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Cervical cancer

The cervical cancer starts in the cells lining the lower, narrow part of the uterus. This is one of the most commonly diagnosed cancers . However, women who routinely undergo a Pap test (= cervical smear) are often diagnosed and treated on time. Indeed, this cancer usually evolves slowly and the vast majority of women treated completely heal.

Cause of Cervical cancer

Cervical cancer is caused by a sexually transmitted infection (STI) that originates from the human papillomavirus (HPV ). There are more than 100 virus strains in the HPV family, some of which are more easily transmitted than others.

HPV infections are widespread. In the majority of cases, the infection is controlled by the system and the virus is eliminated, with no other consequences for the body. In some women, the virus causes genital warts (condyloma ) on the vulva, vagina or cervix. The doctor often has to treat these warts to help the immune system eliminate the virus. More rarely, the virus persists for years and transforms the cells lining the cervix into precancerous cells and then into cancer cells. The latter then multiply at an uncontrolled rate and give rise to a tumor.

Two types of cancer

80 to 90% of cervical cancers originate in squamous cells, cells that look like fish scales and line the bottom of the cervix. This type of cancer is called squamous cell carcinoma.

10 to 20% of cancers originate in mucus-producing glandular cells found in the upper part of the cervix. This type of cancer is called adenocarcinoma.

How many women are affected?

Cervical cancer is the single most important cause of cancer death, both men and women, in several countries in Africa and Latin America. 500,000 new cases are diagnosed each year worldwide.
In 2004, according to the World Health Organization (WHO), the death rate from cervical cancer was 1 in 100,000 people in Canada, compared to 31 per 100,000 in Bolivia and more than 15 per 100,000. 100,000 in many countries.

In 2008, 1,300 Canadian women were diagnosed with cervical cancer, or 1.6% of women’s cancers and 380 died. In Canada, since the introduction of the Pap test in 1941, the death rate from cervical cancer has decreased by 90%.

When to consult?

In case of abnormal vaginal bleeding or unusual pain during sex, consult your doctor without delay.

The cervical cancer starts in the cells lining the lower, narrow part of the uterus. This is one of the most commonly diagnosed cancers . However, women who routinely undergo a Pap test (= cervical smear) are often diagnosed and treated on time. Indeed, this cancer usually evolves slowly and the vast majority of women treated completely heal.

Symptoms of Cervical cancer

 In the beginning, cervical cancer usually develops without any signs or symptoms, hence the importance of regular Pap smear tests. When cancer is more advanced, the following symptoms may occur:

  • Vaginal bleeding after intercourse, between menstruations or after menopause.
  • Menstruation more abundant or longer.
  • Nauseating vaginal discharge.
  • Pain during sex
  • Pain in pelvis or lower back.

 Risk factors of Cervical cancer

  •  Neglecting to undergo a regular Pap test.
  • Have sex at a young age.
  • Have sex with multiple partners, or with people who have multiple sexual partners.
  • Smoking.
  • Do not protect yourself during sex.
  • Have a weakened immune system, because of HIV or because you take immunosuppressive drugs, for example.
  • Have contracted other sexually transmitted diseases.
  • Have taken diethylstilbestrol (DES) or have a mother who took DES – a prescribed drug between 1940 and 1971, including women who were repeatedly miscarried. This risk factor is today very rare.
Why prevent?
Cervical cancer is a serious disease. When discovered and treated early, the likelihood of recovery is much better. All women should therefore be regularly screened.
Can we prevent?
It is estimated that 75% of the population will be infected at some point in their lives with human papillomavirus (HPV). Until the introduction of the vaccine, the only way to protect against the HPV strains that cause cervical cancer was complete sexual abstinence.
Screening measures
Pap test. Before becoming cancerous, the cells change their appearance. This precancerous condition is called cervical dysplasia. Regularly taking a Pap test can detect precancerous cells. The doctor can then monitor their evolution. If necessary, he can administer a treatment to prevent the development of cancer.

If the cancer stage has already occurred at the time of the Pap test, early detection will increase the chances of survival. It may also reduce treatment time and recovery time.

According to a 2009 study in Manitoba , women who do not have a regular Pap test are almost 3 times more likely to develop invasive cervical cancer than those who do.

The Pap test is simple and painless. Cells of the cervix are removed by rubbing with a small brush. They are then examined under the microscope.

Young women are encouraged to have a Pap test shortly after their first sexual intercourse and no later than at the age of 21. According to the results, the test is repeated at an interval of 1 year to 3 years, even if we stopped having sex. Indeed, the HPV virus can survive years on the cervix before leading to the formation of cancer cells. In Canada, it is recommended that women undergo Pap smears until they are 69 years old.

Basic preventive measures
Condom. Wearing a condom reduces the risk of HPV transmission, but offers only partial protection, since it does not cover the entire genital area.

Vaccination. Since 2006, 2 vaccines against the HPV strains causing cervical cancer have been marketed: Gardasil and Cervarix. The vaccine protects against the four most common types of HPV that together cause 70% of all cervical cancers (read our article Two Vaccines That Can Prevent HPV Infections ). It also reduces the risk of having a condyloma.

Although the vaccine protects against future HPV infections, it has no effect on HPV infections that have already been contracted. Thus, the vaccine is especially indicated for girls who have not yet started their sex life and have not yet been exposed to the virus.

Vaccination is given in 3 doses over a period of 6 months. Since vaccination is not 100% effective, it does not exempt women from Pap tests. The vaccine should be considered as a supplement to other preventive measures and not as a substitute.

Medical treatment Cervical cancer

Therapeutic options vary according to the severity of the abnormalities discovered by the physician.

Pre-cervical cells of the cervix

Various treatments can be used to treat precancerous cells of the cervix, to prevent them from becoming cancerous.

Colposcopy. The doctor examines the cervix directly with a specialized microscope. If necessary, the doctor can then perform a biopsy of the cervix to confirm the presence of abnormal cells and assess their severity. Sometimes regular colposcopy monitoring is sufficient for some mild abnormalities. Severe or precancerous abnormalities usually require treatment.

Electro surgery (LEEP or LLETZ). An electric current acts as a scalpel to eliminate abnormal cells.

Laser surgery. Very powerful light rays are directed to the precancerous cells to destroy them.

Cryotherapy. Extreme cold is used to destroy abnormal cells.

Surgical conization. The doctor removes a cone-shaped fragment of the cervix to remove the abnormal cells. This treatment is usually done in the operating room.

Hysterectomy. In some cases, this major surgery, which involves removing the uterus completely, should be considered.

Invasive cancers

When precancerous cells have progressed and become cancerous, more vigorous treatments must be considered. The choice of treatment depends, among other things, on the location of the tumor, its size and whether the patient wants to have children. The treatment of a cervical cancer can cause in fertility. Women who want to start a family should discuss this with their doctor.

Surgery. The tumor and surrounding tissues are removed. The intervention may be limited to a restricted area, in the case of very early cancers. The hysterectomy but usually proves necessary. For some more advanced tumors, the doctor will perform a radical hysterectomy with complete removal of the uterus, but also part of the vagina, tissues adjacent to the uterus and lymph nodes.
Minor surgeries can cause cramps, bleeding or vaginal discharge. These side effects are usually temporary.
Hysterectomy can cause nausea, pain or certain urinary or intestinal problems. Again, these are temporary side effects.

Radiotherapy. Radiotherapy involves directing ionizing rays to the cancer cells to destroy them. In some cases, the radioactive source can be inserted into the body near the tumor.
After a radiotherapy treatment, you may feel tired. The skin can also change its appearance at the treated place. These side effects are usually temporary.
Sometimes the treatment can make the vagina narrower. Relaxation exercises can be helpful. Finally, radiotherapy can lead to menopause, the end of menstruation and infertility.

Chemotherapy. Chemotherapeutic agents are drugs that attack cancer cells to destroy them. For cervical cancer, chemotherapy can be combined with radiation therapy to make the treatments more effective. These drugs are given as an injection. They kill cancer cells, but also some healthy cells, causing side effects such as nausea or intestinal disorders.

 

Complementary approaches

Check out our Cancer fact sheet for all of the complementary approaches that have been studied in people with cancer, such as acupuncture, visualization, massage therapy and yoga. These approaches may be appropriate when used in addition to, but not substituting for, medical treatments.

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