Cervical cancer treatment
Cervical cancer is one of the most prevalent female malignant diseases. Human papillomavirus (HPV) is the proven cause of carcinoma. There are effective methods for cervix cancer treatment, including surgery, chemotherapy, radiotherapy, radiosurgery, targeted therapy, HIFU, and interventional radiology.
Cervical cancer, also known as cervical carcinoma, starts from the epithelium in the area of the external cervix. There are two different types of malignant tumours in the cervix:
- Squamous cell carcinomas (80%) - develop in the transition area (transformation zone) between the endometrium and the squamous epithelium of the vagina.
- Adenocarcinomas (20%) - occur from the mucosal cells of the cervix.
In medicine, two age peaks of morbidity are distinguished: from 35 to 39 years and 60 to 64 years. The disease requires prompt diagnosis and competent treatment under the supervision of an experienced gynaecologist, surgeon, and oncologist. Cervical malignancy is possible to prevent by targeting HPV infection. Thanks to the modern diagnostic approach, the condition can be easily diagnosed in the early stages, leading to successful treatment.
Cervical cancer is one of the most frequent malignant diseases among women. Although, over the past 30 years, the death rate from cervical neoplasm has decreased significantly. The reason is the high level of screening and vaccination against the underlying cause - human papillomavirus (HPV). But still, cancer ranks 4th among the malignancies and leading causes of death among women worldwide.
What causes cancer of the cervix?
It has been proven that the human papillomavirus (HPV) is the reason for cervical cancer. In 2008, Harald zur Hausen received the Nobel Prize "for discovering human papillomaviruses that provoke cervical cancer." HPV is primarily transmitted during sex. Therefore, the risk of getting the disease increases with a number of sexual partners.
But skin contact with an infected person can also be infectious. In most cases, an HPV infection heals without symptoms and consequences. So that is why regular screening, a smear of cells from the cervix (PAP test) and HPV vaccination are the best ways of cervical cancer prevention.
Additional risk factors for cervical cancer include:
- Infections of the genital organs by sexually transmitted pathogens (e.g. chlamydia);
- Chronic disturbance of the immune system;
- Long-term hormonal contraceptives (the pill) can slightly increase the risk of cervical cancer.
Background processes for cervical cancer are erosion, leukoplakia and erythroplakia. Dysplasia of the cervix belongs to the actual precancerous disorder. The mentioned conditions must be treated immediately after their detection to prevent further cervical tumours.
What symptoms to check for cervical cancer?
Usually, the preliminary stages of a malignant cell in the cervix do not cause any symptoms. Cervical cancer in the early stages is also not noticeable. If the disease is already at an advanced stage, the following symptoms can appear:
- Bleeding, for example, after sex;
- Bleeding between periods after exertion, such as cycling, horseback riding or having a hard bowel movement;
- Heavy menstrual bleeding or spotting (in women over 35 years of age),
- Swelling of the legs and genitals (at the last stages of the disease);
- Problems with the work of the bladder and intestines, the formation of fistulas;
- Urinary retention, anuria, uremia;
- Severe infections of the genitourinary system;
- Unexplained weight loss.
In the presence of a large malignant tumour, discharge from the vagina has an unpleasant odour. Pelvic pain, painful and frequent urination and difficulty in defecation are signs of late stages of cervical cancer. As soon as general or warning signs are detected, it is necessary to contact a specialist who will carry out a complete diagnosis.
It is worth mentioning that cancer can have no signs up to advanced stages. Therefore, women are recommended to conduct regular gynaecological screening.
Diagnostic steps for the tumour in the cervix
Necessary diagnosis measures for the detection of cervical cancer are:
- Physical examination: the doctor palpates the cervix and the body of the uterus through the vagina for possible changes.
- PAP test: the cell smear examination to detect malignancy or precancerous conditions in the cervix.
- HPV detection: a test to identify the human papillomavirus in the cervix.
In the case of abnormal findings, oncologist uses the following methods:
- Colposcopy - is the magnifying glass examination of the cervix and the vagina.
- Biopsy - is targeted tissue removal from the cervix for microscope examination.
- Conization - is a procedure of cutting out a cone-shaped piece of cervix tissue with an electric loop or a laser beam under anaesthesia.
- Histology - is the histological, microscopic examination of suspicious tissue, which is crucial to secure the diagnosis.
If a cervix carcinoma is found, further examinations must follow. Above all, they should show how far the tumour has already spread, whether lymph nodes are affected and whether metastases have formed in other body parts. These examination methods include:
The ultrasound examination of the abdomen (abdominal sonography) provides an insight into the internal organs such as the liver, kidneys, ureters, spleen and intestines. With this examination, the gynaecologist can determine whether a tumour has already spread to one of these organs (metastasis formation). X-ray of the chest is the method for lung metastases detection in the advanced stages of the disease. Mammography and breast ultrasound rule out concomitant breast cancer.
Computed tomography (CT) is an X-ray procedure for examining the body layer by layer. Unlike the normal x-ray, it shows a cross-section of the abdomen and is particularly suitable for assessing lymph nodes or distant metastases. Magnetic resonance imaging (MRT) also makes it possible to display the body in layers. The procedure works with magnetic fields. It is suitable for showing cervical tumour size and spreading to the surrounding organs. Your gynaecologist will prescribe a PET-CT scan to check for distant metastases in more advanced stages.
The stages of cervical cancer include:
- I: Malignant process affects the only cervix without damaging vessels and surrounding tissues.
- II: Cancer spreads beyond the cervix and uterus but does not affect the pelvic wall and vagina. There are no metastases.
- III: Tumours can infiltrate the lower part of the vagina, pelvic wall, ureters and nearby lymph nodes.
- IV: Cervical cancer with distant metastases.
Complex cervical cancer treatment
The first group of methods used in treating cervical cancer is divided into two main types: surgery and radiation therapy. The oncologists can use radiation therapy at any stage of the disease. However, surgical treatment is carried out in the early stages when minor intervention is required.
The best choice for treating cervical cancer is surgery to remove the tissue and the lymph nodes affected by cancerous cells, thereby curing the disease. In the case of tiny tumours detected early, a conical excision (conization) can be performed. If it is insufficient and the woman still wants to have children, the surgeon performs partial amputation of the cervix (trachelectomy) with permanent cerclage (closing the cervix). After both procedures, pregnancy is still possible.
There is also a minimally invasive surgical technique using the robotic system. For example, robot-assisted DaVinci cervical surgery ensures minimal trauma and reduces bleeding. And that means less pain, shorter recovery time and hospital stay for patients. But unfortunately, the method is rarely used because it is still not widely available in many clinics.
Chemotherapy attempts to kill cancer cells throughout the body using drugs that inhibit cell growth (cytostatics). Chemotherapy alone affects secondary tumours (metastases) and relieves symptoms in advanced stages of the disease (palliative treatment). But also, there are modern, more targeted types of chemotherapy:
- Transarterial chemoembolization (TACE) - is the injection of drugs into the vessel supplying the cancerous cells. The simultaneous blockage of this artery kills metastatic tumours quickly.
- Transarterial chemoperfusion (TACP) - is the introduction of antitumour drugs into the arteries feeding the malignant neoplasm.
Immunotherapy activates a patient's immune system to fight against cancerous cells in the cervix. Target therapy acts more specifically on cancer cells than on normal cells. For example, drugs prevent the formation of new blood vessels (known as angiogenesis), which cervical cancer needs to survive. It reduces the blood supply, and, as a result, the tumour stops growing and spreading.
Conventional radiotherapy uses radiation to destroy the malignant cells in the cervix. Nowadays, oncologists prescribe more targeted radiation - brachytherapy (internal radiotherapy). During the treatment, a radiation source is introduced into the uterine cavity or vagina and left until the desired radiation dose is reached. The irradiation remains locally limited, so that neighbouring organs are protected as much as possible. Another modern radiotherapy technique is proton beams. Protons treat cervical cancer with the help of high-powered energy. This therapy is safer than conventional radiotherapy because it has minimal effect on surrounding tissues. At the same time, the proton particles are much more powerful and precise.
High-intensity focused ultrasound (HIFU) is the method of mechanical destruction of cervical cancer using focused high-intensity ultrasound. It causes the formation of tiny, nanosized gas bubbles that expand rapidly and then flake, leaving a cavity in the malignant tissue, destroying it.
With successful treatment, women can have an everyday life after cervical cancer. The rehabilitation period includes measures to improve the patient's health and return to working capacity. In addition, women must monitor their diet and weight and regularly perform follow-up examinations.
What patient can expect?
The cervical cancer prognosis is favourable. For the last 30 years, the level of death from the disease has dropped significantly. However, now more than 50% of women are diagnosed with cervical carcinoma in the early stage.
That is why the survival rate for these patients is 90% during the first five years. However, if it is an advanced stage with metastases, the 5-year survival rate has remained almost unchanged for decades at an average of 69%.
Can cervical cancer spread?
A cervical tumour is usually limited to a small area at the beginning of its growth. However, it can spread to the surface of the cervix and invade the underlying tissue layers. Cancer can infiltrate the vagina, uterus, urinary bladder, rectum, and other organs and tissues within the abdominal cavity. Finally, cancer cells reach the lymph nodes of the small pelvis with the lymph flow and form metastases there.
Why do patients choose clinics abroad for cervical malignancy?
Modern oncology has many treatment methods that are not available in all countries. Therefore, patients are searching for alternative, less toxic or more targeted approaches for cervical cancer. The best clinics abroad usually include in their strategies advanced treatments like local high-dose chemotherapy (sometimes combined with embolization), HIFU, local radiotherapy (brachytherapy), and more effective targeted medications.
Is cervical cancer curable?
The early stages of cervical cancer are easily curable. However, if it is invasive malignant tumours, the success of the treatment depends on the extent of the disease and operation. If the surgeon can remove the entire tumour tissue, the chances of a cure are good. In more advanced stages, a permanent treatment is less likely, but it is sometimes possible.
Can you have cervical cancer with a normal pap smear?
A Pap smear identifies all abnormal cells that don't look healthy and may be cancerous. A normal result means that all cells look healthy, and there is no cancer in the cervix. However, the positive pap test does not always guarantee cancer; it can also be precancerous conditions and other damage to the cervix.
What is the best curative treatment for cervical cancer?
The best treatment for cervical cancer is surgical removal. There are many surgical techniques, but the aim is to resect the affected tissues and cure cancer. Unfortunately, radical treatment is not always possible.
Where can I get Cervical cancer treatment?
What are the best clinics for Cervical cancer treatment?
Who are the best doctors for Cervical cancer?
Prof. Dr. med. Thomas J. Vogl from University Hospital Frankfurt am Main of Goethe-University
Dr. med. Anett Tillmann, MBA from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Roland Ladurner from Academic Hospital Martha-Maria Munich
Prof. Dr. med. Alexander Muacevic from European Radiosurgery Centre Munich
Prof. Dr. med Harald-Robert Bruch, MSc, PhD from Oncological and Haematological Praxis Clinic Bonn