Cervical cancer

How common is cervical cancer?

Cervical cancer is the second most common cancer worldwide. However, the largest proportion of patients (>80%) are found in developing countries. In advanced countries it is the eighth most common cancer. This significant difference is due to the widespread use of the Pap test, which helps in the early detection and treatment of cervical lesions.

Which women are more likely to get cervical cancer?

Infection with specific subtypes of the human papillomavirus (HPV) is causally linked to most cases of cervical cancer. Chronic HPV infection causes alterations in the cells of this area (malformations), which can progressively lead to the development of malignancy. The development of cervical cancer has been associated with early sexual activity and multiple sexual partners, as well as with other sexually transmitted diseases (chlamydia, gonorrhoea, syphilis, AIDS). Obesity and long-term use of contraceptive tablets are also aggravating factors.

Is there screening for cervical cancer?

A key role in the early diagnosis of cervical cancer is still played by the Pap test (RAP test), which can detect malformations and precancerous lesions before they develop into malignancy, which is why annual gynaecological screening is considered essential. Prevention measures include: annual Pap test in women over 21 years of age or younger if sexually active, smoking cessation, condom use and of course the HPV vaccine.

What is the HPV vaccine?

In Greece there are vaccines (4, 2 and 9-valent) against the human papillomavirus (HPV) containing the most common high-risk subtypes of the virus. Vaccination against HPV has been introduced in the mandatory vaccination of girls 12-15 years old and girls 15-26 years old who were not vaccinated in the recommended time period. The vaccines are completely safe as they do not contain live virus but an inactivated part of the virus. The only side effects that have been recorded in a small percentage of people are local irritation at the injection site and low-grade fever, which can be seen with all vaccines.

Are there any symptoms indicative of cervical cancer?

In the early stages of the disease there are no symptoms. Symptoms that occur in more advanced stages of the disease are bleeding from the vagina (at times other than during menstruation or during sexual intercourse or after menopause), pain in the pelvic area or pain during sexual intercourse, and smelly or bloody vaginal discharge. If the disease is generalized, symptoms such as anorexia, weight loss and tiredness may be observed, and symptoms in the context of metastatic disease (e.g. fracture or pain at sites of bone metastases) may also appear.

What happens after early mutations are detected on the PAP test?

In cases of precancerous or in situ lesions, there are techniques (such as cone resection, laser sublimation and loop resection) that radically remove the affected area while preserving the uterus.

How is cervical cancer diagnosed?

The final diagnosis of cancer will be made by biopsy of the suspected area.

After being diagnosed with cervical cancer, what happens next?

After the diagnosis of cervical cancer, further imaging with CT or MRI scans will be needed to rule out locally advanced or metastatic disease.

What are the treatments available today?

In early stages of cervical cancer, a hysterectomy and lymph node cleansing of the area is required. Whether or not the lymph nodes are infiltrated will determine whether additional chemotherapy or radiotherapy will be needed.

What is the prognosis for patients with cervical cancer?

Depending on the stage and extension of the disease, cervical cancer is a curable disease in many cases, with a combination of appropriate treatments. As an indication, 5-year survival is 92% for patients with localized disease, which is the stage at which the majority of patients are diagnosed.

What options are available if the disease cannot be treated surgically?

In cases of locally advanced disease, radiotherapy is given with or without chemotherapy, while in metastatic disease chemotherapy is the first treatment option and can be combined with radiotherapy for palliative purposes.