Cervical Cancer Facts: Screening / Treatment / Surgery / Chemotherapy / Radiotherapy

What is Cervical Cancer?

 

Cervical cancer is a sexually transmitted cancer caused in the vast majority of cases by an infection with the human papillomavirus (HPV). It develops over a period of 5 to 15 years.

The infection is common in women, even from the first sexual intercourse. The risk of infection increases with age and with the number of sexual partners.

The virus is transmitted by simple contact with skin and mucous membranes and reaches about 80% of people having sex.

The statistics of cervical cancer

 

Nearly 2/3 of women who have sexual activity are in contact with the virus, but only 1 to 2% of infected women will develop cancer of the cervix.

Cancer of the cervix is the second most common cancer in the world with approximately 470 000 new cases diagnosed each year. In the world, a woman dies of cervical cancer every two minutes.

80% of all cancers occur in developing countries.

In Europe, there were 33 000 new cases in 2002 responsible for 15 000 deaths.

But thanks to the increasing use of Pap smear screening, the incidence of this cancer has declined steadily over the past thirty years.

Risk factors for cervical cancer

 
  • Early first sexual relations.
  • Multiple partners.
  • An infection from sexual partners by HPV or other sexually transmitted diseases.
  • Tobacco.
  • Cancer of the uterus usually occurs in women aged 45 to 60, but it can also be detected in younger or older women.

Contamination occurs during unprotected sex. The use of condoms during sex reduces the transmission of the virus but does not eliminate it completely from any contact, because it is present at the genital mucosa not covered by the condom.

The vaccine against cervical cancer

 

A vaccine against cancer of the cervix, Gardasil ® (from Sanofi Pasteur MSD) is available for girls as young as 14 years old.

The vaccine protects against four strains of HPV, the ones labeled 16 and 18, that cause more than 70% of cancers of the cervix and the 6 and 11 strains, responsible for genital warts.

The goal is to vaccinate 70 to 80% of 14 years old girls before their first sexual intercourse to reduce by 70% the risk of cervical cancer and by 90% the occurence of genital warts ...

The vaccine may be offered to young women between 15 and 23 years old, provided they had no sexual partners, or one at most.

Three doses (injections) are needed. The last 2 must be repeated within 12 months of the 1st injection. They are usually offered at the 2nd and 6th month.

Another vaccine available is Cervarix ® (GSK - GlaxoSmithKline).

Note that these vaccines do not protect against all carcinogenic HPV, or against existing infections.

Also, the smear remains indispensable: The maintenance of screening for women 25 to 65 is necessary in parallel to vaccination because the vaccine does not replace the Pap smear.

HPV Viral Testing

 

The HPV viral test can detect the risk of cervical dysplasia or the presence of cancer in cases of chronic presence of the HPV virus. The risk of occurence appears to be inexistant for the next 5 or 10 years, if the test is negative. Repeat this test every 5 years.

Symptoms

 

Bleeding, infections, losses, pelvic pain ... These symptoms are not specific to the cancer of the uterus and can be observed during more benign diseases, such as a vaginal infection. The persistence of one or more of these signs requires a medical opinion and a pelvic exam. To consult a doctor is the best thing to do on the occurrence of these events.

Screening for cervical cancer

Prevention of cervical cancer is primarily through the detection of precancerous and cancerous lesions caused by the human papillomavirus. It is based on regular smears which, by taking cells from the cervix, allow their analysis under the microscope.

Screening for cancer of the cervix should begin at the age of 20~25 years old.

It is recommended to conduct a smear every 3 years, after 2 initial normal smears obtained in a one year interval (in women with sexual activity), and this from the early twenties. But the 3 years interval recommended seems too long for many specialists. A period of 2 years seems currently recommended.

The Smear or Pap Test

It allows to examine the (most superficial) cells of the cervix under a microscope. The sample is spread and fixed on a glass slide, and is then sent to a anapathology laboratory who will conduct a search for abnormal cells.

Treatment of uterine cancer

 

The treatments options are surgery, radiotherapy or chemotherapy. They can be practiced alone or in combination according to protocols agreed.

Conization allows to take only a small portion of the cervix. It is a biopsy of the cervix in which a cone-shaped sample of tissue is removed from the mucous membrane. Conization may be used either for diagnostic purposes, or for therapeutic purposes to remove pre-cancerous cells. In women who had not had children, that intervention is always the most limited possible...

The surgeon is often forced to practice a hysterectomy, a complete removal of the uterus. This is usually accompanied by a check of, or even the removal of the loco-regional lymph nodes.

Chemotherapy

Chemotherapy is often performed in conjonction with other cervical cancer treatments. It involves the diffusion of drugs to destroy tumor cells.

Radiotherapy in the treatment of cervical cancer

 

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.

Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer may come back. It is often given in combination with chemotherapy.

Scarves and Wigs : accessories to feel better

Alopecia (hair loss) is a side effect of chemotherapy. It begins about 2 to 4 weeks after the first infusion of chemotherapy.

Hair always regrows after cessation of treatment, sometimes even before, at a rate of about one centimeter (half an inch) per month. During the first growth, color and texture of your hair can be changed. Your hair regains its normal appearance 4 months after stopping treatment.

Scarfs, turbans, hats or even a wig are accessories that can help those who wish to cover or hide hair loss, making this period less unpleasant.


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