The mucous membrane lining the inside of the uterus, which is subject to hormonal regulation and its thickness varies according to the menstrual cycle.

The majority of cervical cancers originate from the cervical surface tissue, or squamous cell. Cancer that originates from the squamous cell is known as squamous carbide. Cervical cancer can also begin with cervical ducts in the lining of the glandular cells. This type of cancer is called adenocarcinoma. The majority of cervical cancers are squamous epithelium. Adenocarcinoma and its precursors are more difficult to see through screening than for squamous cell carcinoma.

Cervical cancer causators
The persistent infection caused by the human papillomavirus HPV is the main risk factor for cervical cancer. Without it, it does not arise from cervical cancer. Human papilloma virus is found in over 90% of cervical cancer tumor samples.

It is estimated that 80% of people are exposed to papillomavirus during their lives, but the vast majority of the infection heals in a couple of years. HPV infections are mainly spread through sexual intercourse and are markedly more common after the start of the sex life.

Certain HPV types are classified as high-risk HPV type. Infections caused by these HPV types have a higher risk of prolonging and causing cell changes that are progressing to cancer. The most common cervical cancer-causing types are HPV 16 and HPV 18. They have been estimated to cause 70% of all cervical cancers.

However, alone papilloma virus cannot cause cancer. Smoking increases the risk of cervical cancer by prolonging the HPV infection and slowing its healing. It is therefore imperative to avoid smoking.

Other risk factors for cervical cancer include other sex diseases, in particular chlamydia, early start-up age, sexual partner abundance, sexual partner sexual behaviour and HIV or any other cause of body Defence capability.

What causes cancer?

Protection factors

HPV infections can be prevented with HPV vaccines. The vaccine will best be effective when taken before intercourse commences. The HPV vaccine is now part of the National Vaccine Program and is given to sixth-grade girls. The national vaccination programme uses a Cervarix vaccine.

Take HPV vaccine (without cancer)

HPV vaccine (THL)

Screening

Cervical cancer also protects the regular screening of attendance. Screening with the help of cervical cancer precursors can be found and treated in time before the actual cancer develops.  Either a Pap test or an HPV test is used as a screening test. If the result of the screening test is different, the situation is monitored or, if necessary, further research is carried out with cervical arthroscopy (colposcopy). A severe change can be done by eliminating it by a measure called loop therapy, Electroloop therapy, or conisation.

Pap Smear: The Pap smear is a gynecocturous smear test. A cell sample is taken from a woman's cervical channel, vaginal pohjukasta and the target, and examined under a microscope. The sample is taken by a trained nurse or physician and is not painful. The cells are examined by means of a microscope in a laboratory. The abnormal cell change found in the Pap test does not yet mean cancer, because it is usually a mild pre-order that can be monitored.

HPV test: The HPV test, or papillomavirus test, determines whether a woman has an anti-inflammatory type of papilloma virus. The HPV test is taken in the same way as the cervical canal as a Pap smear, but the HPV test cannot identify cell changes but examine whether the cells have high risk papillomavirus DNA. A positive test result requires monitoring or further study (usually a Pap smear) depending on the age of the woman.

Colposcopy

Serious or repeated milder cell changes found in the Pap test are further investigated in cholescopy (cervical). In colposcopy, the uterine mouth is examined with a microscope and a strong light. The uterus is treated with a dilute acetic solution so that the areas of change appear. The areas of change will be tested for pathologist examination. If experimental fires are diagnosed with a minor degree of cervical cancer, it can be further monitored. Severe changes are performed by removing the area of change with electric loop therapy.

Unfortunately, not all cervical cancers can be prevented by screening, since in some cases the pre-cancer precursor may be short-lived or altered cells may not appear in the cell sample. However, cancers are clearly found more in women who have not participated in screening.

Condom

Condoms are partially blocking HPV infections, but HPV can also be transmitted from the skin and mucous membrane areas that the condom does not cover. However, condoms are well protected from other sex diseases, such as chlamydia, which has been shown to increase the risk of cervical cancer.

Cervical cancer screening

Cervical Cancer Symptoms

Cervical cancer is often in the early stages of asymptomatic. It is therefore important for women to undergo regular screening so that possible precursors can be detected and, if necessary, treated.

If symptoms occur, they are usually different types of bleeding disorders such as bleeding during periods other than menstruation, post-sexual intercourse bleeding or bloody, brownish or bad white bleeding.

In advanced cervical cancers, the tumor may grow onto adjacent tissues or weigh adjacent organs such as the bladder, rectum and large blood vessels that export to the lower limbs. This may include, for example, lower abdominal or back pain, swelling of the lower limbs and blood clots, a blockage of the urinary tract, or disturbances in bowel function. Also, general symptoms such as impotence and fatigue can occur.

Diagnosis and studies of cervical cancer

The diagnosis of cervical cancer is usually based on a physician's conduct of gynecological examinations, tumour testing and imaging studies.

Cervical cancer is usually found in a smear test (Pap smear). In a Pap test, a cell sample is taken from a female's cervical channel, vaginal pohjukasta and a target helper. The sample is taken by a trained nurse or physician and is not painful.

Cervical and tissue changes (health library)

Interpreting the responses to a Pap test (health library)

Detection of cervical cancer

Cervical cancer is often asymptomatic and serious cell changes referring to cervical cancer are usually confirmed by a Pap smear test. Also, a doctor conducting a gynecologist study may arouse suspicion of cancer if the uterus is unusually looking or a visible tumor is detected. A further study will be done with colposcopy, or cervical endoscopy, and will be used to ensure that the diagnosis is confirmed.

The prevalence of the disease is investigated by medical gynecography, colposcopy and uterine test fires and imaging studies (usually echo and MRI).

Cancer detection and studies

Cervical cancer classification

In Finland, cervical cancer is usually diagnosed at an early stage. Cervical cancer metastases are the most common locations are lymph nodes, peritoneum, lung and liver, sometimes vertebrae and pelvic bones.

The choice of treatment for cervical cancer and the patient's prognosis depend on the prevalence of tumour, which is expressed by the Figo Habitat classification or TNM classification. The TNM-classification T (tumor) represents the tumour intrusion into its environment, N (node) spread to nearby lymph nodes and M (metastasis) for potential metastases.

Cervical cancer prevalence rate

Prevalence rate 0 or precursor (carcinoma in situ)

Very early stage cancer: cancer is only in the cervical mucosa.

Penetration ratio

The tumor is confined to the cervix.

IA cancer has grown below 5 mm deep in the cervical mucosa. T1aN0M0

IB cancer has risen to more than 5 mm deep in the cervix. T1bN0M0

Penetration Rate II

The tumor is spread outside the cervical, but not on the pelvic wall. If the tumor has spread to the vagina, it extends only to the upper part of the vagina.

IA The cancer has not spread to the uterus adjacent connective tissue condition. T2aN0M0

IB cancer has spread to the uterus adjacent connective tissue condition. T2bN0M0

Penetration III

The tumor has spread to the pelvic wall or to the lowest third of the vagina, causing urinary tract clogging or a broken kidney.

IIIa tumor does not extend to the pelvic wall, but extends to the vaginal subthird. T3aN0M0

The IIIB tumor has spread to the pelvic wall and/or clogs the urinary tract or causes kidney dysfunction. T3bN0M-1M0

Penetration Rate IV

The tumor is spread to adjacent organs or from the pelvis.

The IVA tumor has spread to nearby organs. T4N0 – 1m0

IVB the tumor has sent metastases to the bodies further afield. T1 – 4n0 – 1m1

In addition to the prevalence of treatment, the choice and outcome is influenced by the histological type of the cancer cells.

Cancer classification

Cervical cancer treatment

The treatment of cervical cancer is determined by the prevalence of cancer and the general condition of the patient. Cervical cancer is usually treated with surgery, supplemented, if necessary, by the risk of spreading cancer by radiotherapy, chemotherapy or a combination of these. In advanced cases which cannot be cut, radiotherapy and chemotherapy are administered.

The majority of cervical cancers can be cured. If it is no longer possible to improve the cancer, symptomatic treatment is aimed at prolonging the life remaining and facilitating disease-induced symptoms.

Cancer treatment

Cervical cancer surgery

Cervical cancer primary treatment is surgery. If the cancer is detected early and the patient has hopes of conceiving, a reduction can be done in which the uterine body is saved. In this case, monitoring is particularly accurate.

In the normal cervical cancer surgery, the uterus, the upper part of the vagina, the pelvic lymph nodes and the uterine organs are removed. In young women, the ovaries can in some cases be left in place.

If the risk of spreading cancer is high or medium, the lymph nodes in the adjacent area of the aorta are also removed from the surgery. Surgery is not always possible if the disease has progressed or the general condition of the patient does not allow it.

Surgery may be performed either as a target or as an aid. The cutting method is influenced by the patient's body mass index and other illnesses.

Surgical treatment of recurresions: If cervical cancer recurs only locally, the removal surgery may be considered.

Cancer surgery Treatment

Radiotherapy

Radiotherapy uses high-energy radiation to destroy cancer cells and reduce tumors. If the patient is not cut, he/she can only be treated with radiotherapy, which is given both as an external and locally-grown radiation treatment. Radiotherapy can also be given after surgery topically to the vagina or externally to the pelvic region.

For small relapse, patients do not need surgery in addition to radiotherapy. For patients with a medium relapse risk, radiation therapy via the vagina and high-risk patients are used for all pelvic radiotherapy. In high risk patients, chemotherapy is also given in addition to radiation therapy.

Radiotherapy causes side effects that are reduced within a few weeks. Common disadvantages include tenderness and sensitization of the mucous membranes of the vagina, diarrhoea, and urinary discomfort.

Radiation therapy is used in the treatment of recurrefor cancer in patients who have not previously received it.

The tumour can also be reduced by radiotherapy prior to surgery.

Radiotherapy

Radiation therapy is used in the treatment of recurrefor cancer in patients who have not previously received it.

The tumour can also be reduced by radiotherapy prior to surgery.

cell blockers or cytostatic

Cell blockers are medicines for the destruction of cancer cells that spread with blood circulation throughout the body. Medicines are given as tablets or as a drip directly into a vein. Chemotherapy is usually given on individual grounds and according to the prevalence of cancer.

Chemotherapy can be used either alone or in combination with radiotherapy.

The most commonly used cytostaates in the treatment of cervical cancer are cisplatin, paclitaxel, Topotecan and Gemcitabine, which may, under certain circumstances, be associated with a vascular growth factor inhibitor, bevacizumab.

Chemotherapy will cause side effects, some of which will improve in a few days. Common side effects include nausea, inflammatory susceptibility, fatigue, and hair loss.

Chemotherapy

Cervical cancer monitoring, recurrefications and prognosis

After cervical cancer, patients are monitored on an individual basis for a period of 3-5 years. During the first year, follow-up visits are every 3 to 4 months and thereafter every 6 to 12 months.

Follow-up visits are conducted with an ordinary gynecoculary examination and taken with a vaginal pohjukasta pap smear and, if necessary, an endoscopy of the vagina and the uterus, as well as taking sample pieces. X-ray examinations and ECHO studies are carried out at individual discretion.

The highest risk of relapse in cervical cancer is within two years of detection of the disease.

A large proportion of cervical cancer sufferers will be cured if the disease is diagnosed early. If cervical cancer is found in the early stages, or is confined to the uterus, 90% of cancer sufferers will be alive after five years. In advanced disease, the five-year survival forecast is 60%.