Cancer is one of the leading causes of death worldwide and is expected to increase, especially in developing countries. The World Health Organization (WHO) predicts that between 2005-2015, approximately 84 million people worldwide will die from untreated cancer, of which 40% are preventable cancers. Therefore, the WHO has a policy for all countries worldwide to campaign for cancer prevention starting from childhood.
Assoc. Prof. Dr. Yaowalak Chansilp, Department of Radiology, Faculty of Medicine Siriraj Hospital, commented that the danger of all types of cancer is the loss of function of the affected organ or the spread of the disease. Therefore, the danger of cancer depends on the organ where the cancer originates and the organs to which it spreads. For cervical cancer, although the uterus is not a vital organ for survival, a localized tumor can cause chronic and severe bleeding that may be life-threatening. It can also cause severe pain and compress the ureters, leading to kidney failure. Another danger is the failure of organs to which the disease has spread.
Causes of Cervical Cancer
Cancer occurs when cells are stimulated to change over a long period. Carcinogens may be pathogens, especially viruses, chemicals causing chronic irritation, or anything that causes cell injury. In cervical cancer, the Human Papilloma Virus (HPV) is the most important carcinogen.
Who is at Risk of Cervical Cancer?
Cervical cancer is related to sexual activity. Those at risk are individuals infected with HPV, especially those who have sexual intercourse at a young age, have many children, have multiple male sexual partners, have partners with multiple sexual partners, and those with immunodeficiency, particularly HIV-infected individuals, who have a 5-6 times higher risk than normal people. In countries where men undergo circumcision, the incidence of cervical cancer is reduced.
Women who have families and monogamous husbands are also at risk of cervical cancer because the disease is associated with injury or chronic irritation, especially if they have many children, or if their husbands are infected with HPV or have multiple sexual partners.
Symptoms of Cervical Cancer from Early to Severe Stages
It is fortunate for women that cervical cancer can be easily detected, allowing diagnosis before symptoms appear and abnormal cervical cell conditions can be detected before turning into cancer cells. So, what are the symptoms of cervical cancer?
- No symptoms but detected during a pelvic exam
- Vaginal bleeding, even slight bleeding after sexual intercourse, spotting between periods, heavy or prolonged menstrual bleeding
- Vaginal discharge, either watery or thick, mucus-like, pus-like, blood-tinged, or containing tissue fragments, with or without odor
- In cases of large tumors, there may be a dull pain in the lower abdomen, difficulty urinating or defecating, or compression of the ureters causing kidney dysfunction, potentially leading to kidney failure
- In the metastatic stage, cancer may spread through the lymphatic system to lymph nodes in the abdomen, causing back pain, epigastric pain, or spread to lymph nodes in the clavicle, especially on the left side, and may also spread through the bloodstream to the lungs, liver, bones, and brain
Treatment of Cervical Cancer
Since cervical cancer tends to spread locally rather than through the bloodstream, treatment is usually local, which may be surgery or radiation therapy. Surgery is used in stages 0 and 1. Stage 0 means the disease starts at the surface layer of the cervical epithelium and has not invaded the underlying layer, so only the cervix may be removed. In stage 1, where the cancer invades the underlying cervical epithelium, the uterus must be removed. Whether only the uterus is removed or pelvic lymph nodes are also dissected depends on the depth of invasion into the underlying cervical epithelium.
Radiation therapy can be used at all stages from 0 to 4 (metastatic stage). However, in stages 0 and 1, surgery is preferred because it provides tissue samples, including the uterus or lymph nodes, for examination, giving more accurate staging information than radiation therapy alone. If the patient cannot undergo surgery, radiation therapy can provide equally good results. Chemotherapy is used for large or invasive tumors, usually combined with radiation therapy, as chemotherapy helps the tumor respond better to radiation. It is also used in cases of metastasis, although the treatment outcome is not very good.
Therefore, cervical cancer can be effectively treated in the early stages. Even in advanced stages where the disease has not spread, combined radiation and chemotherapy still provide relatively good results compared to many other cancers.
Prevention of Cervical Cancer
Prevention of any cancer involves avoiding the carcinogens of that cancer. For cervical cancer, the carcinogen is the HPV virus. Currently, there is a vaccine to prevent HPV infection, which reduces the risk of cervical cancer by more than 70%, likely reducing the incidence of cervical cancer in the future. To maximize prevention effectiveness, HPV vaccination should be combined with regular screening. Screening should begin once sexual activity starts because cervical cancer develops through stages starting from chronic HPV infection and progressing to chronic inflammation leading to cancer. Screening allows detection and treatment of abnormal conditions before cancer develops or early-stage cancer that can be cured, preventing advanced or metastatic cervical cancer.
Besides vaccination, maintaining a proper family life and paying attention to health by regular check-ups is important. Even older women who are no longer of reproductive age, without menstruation or sexual activity, should continue screening at appropriate intervals as recommended by doctors to help Thai women stay away from cervical cancer.
