Cervical cancer is the tumorigenesis of the tissue by transforming into malignant cells by undergoing some changes. The place called the cervix is the part of the uterus, that is, the exit part of the uterus and the vagina. Cervical cancer is a type of cancer that usually progresses slowly. Today, early diagnosis is made in patients with early screening and awareness-raising studies. In almost all cancer diseases, early diagnosis is of great importance for the treatment process.
What cause cervical cancer?
Cervical cancer is mostly caused by infection with human papillomavirus (HPV). In addition, smoking, starting the first sexual intercourse before the age of 18, multiple sexual partners, sexual intercourse with a partner with cervical cancer are among the factors that increase the risk of cervical cancer.
What are the symptoms of cervical cancer?
At early stages, uterine cancer may not show many symptoms. For this reason, regular screening of HPV infection should be done carefully from a young age. During the progression of the disease, complaints such as abdominal pain or bleeding may occur. If you have complaints such as bleeding between menstrual periods, which are among the leading symptoms of cervical cancer, and reoccurrence of bleeding after menopause, you should consult a specialist doctor.
After listening to the patient’s history, a physical examination is performed. After the transvaginal USG application, information about the characteristics of the endometrium is obtained. In order to make a definitive diagnosis, biopsy, that is, tissue suspected of tumor is taken and analyzed. In the next stages, methods such as magnetic resonance, tomography, X-ray and blood tests are used.
Cervical cancer treatment
Surgery in cervical cancer is a preferred method at early stage. However, radiotherapy is among the treatment options that can be used alone or in combination with chemotherapy. If the disease has progressed and spread to distant tissues, chemotherapy and targeted smart drugs can be applied. The stages of the disease are an important source for the determination of the treatment method.
Treatment applied at early-stage cervical cancer
Surgery is a treatment applied only at very early stage at early-stage cervical cancers. The most performed total abdominal hysterectomy and bilateral salpingo-oophorectomy are the removal of the uterus, cervix, and both ovaries from the body together with the surrounding tissue lymph nodes.
If the disease is still at a microscopic level, a treatment in which a part of the cervical canal called cervical conization is removed is applied and fertility is preserved in this treatment. Fertility is preserved in the radical trachelectomy method. In this method, all or part of the cervical canal is removed. The type of surgery to be applied varies according to the extent of the disease and the expectation of the patient.
Radiotherapy in the treatment of cervical cancer
Radiation therapy, that is, radiotherapy, is a treatment method applied to kill abnormal cells by targeting the X-ray with high energy to the cancerous region. Before the treatment process, the region that needs to be irradiated is determined and sent to the tumor in the region by the devices. By using different radiotherapy devices, the process is performed without damaging the body integrity by making use of technological developments. In external beam radiotherapy (EBRT), it is aimed not to damage healthy tissues by sending minimal radiation as much as possible. At this point, three-dimensional radiotherapy techniques are also used with the help of magnetic resonance and tomography. Intensity modulated radiotherapy is called intensity modulated RT (IMRT). Stereotactic radiotherapy (SBRT) is preferred for tumors within a limited region. The lethal radiation dose that is planned to be administered to the person can be given in one or several times (fractions) with some special technological devices.
When cervical cancer is treated with radiotherapy/radiochemotherapy alone, high doses are required to control the disease. EBRT is administered up to a certain dose in order not to damage the surrounding organs such as the Intestinal or bladder. And brachytherapy is applied to deliver the remaining dose.
In brachytherapy, which is one of the types of radiation therapy, it is the process of applying radiotherapy to tissues or cavities, and tumor sources closely. Radioactive sources can be applied temporarily or permanently. In the temporary application, since the source will move away from the patient after the procedure, there is very little exposure to radiation and the person can continue to live.
In cervical cancer, the method applied to the cavities in general, namely intracavitary brachytherapy, is preferred. In this method, the radioactive source is positioned in the anatomical spaces adjacent to the tumor.
Chemotherapy in the treatment of cervical cancer
Chemotherapy is given in cancers that have spread beyond the cervix and surrounding lymph nodes, which we call locally advanced stage, or in metastatic disease.
Low-dose platinum-based chemotherapies are administered simultaneously with radiotherapy in the local advanced stage to increase the effectiveness of radiotherapy. In the metastatic stage, higher doses should be applied according to the general conditionof the patient.