Cervical cancer is a type of cancer that is mainly related to the HPV virus infection, having a slow development and that does not lead to the appearance of signs or symptoms, being noticed only during gynecological exams.
However, when the cancer is at an advanced stage, some symptoms such as vaginal bleeding outside of menstruation and after intercourse, abnormal discharge and constant pelvic pain may be noticed.
It is important that the woman sees the gynecologist regularly and that she undergoes the preventive examination every year or according to the doctor’s guidance, as this way it is possible to identify any changes that may be suggestive of cancer early, and then start the treatment most appropriate.
Symptoms of Cervical Cancer
Cervical cancer develops slowly and, therefore, in the initial stage of the disease, no signs or symptoms are identified, and this type of cancer is only identified during the preventive exam or when the cancer is already at a more advanced stage, as at this stage there may be symptoms, the main ones being:
- Uncaused vaginal bleeding apparent and outside menstruation, it can also happen after sexual intercourse;
- altered vaginal discharge, with a bad smell or brown coloration, for example;
- Constant abdominal or pelvic pain, which can worsen when using the bathroom or during intimate contact;
- feeling of pressurethe one in the bottom of the belly;
- Willingness to urinate more frequently, even at night;
- fast weight loss without being on a diet.
Furthermore, in some cases there may also be excessive tiredness, pain and swelling in the legs, as well as involuntary leakage of urine or feces. Know other signs that could indicate problems in the uterus.
In the presence of signs and symptoms indicative of alterations in the uterus, it is important that the gynecologist be consulted for an evaluation and tests that can help identify the cause of the symptoms and the presence of cells with potentially malignant characteristics. See which exams assess the cervix.
How is the diagnosis made
The diagnosis of cervical cancer must be made by the gynecologist through a pelvic exam and evaluation of the clinical history. During the gynecological evaluation, vaginal examination and analysis of the vagina and cervix can be performed.
In addition, colposcopy and pap smear tests are recommended, which is also known as a preventive test, as this makes it possible to assess the cervix in more detail. Learn more about the Pap smear.
If the presence of abnormal cells is verified during the Pap smear, a biopsy may be requested, in which a small sample of tissue from the cervix is collected to be analyzed in the laboratory.
Who is at higher risk of getting cancer
The risk of cervical cancer is higher in women who have HPV infection, have multiple sexual partners, who use oral contraceptives for a long time, or who smoke a lot. Furthermore, the risk is greater in women who have other sexually transmitted infections, such as chlamydia or gonorrhea, for example.
Stages of cervical cancer
After making the diagnosis, the doctor usually classifies cervical cancer according to its stage of development, with the stage indicated in the medical report:
- Tx: Unidentified primary tumor;
- T0: No evidence of primary tumor;
- Tis or 0: Carcinoma in situ.
Stage 1:
- T1 or I: Cervical carcinoma in the uterus only;
- T1 a or AI: Invasive carcinoma, diagnosed only by microscopy;
- T1 to1 or IA1: Stromal invasion up to 3 mm deep or up to 7 mm horizontally;
- T1 a2 or IA2: Stromal invasion between 3 and 5 mm in depth or up to 7 mm horizontally;
- T1b or IB: Clinically visible lesion, only in the cervix, or microscopic lesion larger than T1a2 or IA2;
- T1b1 or IB1: Clinically visible lesion measuring 4 cm or less in its largest dimension;
- T1b2 IB2: Clinically visible lesion measuring more than 4 cm in its largest dimension.
Stage 2:
- T2 or II: Tumor found inside and outside the uterus but does not reach the pelvic wall or the lower third of the vagina;
- T2a or IIA: No parametrium invasion;
- T2b or IIB: With parametrium invasion.
Stage 3:
- T3 or III: Tumor that extends to the pelvic wall, compromises the lower part of the vagina, or causes changes in the kidneys;
- T3a or IIIA: Tumor involving the lower third of the vagina, without extension to the pelvic wall;
- T3b or IIIB: Tumor that extends to the pelvic wall, or causes kidney damage
Stage 4:
- T4 or VAT: Tumor that invades the bladder or rectal mucosa, or extends beyond the pelvis.
In addition to knowing the type of cervical cancer a woman has, it is also important to know whether there are affected lymph nodes and metastases or not, as it helps to determine the type of treatment the woman needs.
How is the treatment done
Treatment for cervical cancer depends on the stage the tumor is at, whether there are metastases from the disease, age, and the woman’s general health status. The main treatment options include:
1. Conization
Conization is the removal of a small part of the cervix, in a cone shape. Although it is the most widely used technique to biopsy and confirm the diagnosis of cancer, conization can also be considered a form of standard treatment in cases of HSIL, which is a high-grade squamous intraepithelial lesion, which is not yet considered cancer, but it can develop into cancer. See how the conization of the uterus is done.
2. Hysterectomy
Hysterectomy is the main type of surgery indicated for the treatment of cervical cancer, which can be used in the early or more advanced stages and which is usually performed in one of the following ways:
- Total hysterectomy: removes only the uterus and cervix and can be done through a cut in the abdomen, laparoscopy or through the birth canal. It is usually used to treat stage IA1 or stage 0 cervical cancer.
- Radical hysterectomy: in addition to the uterus and cervix, the upper part of the vagina and surrounding tissues, which may be affected by cancer, are also removed. In general, this surgery is recommended for cases of cancer in stages IA2 and IB, being performed only by cutting the abdomen.
It is important to remember that in both types of hysterectomy, the ovaries and fallopian tubes are only removed if they have also been affected by cancer or if they have other problems. See types of hysterectomy and care after surgery.
3. Trachelectomy
Trachelectomy is another type of surgery that removes only the cervix and the upper third of the vagina, leaving the body of the uterus intact, allowing a woman to still become pregnant after treatment. Usually, this surgery is used in cases of cervical cancer detected early and, therefore, has not affected other structures.
4. Pelvic exenteration
Pelvic exenteration is a more extensive surgery that may be indicated in cases where the cancer returns and affects other regions. In this surgery, the uterus, the cervix, the pelvic ganglia are removed, and it may also be necessary to remove other organs such as the ovaries, fallopian tubes, vagina, bladder and part of the end of the intestine.
5. Radiotherapy and chemotherapy
Treatment with radiotherapy or chemotherapy can be used both before and after surgical treatments to help fight cancer, especially when it is in advanced stages or when there are tumor metastases.
