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According to the World Health Organisation, cervical cancer is the 4th most common cancer in the world. However, 90% of patients come from low- and middle-income countries, where cancer survival rates are the lowest. Awareness of the disease is important for every woman. In this article, we have compiled a list of questions that most frequently concern our female patients, and asked them to experienced gynaecological oncologists. Learn their answers in our article.

 

 

1. What are the causes of cervical cancer in women?

According to the US CDC, 91% of cervical cancer cases are caused by human papillomavirus (HPV). It is a sexually transmitted infection. In most cases, it is asymptomatic, so people can unknowingly be carriers of the disease and pass it on to their sexual partners. Sometimes, however, HPV can form so-called “genital warts”. Finding them is a good reason to see a doctor. The problem with the human papillomavirus is that it cannot be completely cured but only goes into remission. Because of this, many doctors insist on preventive treatment such as HPV vaccination.

 

Other causes of cervical cancer include reduced immunity (e.g. due to HIV infection), oral contraceptives, and smoking, which is a risk factor for all types of cancer. The use of diethylstilbestrol by the patient’s mother during pregnancy is also a potential risk factor.

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2. What types of cervical cancer are there?

There are two main types of cervical cancer. The most common form is squamous cell carcinoma. It is found in 70-90% of cervical cancer patients.

 

In other cases, patients are usually diagnosed with cervical adenocarcinoma. It is believed that this type of cancer has a worse prognosis, although some studies show that the effectiveness of treatment in the earliest and latest stages of the disease is about the same in both types of cervical cancer.

 

Other types of cervical cancer are extremely rare. One of them is mixed carcinoma, which has features of both squamous cell type and adenocarcinoma.

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3. Is cervical cancer preventable?

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The American Cancer Society (ACS) recommends regular gynaecological examinations and the human papillomavirus vaccine as the most effective way to prevent cervical cancer.

 

It is recommended that women aged 25-64 years have a primary HPV test every 5 years or a PAP smear every 3 years. This includes women vaccinated against HPV.

 

In some countries, HPV vaccination is offered free of charge to both boys and girls from the age of 9-13 years. People over 26 are usually not offered this treatment, as it is not as effective in preventing cancer as early vaccination.

 

Using condoms during sexual intercourse and quitting smoking also reduces the risk of cervical cancer.

4. How dangerous is cervical cancer?

The risk of cervical cancer depends on the stage at which the disease is detected and the treatment options available to the patient. To compare, in India 7-8 per 100,000 die from cervical cancer. For Western Europe and the USA, this number is 4 times lower.

5. Can cervical cancer be completely cured?

Yes, it is possible to cure cervical cancer completely. Women in the early stages of the disease have a better chance of a complete cure. However, a certain percentage of patients will relapse and need to be treated again. The recurrence statistics, depending on the stage, are as follows:

 

StageRelapse rate
1B-2A11-22%
2B-4A28-64%
3-4Bup to 70%

6. What types of HPV cause cervical cancer?

There are more than 100 different strains of the human papillomavirus. Only 40 of them are sexually transmitted, and only 14 can cause cervical cancer. These are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. HPV-16 and HPV-18 are the most common types of virus found in cancer patients.

 

It is important to understand that most people will come into contact with the human papillomavirus during their lifetime, and in most cases, they will not need treatment – the immune system will be able to overcome the disease on its own. Only the dangerous strains associated with gynaecological cancer cannot be cured.

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7. Can cervical cancer develop without HPV?

Yes, it is possible to get cervical cancer without HPV, but this is very rare. Usually, cancer in such cases is related to the effect of diethylstilbestrol on the foetus during pregnancy. It is an artificial hormone that can sometimes be prescribed to women to prevent miscarriage. Cervical cancer without HPV cannot be detected during a gynaecological examination or a PAP smear. In these cases, the tumour is found after the first symptoms appear.

8. Can virgins get cervical cancer?

Since the vast majority of cervical cancers are related to HPV, a sexually transmitted disease, it very rarely occurs in virgins. However, there is still a very small percentage of risk, so women who are not sexually active are still advised to have a gynaecological check-up.

 

ГWhen talking about HPV, it is important to understand that the virus is not only transmitted through penetrative sex, but also through other forms of sexual contact that involve skin-to-skin contact with genitalia or secretions, including oral and anal sex.

9. At what age does cervical cancer usually develop?

The majority of patients diagnosed with cervical cancer are between the ages of 35 and 50. Only 20% of women diagnosed are over 65. For this group, the risk factor is not having gynaecological check-ups at a younger age. In women under 20 years of age, cervical cancer is very rare.

10. Can I get uterine cancer during menopause?

Cervical cancer can occur many years after the initial HPV infection, so post-menopausal women remain at risk. The symptoms are the same for this group of patients as in their younger years: abdominal or back pain, unusual vaginal discharge, especially with blood, and pain during sexual intercourse.

 

The accuracy of HPV and PAP tests decreases with age, so at some point, your gynaecologist may recommend stopping regular check-ups.

 

11. Is there a link between hormonal contraceptives and cervical cancer?

The US National Cancer Institute (NCI) confirms that women taking oral contraceptives have an increased risk of developing cervical cancer, breast cancer, endometrial cancer, testicular cancer and colorectal cancer. This is because oral contraceptives are inherently hormonal and a large number of gynaecological tumours are hormone-dependent.

 

Studies show that taking oral contraceptives for 5 years increases the risk of cervical cancer by 10%. Taking them for 5-9 years increases the risk by 60%, and the risk doubles if you take them for longer. However, the good news is that if you stop taking these drugs, your risk of developing cancer decreases over time.

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12. How long does it take for cervical cancer to develop?

It can take 15-20 years from the initial HPV infection for cervical cancer to develop. In immunocompromised women (e.g. after cancer treatment or due to HIV infection), the process occurs more quickly, in 5-10 years.

13. What are the first signs of cervical cancer?

Early signs of cervical cancer have symptoms similar to those of common sexually transmitted infections, and they do not occur in all patients. Most often, affected women have:

 

    иконка галочки Bleeding during or after intercourse, outside the menstrual cycle, after menopause; also more heavy menstruation;  

    иконка галочки Abnormal vaginal discharge of pink or brownish colour with an unpleasant odour; 

    иконка галочки Pain during sexual intercourse; 

    иконка галочки Atypical abdominal pain outside the menstrual cycle; 

    иконка галочки Frequent urges to go to the toilet. 

14. Can cervical cancer be seen during an examination?

In most cases, cervical cancer is first detected during a colposcopy (gynaecological examination). The accuracy of this method is 73-82%, so an ultrasound scan is needed to confirm the diagnosis.

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15. Does an ultrasound show cervical cancer?

Yes. In 92-96% of cases, doctors can accurately detect signs of cervical cancer on ultrasound, even in the early stages of the disease (IA and IB).

16. What is included in routine screening for cervical cancer?

International medical organisations have different screening programmes for women, depending on their risk group (age, presence of human papillomavirus, family history of cancer, etc.). The programmes differ in terms of which methods are recommended and how often patients should see a doctor.

 

A routine screening package for cervical cancer usually includes a colposcopy, HPV test and PAP test (together or just one of these).

17. What cancer markers show cervical cancer?

Cervical cancer may show an increase in one or more cancer markers: CA 125, CA 19-9, CEA, SCCA and CYFRA 21-1. It is important to remember that cancer markers are not an accurate way of diagnosing cancer – sometimes their levels remain normal when there is an active cancer process, and sometimes they increase in healthy women. Most often, oncological markers are used to select therapies and monitor the body’s response to therapy.

18. Can stage 1, 2, 3, and 4 cervical cancer be cured?

Provided modern cancer control methods are used, patients have the following prognosis for the treatment of cervical cancer:

 

Stage5-year survival rate
1A93%
1B80%
2A63%
2B58%
Stage5-year survival rate
3A35%
3B32%
4A16%
4B15%

19. Can cervical cancer be cured without surgery?

Depending on the nature of the disease, stage 1 cervical cancer can sometimes be treated without surgery, using external beam radiotherapy, brachytherapy and chemotherapy. The location and size of the tumour, its histological characteristics, and whether the patient wants to remain fertile will influence the choice of treatment. If possible, the oncologist will take the patient’s preference for surgery into account.

 

In the later stages of the disease, surgery is necessary to preserve the patient’s life.

20. Is radiation therapy necessary after a hysterectomy?

The treatment plan for cervical cancer depends on the stage of the disease and the type of cancer. Adjuvant (post-surgical) radiotherapy is indicated if there is a risk that cancer cells may have remained in the body after the hysterectomy. At stages 1 and 2, radiotherapy after the removal of the uterus is typically not necessary. Your doctor will be able to tell you more about the treatment plan after the histological examination of the tissue.

21. What should I do if I was diagnosed with cervical cancer during pregnancy?

The treatment plan for cervical cancer in pregnant women depends on several factors:

 

    иконка галочки In which trimester was the disease detected?  

    иконка галочки Size, location and stage of the tumour;  

    иконка галочки Type of cancer (squamous cell carcinoma or adenocarcinoma);  

    иконка галочки Presence of cancer in the lymph nodes.  

 

In stage 1A, it is usually possible to continue the pregnancy and begin treatment after the birth. If the cancer is at stage 1B, doctors may consider terminating the pregnancy and starting treatment (hysterectomy and/or radiotherapy) immediately. In some cases, chemotherapy can be started in the 2nd or 3rd trimester of pregnancy.

 

In 70% of cases, cervical cancer in pregnant women is diagnosed at stage 1.

 

If a pregnant woman has been diagnosed with cervical cancer, an early caesarean section is recommended instead of a normal delivery so that doctors can begin the treatment as soon as possible.

22. Where does cervical cancer spread?

Cervical cancer first spreads to nearby lymph nodes, from where it can travel to distant parts of the body. Most often, metastases form in the lungs, liver and bones.

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23. Can cervical cancer recur after conization?

Yes, there is a risk of cervical cancer recurrence after conization, even many years after treatment. The earlier the disease is detected and treated, the lower the risk of it returning. While at stage 1A cervical cancer recurs in 2% of patients, at stage 3 this figure rises to 29%.

 

Factors influencing postoperative recurrence include full-term pregnancy, history of preterm birth, history of abortion, positive tumour resection margin; length, width and depth of cone, and presence of complicating diseases and smoking.

24. Can cancer recur after the removal of the uterus?

Yes, even after the removal of the uterus, cancer can recur. This happens for two reasons:

 

    иконка галочкиA partial hysterectomy was performed, which does not remove the cervix. If the patient tested positive for papillomavirus, the tumour may grow again. 

    иконка галочкиIf cancer has already spread to distant organs at the time of surgery. This risk is higher in the later stages of the disease. 

 

Gynaecologists usually recommend continuing regular check-ups with a gynaecologist even after a hysterectomy.

25. Can I get breast cancer after having my uterus removed?

If a woman is genetically predisposed to develop breast cancer, it can develop even after a hysterectomy, regardless of whether the uterus has been removed completely with the ovaries or only partially.

26. Where to treat cervical cancer abroad?

MediGlobus recommends the following clinics for effective and advanced treatment of gynaecological cancer:

 

 

 

 

    Summary

    иконка галочкиCervical cancer is the 4th most common cancer worldwide. The disease is well treated in its early stages but has a high risk of recurrence. The main cause of cervical cancer is the human papillomavirus (HPV). 

    иконка галочкиTo prevent the development of cervical cancer, doctors recommend regular check-ups with your gynaecologist (including HPV test or PAP smear), getting vaccinated against HPV as a child, not smoking and using condoms. 

    иконка галочкиThe most effective ways of diagnosing cervical cancer are colposcopy and ultrasound. 

    иконка галочкиTreatment for cervical cancer includes surgery, chemotherapy, radiation therapy, brachytherapy, targeted therapy and immunotherapy. 

    иконка галочкиMediGlobus recommends the following clinics for the treatment of gynaecological cancer: Liv Vadistanbul (Turkey), Liv Bona Dea (Azerbaijan), Teknon University Hospital (Spain), Vienna Private Hospital (Austria), University Hospital of Cologne (Germany), Ichilov Medical Centre (Israel). 

 

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Frequently asked questions about cervical cancer

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Sources:

  1. 1. WHO about cervical cancer treatment
  2. 2. CDCP about HPV
  3. 3. Does adenocarcinoma have a worse prognosis than squamous cell carcinoma in patients with cervical cancer? A real-world study with a propensity score matching analysis
  4. 4. American Cancer Society Guidelines for Cervical Cancer Prevention and Early Detection
  5. 5. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative
  6. 6. Diagnostic performance of ultrasound compared with clinical examination, for measuring primary tumor size in patients with cervical cancer
  7. 7. Cervical Cancer Screening Guidelines
  8. 8. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer
  9. 9. Long-term risk of cervical cancer following conization of cervical intraepithelial neoplasia grade 3—A Danish nationwide cohort study
  10. 10. Oncologic and obstetric outcomes after conization for adenocarcinoma in situ or stage IA1 cervical cancer
  11. 11. Residual and recurrent lesions after conization for cervical intraepithelial neoplasia grade 3

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