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 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.
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:
Advanced cervical cancer
If cancer spreads from the cervix to adjacent tissues and organs, it can trigger many other symptoms, including:
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 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.
Known risk factors include:
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.
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.
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:
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.
There are three main types of surgery for cervical cancer. These are:
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:
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:
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:
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.