"For young patients with fertility desires, if the tumor is smaller than 2 cm and there is no lymph node involvement, a conservative surgical treatment can be proposed that removes only the affected part of the cervix, as well as the lymph nodes."
DR. JOSÉ ÁNGEL MÍNGUEZ
SPECIALIST. GYNAECOLOGY AND OBSTETRICS DEPARTMENT
Cancer of the cervix is one of the most common cancers of the female genital tract.
The virus called human papilloma virus or HPV, a sexually transmitted infection, plays an important role in causing most cases.
Most are of the squamous type and come from the cells that cover the surface of the cervix. Those that come from the endocervical canal that is covered by glandular cells are called adenocarcinomas.
Thanks to prevention by means of cervical-vaginal cytology or Pap test, death from this type of cancer has decreased dramatically over the last 50 years.
Depending on the extent of the tumor, treatment can range from surgical removal of the tumor to more radical surgeries or to be complemented with chemotherapy and/or radiotherapy.
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What are the symptoms of cervical cancer?
Most of the time it is asymptomatic, especially at the beginning.
It can be associated with postcoital genital bleeding or between periods or at menopause. Sometimes there can be bloody or malodorous vaginal discharge.
Pelvic pain or pain during sexual intercourse is also referred to by some patients.
The most common symptoms are:
- Genital bleeding.
- Bloody or malodorous vaginal discharge.
- Pelvic pain.
Do you have any of these symptoms?
You may have cancer of the cervix
What are the causes of cervical cancer?
In general, cancer begins when normal cells acquire a genetic mutation that transforms them into abnormal cells that grow and multiply uncontrollably and also become immortal.
The accumulation of abnormal cells forms the tumor and also invades the surrounding tissues and can separate from it to spread throughout the body.
It is still not clear what produces this cellular transformation, although it is known that HPV infection plays an important role. However, HPV is a very common virus and most women will not develop cancer for this reason alone.
What are the risk factors?
- Multiple sex partners: the higher the number on either side, the greater the likelihood of acquiring HPV infection.
- Early sexual activity (less than 18 years): Immature cells appear to be more susceptible to the precancerous changes that HPV can cause.
- Immune system deficiency: typical of people who have had a transplant or who have HIV or other circumstances.
- Tobacco: although the exact mechanism is not well known, especially when associated with HPV infection.
How is cervical cancer diagnosed?
The diagnostic process when cervical cancer is suspected consists of the following steps:
- Clinical exploration that includes inspection and palpation of the cervix.
- Colposcopy (magnifying glass) helps to see lesions invisible to the naked eye.
- Cytology, although essentially used for prevention, can contribute to the suspicion of cancer.
- Biopsy of any suspicious area using specific tweezers for this purpose, in the consultation room and without the need for anesthesia or using "diathermy handle" (electric scalpel) with local anesthesia also in the consultation room.
- Conization: cone-shaped biopsy that allows a more complete study of the lesion than conventional biopsy.
When a cancerous lesion has been found, we perform the sentinel lymph node biopsy to find out if there is nodal involvement and if surgery can be more conservative.
How is cancer of the cervix treated?
When it is not yet an invasive cancer ("in situ" carcinoma), it can be treated by conization or hysterectomy depending essentially on fertility desires and some prognostic findings evidenced after analysis.
In invasive cancer, more extensive or radical treatment is required. Hysterectomy may be sufficient when the invasion is up to 3 mm. If the invasion is greater, a radical hysterectomy is recommended, which also removes part of the vagina and surrounding tissues, as well as the pelvic nodes. This surgery can also be done by laparoscopy or robotic surgery.
Radiation therapy can also be used as a curative treatment for these early stages, but because of its side effects, surgical treatment is preferred. When the size of the tumor is greater than 4 cm. or it has already spread outside the cervix, it is the treatment of choice, associated with chemotherapy that would act by enhancing the effect of the radiation.
Also in some locally advanced cases we do aortic lymphadenectomy by laparoscopy to know if it is necessary to also irradiate the aortic area.
When after radiotherapy a recurrence appears in the pelvis, the treatment can be a pelvic exenteration which involves the removal of the internal genitals next to the bladder or rectum. In some circumstances, in our center, we can add intraoperative radiotherapy when in spite of the exenteration there may be an added risk of new local recurrence. Whenever this surgery is performed, the preservation of bladder, rectal and vaginal function is valued through surgical reconstruction techniques, in order to achieve the highest quality of life for the patient.
In those circumstances where the disease may be advanced, affecting other parts of the body, chemotherapy is the most frequent treatment option. However, as all circumstances are not the same, in each case an individual treatment plan is made which in some cases involves a treatment that can integrate surgery, chemotherapy and radiotherapy.
Cervical cancer is a tumor of the middle ages and most cases are diagnosed between 35-50 years old. There is a significant number, more than 25% of women who present it, who are under 40 years old.
This, together with the fact that the age of motherhood is increasing, above 30 years and even close to 40, a not insignificant number of women who present a cervical cancer will still want to have a child.
The previously recommended surgical treatment for early stages (IA2 and IB1), tumors that infiltrate more than 3 mm or are up to 4 cm in diameter was radical hysterectomy and pelvic lymphadenectomy. In all cases, this operation led to loss of fertility.
In young patients with fertility desires, if the tumor is equal to or smaller than 2 cm in size, a conservative treatment can be performed that removes only the part of the cervix affected (trachelectomy) as well as the lymph nodes. The sentinel node study by laparoscopy can avoid the complications that sometimes arise from lymphadenectomy.
With this treatment it has been shown that fertility rates are high and tumor recurrence is low, results very similar to the more radical treatment previously performed.
Women who until now, as a result of cancer, lost the option of becoming mothers in exchange for a cure, may have the opportunity to be cured with a probability similar to that of the most radical surgeries, and also be able to have a future successful pregnancy.
Prevention should begin within three years of the start of sex at any age or no later than 21.
- Cervico-vaginal cytology (Pap test): serves to detect abnormal cells when cancer has not yet occurred.
- HPV test: to determine whether or not there is this infection and to determine which of the different types (high or low risk). The sample used can be the same as the cytology sample. The advantage of this test is that, by detecting some of the high-risk types, it can anticipate the cellular changes (dysplasia) that the cytology can see, but it does not replace it.
- Co-Testing: is the combination of the cytology and the HPV test, performed at the same time. This technique improves the sensitivity of the cytology in that when both tests are negative, the chance of developing severe dysplasia is very low over a period of up to five years.
What clinical trials do we have on Cervical Cancer?
Proton therapy against cancer
Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.
The Proton Therapy Unit of the Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.
Where do we treat it?
IN NAVARRE AND MADRID
OUR MEDICAL TEAM
Specialists from the Department of Gynecology and Obstetrics
Comprehensive care that includes a wide range of consultation and treatment options from regular preventive screening to the most advanced diagnostic and treatment options for obstetric and gynecological problems at all ages.
The department also offers routine pregnancy monitoring that includes a variety of diagnostic and screening procedures to identify potential problems of the fetus as well as its proper growth and development.
Why at the Clinica?
- Highly specialized team of doctors, nurses and midwives.
- Reproduction and Fertility Unit.
- Pregnancy follow-up with a personalized delivery.
- All the comfort, with the guarantee and safety of a hospital with the most advanced equipment.
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