Cervical Cancer and HPV

What is cervical cancer?

Cervical cancer is a malignant tumor originating from the cervix. The cervix is ​​called the uterine cervix in technical language, and the lower part of the uterus, which connects the vagina with the uterus. The bottom of the cervix can be seen by a gynecological examination and can often be felt by the woman herself deep in the vagina.

By cervix meet glandular tissue of the cervical canal (cylindrical cells) with the surface tissues of the vagina (plate-shaped cells). In most cases of cervical cancer and precancerous cervical cancer arises as that in which the two types of tissue meet. The area is called the transition zone and the LSP transformation zone.

Most cases of cervical cancer beginning at the surface of cells in the transition zone (squamous cell carcinoma), while a minor portion extending from the cylindrical cells (adenocarcinoma).

How common is cervical cancer?

In South Africa, cervical cancer, the third most common cancer in women under 35 years.

The number of cases of cervical cancer in South Africa has declined over the past decades from about 600 cases per year to about 350 in 2012. The lifetime risk of 1%. This decrease is attributed to the introduction of the national screening program for preliminary stages of cervical cancer (cell sample / smear). It is expected that HPV vaccination will lead to a further decline.

Some 15,000 South African women get each year demonstrated precursors to cervical cancer and 5,000 undergoing cone biopsy for cervical cancer precursors. Only a small proportion of these precursors to develop into cancer.

On world basis is cervical cancer, second only to breast cancer, the most common cancer in women. More than 80 percent of new cases of cervical cancer occur in countries where there is an organized program of population survey. Each year approximately 60,000 women in Europe cervical cancer and nearly 30,000 women die of the disease.

The number of cases of cervical cancer has declined dramatically in countries that have introduced effective population surveys in the form of examination for cell changes.

What causes cervical cancer?

Cervical cancer caused by an infection with HPV virus (Human Papilloma Virus). There are over 100 kinds of HPV, some of which are carcinogenic in humans. HPV types 16 and 18 are responsible for 70% of all cases of cancer of the cervix, the residue is due to less frequent HPV types.

HPV infection is a sexually transmitted disease, and 80% of all sexually active have had an HPV infection. Most HPV infections disappear without symptoms and do not cause cell changes. It is only in cases where the infection is persistent, and the body is unable to fight the virus, the risk of developing cancer.

HPV virus may be latent in the cervix and be activated by an impairment of the immune system, either because of disease that weakens the immune system or old age.

The incidence of cervical cancer is highest in women 35 years of age, falls again in 45 to 65 years of age and rises again at 75 years old.

Precancerous cervical lesions found predominantly in young women.

Tobacco smoking increases the risk, since smoking can cause harmful substances in the tissues, which increases the risk of cancer developing later.

What are the symptoms of cervical cancer?

Cancer of the cervix allows in the earliest stages sometimes no symptoms, but that is typical bleeding disorders and vaginal discharge.

There may be vaginal bleeding after menopause or bleeding during sexual intercourse. These symptoms should always be investigated. In other cases, there spotting between periods or irregular bleeding.

Udflådet may be aqueous at first, but is often bloody gradually and possibly. smelly.

In advanced cases there may be pain in the abdomen.

How is it diagnosed?

Often available suspicion after a routine Pap smear in the screening study. The doctor may also suspect cervical cancer at the gynecological examination if there is seen a wound or a tumor of the cervix. Diagnosis is made by tissue samples from the cervix and a scraping from the cervix. These tissue samples can in most cases be taken without anesthesia, but there may be local anesthetic.

If there is evidence cervical cancer is made at the hospital a gynecological examination in general anesthesia, which examines whether the cancer has spread. Here one can supplement with curettage of the uterus and colonoscopy bowel and bladder. Other studies have X-ray examination and various scans.

In some early cases of cervical cancer is to perform an cone biopsy of the cervix to assess the spread of cancer change.

What treatment is there?

In the very early stages of cervical cancer, a cone biopsy may be sufficient.

In most cases, the treatment operation, which removes the uterus and the upper small portion of the sheath. Often you will also remove the lymph nodes in the pelvis to which the cancer typically spreads.

In individual cases of cervical cancer in young women who have not had children, it may be possible to preserve the uterus and only remove the cervix and lymph nodes. This operation is called trakelektomi and carried out only on special hospitals.

In other, more advanced, cases are treated the disease with radiation therapy and / or chemotherapy, possibly. by a combination of surgery and radiation therapy.

How is long-term prospects?

The disease is divided into four stages (I-IV), depending on how much the disease has spread at diagnosis. The higher the stage, the greater the risk of dying from the disease.

The very early stages of cervical cancer can be removed by surgery. Here is a very small risk of disease recur.

At a cancer that is confined to the cervix and has not spread, the 5-year survival from 85 to 90% (the average proportion of women with the disease to live five years after diagnosis). Has the disease spread to the upper part of the vagina or grows out against the pelvic wall is 5-year survival is about 60%. Growing cancer into the lower part of the vagina or completely out of the pelvic wall is 5-year survival 30% and has spread to distant organs, the 5-year survival 15%.

Without treatment, the disease will spread into the surrounding tissues and grow into the vagina. The tumor can spread to the bladder and rectum and can cause pain and problems with urination and defecation.

There may also be genes, and complications in the treatment of the disease. After an operation in which the lymph nodes in the pelvis will be removed, it may cause the accumulation of lymph and problems with drainage of the lymph from the legs. After radiation therapy can cause irritation of the bladder and the intestine and, in rare cases a fistula between the bladder and vagina, or intestinal and vaginal.

How do I avoid or aggravate cervical cancer?

By vaccinating with HPV vaccine Prior to the onset of sexual may be 70% of all cervical cancer cases are preventable.

Vaccination has not demonstrated activity when that has developed cancer or precancerous lesions on the cervix.

The risk of developing cancer reduced by detecting and treating precancerous cervical cancer. The earlier you detect precursors, the easier they are to treat, and the greater the chance is there to prevent cervical cancer.

In South Africa, all women aged 23-65 years cell sample from the cervix routinely every 3 years. Regular participation in population screening can detect about 80 percent of all the precursors of cervical cancer. In most cases, you can treat the precursors, and it can be avoided that develops cancer.

There is no reason for Pap smears with periods shorter than three years, if there are normal cells. However, it is important that all women with abnormal pap smear tests are followed up according to the guidelines.

In more than half of the cases of cervical cancer a woman has not participated in the regular celleprøvetagninger.