What is it?
Cervical cancer is the neoplasm that affects the portion of the uterus that juts into the vagina and is called the portio. Cervical carcinoma has a well known natural history that, through pre-neoplastic forms (determined by papillomavirus infection) and carcinoma in situ, leads to the invasive type of cancer. Cervical cancer is the second most common cancer in women.
Cervical cancer is one of those cancers for which there is now a preventive screening; the two main screening tests in the world are represented by the PAP test (commonly called vaginal smear), and the search for HPV DNA. The first is a cytological examination that tends to detect cellular alterations of the distal part of the cervical canal; it should be done in women who have not used lavage and/or ovules for at least 24 hours, who have no bleeding and/or inflammatory processes in place and who have not had sexual intercourse for 24 hours.
HPV DNA test detects the presence of the HPV virus, the main player responsible for cervical carcinogenesis. Мaccination against the papillomavirus is very important in the prevention of infection and cancer. The 9-valent vaccine (Gardasil® 9), in addition to subtypes 16, 18, 6, and 11 (strains with high oncogenic risk), also protects against subtypes 31, 33, 45, 52, and 58.
Causes and risk factors
Risk factors for developing invasive cervical neoplasia include early onset of sexual activity, high number of partners, multiple pregnancies, young age at first pregnancy, low socioeconomic status, cigarette smoking, genital infections, and poor sexual hygiene. Infection with human papillomavirus (HPV) is a necessary but not sufficient condition in the development of cervical neoplasia; in about 99.7% of cervical carcinomas the DNA of the virus is found. The simultaneous existence of concomitant causes (immunodepression, other sexually transmitted infections) create the conditions for the establishment of persistent HPV infection.
How is it diagnosed?
The diagnosis of cervical cancer is made more frequently on the basis of a doubtful or positive Pap test and/or HPV DNA test, which are level I examinations. The level II examination aimed at detecting the presence and severity of pre- and cancerous lesions is colposcopy, with which a biopsy can be taken to get a histological diagnosis of the lesion.
- Abnormal vaginal bleeding (outside of the menstrual cycle)
- Unusual vaginal discharge (in color and consistency)
- Pelvic pain
- Pain or bleeding during sexual intercourse.
How is it treated?
Treatment depends on the age of the patient and the stage (extent of the tumor). Surgical treatment of portio cancer is reserved for the early stages. Early stage treatment:
- Conization, which allows the preservation of reproductive activity with eventual lymphadenectomy or removal of sentinel lymph nodes;
- Radical hysterectomy with lymphadectomy or sentinel lymph node removal.
Advanced stage local treatment:
- Radiotherapy with concomitant chemotherapy.
In selected cases, it is possible to consider a treatment with neoadjuvant chemotherapy followed by definitive surgical treatment. Advanced stages with distant metastases deserve definitive chemotherapy treatment. There are currently ongoing clinical trials involving the use of immunotherapy-type drugs for the treatment of advanced or recurrent cervical cancers.
Where do we treat it?
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