What you should know about cervical cancer and whether there is life in remission
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According to the World Health Organization, cervical cancer (CRC) is the fourth most common type of cancer among women in the world. In 2020, 604,000 new cases of the disease and 342,000 deaths were registered on the planet. About 90% of new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. “Ukrainian truth. Life” analyzed what causes this disease, how to prevent it, detect it in time and treat it. In addition, we will explain how human papillomavirus, for which there is a vaccine, is associated with cervical cancer and debunk a number of myths about cervical cancer. Obstetrician-gynecologist, doctor-oncologist of the “Dobrobut” medical network Roman Ismailov and head of the department of minimally invasive surgery of the Kyiv Oncology Center, doctor of medical sciences, oncologist Kateryna Kharchenko helped us to understand. What is cervical cancer and how does it occur Cervical cancer is a type of cancer that occurs in the cells of the cervix, particularly in its lower part, which connects to the vagina, explains the Mayo Clinic, an American academic medical center, the cell’s DNA contains instructions, which tell her what to do. Healthy cells grow and reproduce at the right rate and eventually die at a set time. The cancer process begins when healthy cells of the cervix begin to mutate. Mutations cause cells to grow and multiply uncontrollably. Accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break away from the tumor to spread (metastasize) to other parts of the body. Also, a neglected tumor can spread to nearby organs, namely the rectum and bladder. Photo: drnn/Depositphotos Cervical cancer is usually preceded by a condition called dysplasia, when cells with a different appearance than typical are found on the surface of the cervix. Dysplasia is asymptomatic, so it can only be detected by a doctor during an examination. However, dysplasia is not yet cancer. It can be both light and heavy. In cases of lung disease, the patient is observed, because dysplasia can usually disappear on its own. In severe cases, excision of the pathological area is performed. At the same time, the cervix and uterus continue to function after the intervention, and a woman can conceive and give birth to a child. If severe dysplasia is not treated, it usually turns into cancer. You should not worry when a gynecologist finds any changes on a woman’s cervix. For example, ectopy, which is mistakenly called erosion of the cervix. Usually, these changes are natural and won’t turn into cancer after a year or two. The main thing is to visit the doctor on time, who will monitor the changes. According to WHO, cervical cancer in women with a normal immune system can develop from 15 to 20 years. How the human papillomavirus is linked to cervical cancer Professor Harald zur Hausen has demonstrated a link between the human papillomavirus (HPV) and cervical cancer. For his work, he received the Nobel Prize in Physiology and Medicine in 2008. “These studies had revolutionary consequences. The first anti-cancer vaccine was created,” says Kateryna Kharchenko. HPV is mainly transmitted sexually. Most people become infected with it soon after they start having sex. Different strains of HPV play a role in causing most cases of cervical cancer, according to Christina Butler, a gynecologic oncologist at the Mayo Clinic. “When exposed to HPV, the immune system usually fights off the virus. However, in a small percentage of people, the virus survives for years, contributing to a process that causes some cervical cells to turn into cancer cells,” explains Christina Butler. Photo: rob3000/Depositphotos According to the WHO, the vast majority of cervical cancer cases (more than 95%) are caused by HPV. “Although most HPV infections resolve on their own and most precancerous lesions disappear spontaneously, all women are at risk that HPV infection can become chronic and precancerous lesions progress to invasive cervical cancer,” the organization says. However, the Mayo Clinic points out that other factors also determine whether you will get cervical cancer. First of all, it is about the environment and lifestyle. Cervical Cancer Symptoms Neither dysplasia nor early stage cervical cancer usually cause any signs or symptoms. “Therefore, the only chance to prevent the disease or at least “catch” it at an initial stage is to visit a gynecologist at least once a year,” says Roman Ismailov. Kateryna Kharchenko says that young women with cervical cancer who have not visited a gynecologist for more than 5 years for various reasons often come to see her. “Everyone has their own reason: “career – no time”, “nothing bothered me”, “I don’t have a sexual life – why should I be checked”. Usually every fourth case of RSM is found in an advanced stage. Although this disease is a visual form of cancer That is, it can be detected at a precancerous and early stage and radically treated so that it does not return to this again,” says the doctor. Photo: photographee.eu/Depositphotos Signs and symptoms of later-stage cervical cancer include: vaginal bleeding after intercourse, between periods, or after menopause; watery, bloody discharge from the vagina, which can be abundant and have an unpleasant smell; pelvic pain or pain during intercourse. According to Roman Ismailov, in neglected cases, when the cancer already affects neighboring organs, a woman may experience dysuric disorders (urination problems) and defecation problems. “Very often such women go, for example, to urologists. However, problems with the urinary bladder may be related to the growth of a tumor that previously developed on the cervix,” says the doctor. How cervical cancer is diagnosed Cervical cancer screening, which should be done once a year in the absence of symptoms, includes: colposcopy: examination of the vagina and cervix using an optical device; cytology (PAP test): scraping from the vaginal part of the cervix and cervical canal; human papilloma virus test; ultrasound Kateryna Kharchenko believes that the most important are the Pap test and the HPV test. Chair examination and ultrasound can be considered only additional methods. “There are only two tests for cervical cancer screening in the world. These are the Pap test (cytology smear) and the HPV test. Or their combination – co-testing. Other methods (neither colposcopy, nor ultrasound, nor analysis for various infections) have no relation to the screening of RSM,” she says. Since 2014, studies have been published that prove that HPV testing as a primary screening method is the most effective and cost-effective. The second diagnostic stage is a biopsy of the cervix – removal of a piece of the affected tissue and its further study to confirm the oncodiagnosis. The procedure is not part of mandatory screening and is prescribed only when there are indications for it. “If the patient has a bad colposcopic picture and cytological examination, a biopsy is prescribed. Only the results of the biopsy are the basis for diagnosing a person with oncology,” says Roman Ismailov. Further treatment of the patient depends on the results of the biopsy. Also, if an oncodiagnosis is suspected, the doctor can prescribe magnetic resonance and computer tomography with contrast to determine the spread of the tumor and understand whether there is metastasis. How cervical cancer is treated and whether sex life is possible after remission After the patient undergoes the necessary diagnosis, she will be offered treatment depending on the stage and type of cancer. Like other cancers, cervical cancer is treated with surgery (removal of the cervix, uterus, sometimes ovaries, lymph nodes, and part of the vagina), radiation therapy (both external and internal), and chemotherapy. Sometimes one or two of these types of treatments are enough, and sometimes all of them need to be involved. If the treatment was successful, the woman goes into remission, but must periodically visit the doctor and do control tests. The first two years – every 3 months, the next 5 years – once every 6 months, and then once a year. It is necessary to be checked in order to prevent relapse – the reappearance of cancer. Photo:vitalio333/Depositphotos “Almost a third of patients (28-30%) have relapses after successful treatment. 80% of them occur in the first two years after remission. Survival after relapse is 27%, and this is in the case of local relapse without distant metastases” , – says Roman Ismailov. Is sexual life possible after treatment of cervical cancer, especially radical, which involves the removal of certain organs? “A gynecologist often has to be a psychologist as well. My patients sometimes say that after the operation to remove the uterus they will “cease to be women”. This is a complete delusion. First of all, neither the uterus nor the cervix is involved during intercourse and has no role in this they don’t play. Everything happens in the vagina, which remains after the operation. Secondly, during sex, a man does not feel whether a woman has a uterus or not. The only “task” of the uterus is childbirth,” says Roman Ismailov. Kateryna Kharchenko refutes another myth about sex after removal of the uterus. He said, a woman cannot have an orgasm after such an operation. “Orgasm occurs due to nerve impulses transmitted from the genitals to the brain. It occurs when erogenous zones are stimulated – they can be different parts of the body, and they are individual for each person. Several nerves are responsible for sensations during sex (not one and not two ). The orgasm will be felt differently depending on which nerves are involved. After the operations, you will definitely be able to feel the orgasm. Because it is practically impossible to cross all the nerves responsible for it,” the doctor explains. What you need to know about vaccination against human papillomavirus The risk of developing cervical cancer can be reduced by regular screening and vaccination against HPV. In 2020, the WHO published a strategy according to which by 2050, more than 40% of new cases of RSM and 5 million related deaths in the world can be prevented. 194 countries have pledged to eradicate this type of cancer by 2030. The global strategy to accelerate the elimination of cervical cancer outlines three key steps: vaccination, screening and treatment. “Eliminating all cancer once seemed like an impossible dream, but now we have cost-effective, evidence-based tools to make that dream a reality,” said WHO Director-General Dr Tedros Ghebreyesus. If no additional measures are taken, the annual number of new cases of cervical cancer is expected to increase from 570,000 to 700,000 between 2018 and 2030, and the annual number of deaths will increase from 311,000 to 400,000. Photo: imagepointfr/ Depositphotos However, the WHO strategy was launched at a difficult time. The COVID-19 pandemic has created challenges for preventing cancer deaths. In Ukraine, the war creates problems for the timely detection of RSM, due to which many women do not have access to medical care. We also do not have a state vaccination program against the human papillomavirus (HPV). “Elimination of cervical cancer will be possible only with a combination of vaccination and screening, preferably with HPV testing,” says Kateryna Kharchenko. Roman Ismailov also believes that RSM is a controlled disease that can be prevented by vaccination. “In the developed countries of Europe, in particular in Denmark and Sweden, girls and boys are vaccinated against HPV at the national level. This is done before the beginning of sexual life. This virus can cause not only cervical cancer, but also cancer of the anal canal, penis, and oropharynx.” – says the doctor. According to doctors, there are three types of HPV vaccines. “Any vaccination is usually perceived ambiguously by society. But vaccination is an effective method of preventing the occurrence of one or another disease. It is especially important that in the case of HPV vaccination, we are actually talking about preventing cancer,” says Kateryna Kharchenko. Yana Osadcha, “UP. Life” Read also: “There will be no “charitable” contributions”: the new director of the Cancer Institute on free treatment, corruption and treatment of patients
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