Cervical cancer


Cervical cancer is the second most common type of cancer, after breast cancer, affecting women in Romania, especially sexually active women over 30. About 4000 women are diagnosed with cervical cancer every year.

Symptoms of cervical cancer

Symptoms of cervical cancer are not always obvious and there may be no warning signs until it has reached an advanced stage. This is why regular screening for certain potentially cancerous lesions and at least annual Pap smears are very important.

Abnormal bleeding

In most cases, vaginal bleeding is the first visible symptom of cervical cancer. It usually occurs after sexual intercourse. Any bleeding that occurs at any time other than during menstruation is also considered abnormal.

Other symptoms of cervical cancer may include:

  • Pain in or around the vagina during sexual intercourse;
  • Vaginal discharge with unpleasant odour;
  • Pain when urinating.

Advanced cervical cancer

If cancer spreads from the cervix to adjacent tissues and organs, it can trigger many other symptoms, including:

  • Constipation;
  • Presence of blood in the urine (haematuria);
  • Loss of bladder control (urinary incontinence);
  • Bone pain;
  • Swelling of one of the legs;
  • Swelling of one or both kidneys, which can become deformed by an accumulation of urine and cause severe pain in the side or back region;
  • Changes in bowel and bladder habits;
  • Loss of appetite;
  • Weight loss;
  • Fatigue and lack of energy.

Causes and risk factors for cervical cancer

Human papillomavirus (HPV).

Almost all cases of cervical cancer occur in women who have previously been infected with the human papillomavirus (HPV). HPV is actually the name of a group of viruses and not a single virus. There are more than 100 different types.

HPV is spread during sexual intercourse and is thought to be common.

It is estimated that 1 in 3 women will contract an HPV infection within two years of starting a regular sex life.

Some types of HPV cause no detectable symptoms and the infection will pass without treatment.

Cervical intraepithelial neoplasia (CIN)

Cervical cancer usually develops over several years. Before cancer develops, cervical cells often show changes known as cervical intraepithelial neoplasia (CIN). CIN is a pre-cancerous condition. Pre-cancerous conditions do not pose an immediate health risk, but in the future they may develop into fully advanced cancer. However, most women who have CIN do not develop cervical cancer.

Other risk factors

Known risk factors include:

  • Smoking – women who smoke have twice the risk of cervical cancer compared to non-smokers; this may be due to the harmful effects of tobacco chemicals on cervical cells.
  • Weakened immune system – which can be the result of using certain drugs, such as immunosuppressive drugs, which are used to prevent rejection of donated organs, or as a result of a condition such as HIV/AIDS.
  • Use of oral contraceptive pills for more than five years – women who use oral contraceptive pills are thought to have twice the risk of developing cervical cancer compared to women who do not use oral contraceptive pills.
  • Children (the higher the risk the more children you have) – women who have two children are twice as likely to develop cervical cancer as women who have no children at all. The reason for the link between cervical cancer and childbirth is unclear. One theory suggests that hormonal changes that occur during pregnancy could make the cervix more vulnerable to the effects of HPV.

Diagnosing cervical cancer

If there is a suspicion of cervical cancer (e.g. due to abnormal vaginal bleeding), your gynaecologist will most likely recommend that you get tested for an STD.

Chlamydiosis is a bacterial infection with Chlamydia that is transmitted through sexual contact and is one of the most common sexually transmitted diseases worldwide, for which women have abnormal vaginal bleeding. Chlamydia infection increases the risk of HIV (human immunodeficiency virus) infection if exposed. An infected mother can also transmit the infection to her baby during birth.

Testing for chlamydia involves taking a small sample from the cervix or taking a urine test.


If you have had an abnormal cervical screening test result, or if your symptoms suggest that you may have cervical cancer, your gynaecologist may perform a colposcopy. This is an internal vaginal examination performed to see if there are any abnormalities in the cervix. In addition to examining the cervix, your gynaecologist may take a small sample of tissue for biopsy so that it can be examined under a microscope to see if cancer cells are present. Colposcopy is an easy, non-invasive procedure. The examination takes about 10-15 minutes and may cause vaginal irritation and burning for several minutes. It would be advisable to schedule your examination one week after the onset of menstruation.


If your gynaecologist cannot see your cervix properly using a colposcope, you may need to have a conization. Conization is a minor surgical procedure performed in a hospital, usually using a local anaesthetic.

During the procedure, a small conical or cylindrical section will be taken from the cervix and examined under a microscope for cancer cells. You may experience vaginal bleeding for up to four weeks following this procedure. You may also experience pain similar to that of your period. Conization is usually performed following a Pap test, a colposcopy and, if necessary, a targeted biopsy.

Further testing

If the biopsy results suggest that you have cervical cancer and that there is a risk that it has spread, you may need to have further tests to assess how far the cancer has spread. These tests may include: An examination of the pelvis carried out under general anaesthetic – the uterus, vagina, rectum and bladder will be checked for cancer.

  • Blood tests – which can be used to help assess the status of the liver, kidneys and bone marrow.
  • Computed tomography (CT scan) 3.2.- this method takes internal scans of the body, which are assembled into detailed three-dimensional images using a computer; CT is useful for locating cancerous tumours and checking whether cancer cells have spread.
  • Magnetic Resonance Imaging (MRI) – this type of scan uses strong magnetic fields and radiofrequency waves to produce detailed images of the inside of the body; this method can also be used to check the extent of cancer.
  • Chest X-ray – this will indicate if there has been extension of the cancer to the lungs.
  • Radiografie pulmonară – aceasta va indica dacă a avut loc extensia cancerului la nivelul plămânilor.
  • Positron Emission Tomography (PET) – this method is similar to MRI, except that it can also show how well different organs of the body are functioning; this type of scan can be used to see how well the patient is responding to treatment.


Staging is the measurement of how far the cancer has spread. The lower the stage, the greater the likelihood that treatment will be complete. Thus, cervical cancer is classified into 5 stages:

  • Stage zero (pre-cancer) – there are no cancer cells on the cervix, but there are biological changes that could trigger the onset of cancer in the future; this stage is called cervical intraepithelial neoplasia (CIN).
  • Stage I – the cancer is still only in the cervix.
  • Stage II – the cancer has spread outside the cervix to the upper section of the vagina or adjacent tissue.
  • Stage III – the cancer has spread to the lower section of the vagina and/or pelvic tissue.
  • Stage IV – the cancer has spread to the intestines, bladder or, in very advanced cases, to the lungs.

Treatment of cervical cancer

People with cervical cancer should receive care from a multidisciplinary team, a team of specialists working together to provide the best treatment. They all form the Oncology Commission.

Surgery as a treatment for cervical cancer

There are three main types of surgery for cervical cancer. These are:

  • Radical trachelectomy – the cervix, adjacent tissue and the upper portion of the vagina are removed, but the uterus is unaffected.
  • Radical hysterectomy – the cervix and uterus are removed; depending on the stage of the cancer it may be necessary to remove the ovaries and fallopian tubes.
  • Pelvic exenteration – a complex surgery that removes the cervix, vagina, uterus, bladder, ovaries, fallopian tubes and rectum.

Radiotherapy as a treatment for cervical cancer

Radiotherapy uses controlled doses of radiation to destroy cancer cells. For cervical cancer, this type of radiotherapy is often given in conjunction with low-dose chemotherapy. External radiotherapy is usually given daily, 5 days a week, with a break on weekends. Depending on the size of the tumour, you may need 1 to 6 weeks of treatment. Each radiotherapy session is short and will last about 5-10 minutes.

Another type of radiotherapy used is called internal radiotherapy or brachytherapy. For the treatment of cervical cancer the radioactive source is placed in the vagina. It delivers a high dose of radiation directly to the area where cancer cells are most likely to be found, and this helps minimise the effects of radiation on healthy tissue. The device is placed in the vagina or uterus for only a few minutes once a day and the treatment is repeated three to five times, making this treatment convenient for patients. The treatment is administered on an outpatient basis, and women who undergo it do not have to stay in hospital overnight, as they can continue their normal daily activities during treatment.

Radiotherapy is the only treatment used for early stage one cancer. It can be combined with chemotherapy to treat advanced stage two, stage III and early stage IV cervical cancer.

Radiotherapy is sometimes used after surgery. In advanced cancer (when there is a very large spread to other organs) radiotherapy can be used as palliative treatment to control bleeding and pain.

With the latest IMRT-VMAT technology, it is now possible to protect organs at risk that are close to the tumour from being affected by the treatment itself, while still being able to deliver high doses to the tumour.

For some patients, radiotherapy offers the only hope of getting rid of cancer.

Side effects include:

  • Diarrhoea;
  • Pain when urinating;
  • Bleeding from the vagina or rectum;
  • Feeling tired (fatigue);
  • Feeling sick (dizziness);
  • Inflamed skin in the pelvic region, similar to sunburn;
  • Narrowing of the vagina, which makes intercourse more painful;
  • Infertility;
  • Ovarian damage, which will usually trigger the early onset of menopause (if menopause has not already occurred);
  • Bladder and bowel damage, which could lead to urinary incontinence.

Chemotherapy as a treatment for cervical cancer

Chemotherapy can be combined with radiotherapy to treat the cancer; or it can be used as a palliative treatment method for advanced stage IV, thus slowing the progression of the cancer and relieving symptoms (palliative chemotherapy).

Chemotherapy involves either the use of a single chemotherapy drug or a combination of different drugs to destroy cancer cells. It is usually given using an outpatient intravenous infusion, so you will be able to go home after receiving your dose.

These drugs can also destroy healthy tissue and side effects are common. These include:

  • Feeling sick/painful (vomiting);
  • Diarrhoea;
  • Feeling tired all the time;
  • Anaemia;
  • Mouth ulcers;
  • Lack of appetite;
  • Hair loss – hair should grow back in three to six months after completion of chemotherapy treatment – although not all chemotherapy drugs cause hair loss;
  • Kidney damage (for certain types of chemotherapy).

The Oncology Commission recommends a treatment plan depending on the stage of cervical cancer. It can be one of the treatments or a combination of them:

  • For stage zero cervical cancer (cervical intraepithelial neoplasia) – the abnormal cells are removed, a procedure that can be carried out by various methods, including the use of lasers to “burn” the cells or an instrument that removes them by freezing.
  • For early stage I cervical cancer – surgery is used to remove a segment or the entire uterus.
  • For advanced stage I and stage II cancer – surgery or radiotherapy is used; sometimes surgery is followed by radiotherapy.
  • For stage III and early stage IV cancer – radiotherapy is used in combination with chemotherapy.
  • For advanced stage IV cancer – chemotherapy, radiotherapy and possibly surgery are used to provide palliative treatment.


After treatment is complete and the tumour has been removed from your body, you will need to come in for regular appointments for testing. As a rule, this will involve a physical examination of the vagina, and – if appropriate – the cervix.

If the examination detects any potentially suspicious changes then an additional biopsy may be performed.

In about 1 in 5 cases, cervical cancer can recur. This usually happens about 18 months after the completion of a treatment session.

Monitoring appointments are quite varied. They are usually recommended every four months after completion of treatment for the first two years and then every six to 12 months for a further three years.

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