Let's learn more about cervical cancer. Let's talk about it without fear!

Hello! How are you? Today we are going to talk about a disease that is important to many women, and although it may sound a little scary when you hear its name, it can be controlled and cured to a large extent if detected early. That is cervical cancer, or as some call it `(Cervical Cancer)` . It is normal to get a little shocked when you hear this name, but if we understand it properly, there is nothing to be afraid of unnecessarily. Because knowledge is the greatest power, right? So let's see what it is, how it develops, what are the symptoms, how to protect ourselves, and what are the treatments.

What is cervical cancer?

Simply put, cervical cancer is cancer that develops in the lower part of your uterus, the part that connects to the vagina, called the cervix . Remember, this is not something that develops suddenly, overnight. Most of the time, healthy cells in the cervix change little by little over the years, becoming 'precancerous' cells before they become cancerous. The main cause of this is a virus called `HPV (Human Papillomavirus).` This is a sexually transmitted virus, that is, a virus that is spread through sexual contact. But here's an important thing. Not everyone infected with the `HPV` virus develops cervical cancer. In fact, in most people, this virus goes away on its own within a few months without any treatment, as our immune system fights it off. But in some women, this virus can persist in their bodies and cause the aforementioned cell changes. Those are the people who are at higher risk of developing cervical cancer. That's why we always say that it's very important to have regular checkups, such as a Pap smear and, if necessary, an HPV test . Also, getting the HPV vaccine can significantly reduce this risk. Remember, cervical cancer is a completely curable disease if detected early .

What are the main types of cervical cancer?

There are two main types of cervical cancer. They are:

• Squamous Cell Carcinomas : This is the most common type. It starts in the flat cells on the outer surface of the cervix. About 80% to 90% of cervical cancers are of this type.
• Adenocarcinomas : These types develop from glandular cells that line the inner lining of the cervix . They account for about 10% to 20% of cervical cancers .

Sometimes cancer can occur as a mixture of both types.

What are the symptoms of cervical cancer? Can it be detected early?

This is a question that many people ask, and it's also something that scares many. To be honest, cervical cancer may not show any symptoms in its early stages.It's like it's growing in secret. That's why we always say how important it is to get tested at the right age, at the right intervals. Symptoms start to appear when the cancer has grown a little, and maybe even spread to the surrounding tissues.

Symptoms that can be seen in the early stages (like Stage I):

• Abnormal vaginal discharge: There may be a discharge that is watery, possibly with a little blood, that is profuse, and may have a foul odor.
• Irregular bleeding :
• Bleeding after sex.
• Bleeding between two menstrual cycles.
• Bleeding again after menopause (that is, after the monthly periods have completely stopped).
• Pain during intercourse: You may experience new pain (dyspareunia) that was not present before.

Important: Just because you have one or two of these symptoms doesn't mean it's cervical cancer. These things can happen for other simple reasons. However, if you have something like this, please don't be afraid or embarrassed, and see a doctor right away for advice. That's the best thing you can do.

Symptoms that may occur as the cancer spreads further:

If the cancer spreads beyond the cervix, to surrounding tissues or other organs, symptoms such as these may also occur:

• Difficulty urinating, pain, and possibly blood in the urine.
• Change in bowel habits, constipation or diarrhea , pain during bowel movements, or blood in the stool (from the rectum).
• Constant feeling of extreme fatigue and exhaustion.
• Loss of appetite and weight loss.
• Feeling generally unwell and constantly sick.
• Persistent lower back pain or swelling in the legs.
• Pelvic/abdominal pain.

If you have symptoms like these, it means that the condition may be a bit serious. Therefore, it is essential to seek medical advice immediately.

What is the main cause of cervical cancer?

As we mentioned earlier, about 99% of cervical cancers are caused by infection with a virus called `HPV (Human Papillomavirus).`There are more than 100 types of HPV. Not all types cause cancer. There are several "high-risk" types that can cause cancer. This virus is mainly spread through sexual contact (vaginal, anal, or oral sex). Think about it, HPV is a very common virus. Many sexually active people will be infected with HPV at some point in their lives, but they don't even know it. This is because our body's immune system can fight this virus and get rid of it. However, sometimes, especially the high-risk types of HPV, they don't leave the body, and they stay in the cells of the cervix for a long time, gradually changing those cells in an abnormal way, and eventually developing into cancer. That's why the HPV vaccine is important. The HPV vaccine can protect you from almost 90% of the types of HPV that most often cause cervical cancer. Also, if HPV infection or pre-cancerous conditions are detected early through regular tests, treatment can be initiated before cancer develops.

Who is at higher risk of developing cervical cancer?

Some people may not have any obvious risk factors for developing cervical cancer. However, there are some factors that increase this risk. Some of these we can control, and some we cannot.

Risk factors we can control:

• Test history: Those who do not have regular Pap tests are at higher risk of developing cervical cancer, as Pap tests detect precancerous cells.
• HPV infection: Infection with high-risk HPV types is the main risk factor. Protecting yourself from HPV can reduce the risk of cervical cancer.
• Sexual history: Being sexually active before the age of 18 and having multiple sexual partners increase the risk of HPV infection.
• Smoking: Cigarette smoking significantly increases the risk of cervical cancer.
• HIV infection: Women infected with HIV have a higher risk of developing cervical cancer than the general population.
• Having a weak immune system: When the immune system is weak, the body's ability to fight infections decreases. This makes it more likely that the HPV virus will persist in the body.

Risk factors we cannot control:

• `DES (diethylstilbestrol)`: This is a drug that was given to some pregnant women between 1938 and 1971 to prevent miscarriages. If your mother took `DES` during pregnancy, you may have a slightly increased risk of developing cervical cancer.
• Family history: If someone in your family (mother, sister) has had cervical cancer, you may also have a genetic predisposition. However, this is not common.

How long can cervical cancer develop secretly?

It usually takes 3 to 7 years for abnormal changes in cervical cells (precancerous conditions) to develop into cancer.Sometimes it can take even longer. Although this precancerous stage grows slowly, once it becomes a full-blown cancer, the growth can be rapid. That's why we say that if you have regular Pap tests, your chances of developing cervical cancer are much lower. Because these tests can catch precancerous cells before they become cancerous.

What are the possible complications of cervical cancer?

Early detection and treatment of cervical cancer is the best way to prevent life-threatening complications. If the cancer progresses or treatment is delayed, complications such as:

• Pain: When cancer spreads, especially when it affects nerves, severe pain can occur.
• Bladder and bowel changes: If cancer spreads to the bladder or bowel, problems such as difficulty urinating and constipation may occur.
• Kidney damage: If cancer blocks the urinary tract, it can damage the kidneys, eventually leading to kidney failure. This is a serious complication seen in advanced cancer.
• Blood clots: When you have cancer, the blood becomes a little "thick", which increases the risk of blood clots.
• Bleeding: If the cancer spreads to the vagina, rectum, or bladder, bleeding may occur from those organs.
• Effects on fertility or pregnancy: Depending on the type of treatment (e.g., hysterectomy), the ability to have children may be lost. If part of the cervix is ​​surgically removed, the risk of miscarriage in future pregnancies may increase.
• Side effects of cancer treatments: Chemotherapy and radiation therapy can cause side effects such as nausea, vomiting, fatigue, hair loss, and sexual dysfunction.

These may sound scary, but remember, many of these complications can be prevented if cancer is identified early and treatment begins.

How is cervical cancer diagnosed?

Cervical cancer usually develops slowly over many years. Healthy cells develop into abnormal cells (pre-cancerous cells) and then into cancerous cells. Cervical cancer is often caught through regular cervical cancer screenings. The main goal of these tests is to detect abnormal changes in the cells of the cervix before they become cancerous.

• Pap test (Pap test / Pap smear): This involves taking a few cells from the surface of the cervix, examining them under a microscope, and checking for any abnormalities or signs of pre-cancer.
• HPV test: Sometimes, along with a Pap test, or if the Pap test is abnormal, cervical cells are also tested for the high-risk HPV virus.

If your Pap test result is "abnormal," don't worry. It doesn't mean you have cancer. However, you may need further testing.

Tests to confirm cancer:

If the Pap smear is abnormal, the doctor will refer you for several more tests.

• Colposcopy: This involves using a special instrument (colposcope) to magnify the cervix and clearly identify any abnormal cells.
• Biopsy: If a suspicious area is seen during colposcopy, a small piece of tissue is taken and sent to a lab to check for cancer cells. There are several ways to do this biopsy:
• `Punch biopsy`: A small instrument is used to remove a piece of suspicious tissue.
• Endocervical curettage (ECC): Cells are scraped from inside the cervical canal.
• Loop electrosurgical excision procedure (LEEP): An electric wire loop is used to remove abnormal tissue. This is sometimes used as a treatment.
• `Cone biopsy (conization):` A cone-shaped, slightly larger piece of tissue is removed from the cervix. This is used for both diagnosis and treatment.

If the biopsy results confirm that you have cervical cancer, the next step is to find out how far the cancer has spread (metastasized). This may involve tests such as:

• Tests to check liver and kidney function.
• Blood and urine tests.
• X-rays of the bladder, rectum, intestines, and lungs.
• ``CT (Computed Tomography) scans''.
• ``MRI (Magnetic Resonance Imaging) scans''.

The doctor determines the stage of the cancer based on the information obtained from these tests.

What are the stages of cervical cancer?

The stage of the cancer is how large the cancer is and how far it has spread. This is very important for planning treatment. There are four main stages of cervical cancer (Stage I to Stage IV).

• Stage I: The cancer is confined to the cervix. It has not spread to the deeper tissues of the cervix.
• Stage II: The cancer has spread beyond the cervix and uterus, but has not spread to the pelvic wall or lower part of the vagina.
• Stage III: The cancer has spread to the lower part of the vagina. It may also have spread to the pelvic wall, ureters, and nearby lymph nodes.
• Stage IV: The cancer has spread to the bladder, rectum, or distant organs such as the bones and lungs.

Your doctor will explain to you in detail what the stage of your cancer is and what it means.

How is cervical cancer treated?

Treatment for cervical cancer depends on several factors. The stage of the cancer, your age, general health, and whether you hope to have children in the future are considered. The main treatment options are:

• Surgery
• Radiation Therapy
• Chemotherapy
• Targeted Therapy
• Immunotherapy

Sometimes one or more of these treatments are used together.

Surgery:

For early-stage cancers, only the cancer cells can be removed.

• Laser surgery: Laser rays are used to destroy cancer cells.
• Cryosurgery: Uses extreme cold to freeze and destroy cancer cells.
• `Cone biopsy` or `LEEP`: These are used for diagnosis as well as to remove very small, superficial cancers.
• Trachelectomy: This involves removing the cervix and upper part of the vagina, but leaving the uterus intact. This is sometimes done on young, childbearing women.
• Hysterectomy: Complete removal of the uterus and cervix.
• Pelvic exenteration: This is a major surgery. The uterus, cervix, bladder, vagina, rectum, and part of the colon are removed, depending on how far the cancer has spread. This is only done if the cancer has come back or has spread a lot.

Radiation Therapy:

High-energy rays are used to destroy cancer cells.

• External Beam Radiation Therapy (EBRT): A machine outside the body directs radiation to the cancer site.
• Brachytherapy: A radioactive material is placed inside or very close to the tumor.

Chemotherapy:

Cancer-killing drugs (chemo drugs) are given intravenously (by injection) or as pills. These drugs enter the bloodstream and travel throughout the body to kill cancer cells. Chemotherapy is usually given in cycles. Sometimes radiation therapy and chemotherapy are given together (chemoradiation) to shrink the cancer before surgery, or to kill any remaining cancer cells after surgery.

Targeted Therapy:

These drugs are designed to target and destroy specific proteins that help cancer cells grow and spread, without harming healthy cells.

Immunotherapy:

This involves stimulating your own immune system to recognize and attack cancer cells. Your medical team will decide on the best treatment plan for you. You may also have the opportunity to participate in clinical trials that test new treatments.

Can cervical cancer be completely cured?

Yes! Cervical cancer is a cancer that has a very high cure rate, especially if detected early. Doctors use the term ``remission`` rather than ``cured.`` This means that the cancer cells in the body have been controlled to the point where they can no longer be found. However, they can still come back. That's why you need to keep going for regular checkups. For stage I cervical cancer, surgery is usually the first treatment. Chemotherapy may not be necessary. But that depends on several other factors. Although it is difficult to achieve a complete cure in stage IV , it is possible to go into ``remission``, which means that the disease can be controlled. At this stage, treatments (radiation, chemo, targeted therapy) are still given to prolong life and improve quality of life.

Can cervical cancer be prevented?

The good news is, yes, cervical cancer is largely preventable! There are a few things you can do:

• Get the HPV vaccine: Get the HPV vaccine at an eligible age (usually 9-26 years, sometimes up to 45 on medical advice). This is the main protection.
• Get a Pap test and, if necessary, an HPV test at regular intervals: Starting after age 21 (or 3 years after becoming sexually active), get these tests at the intervals recommended by your doctor.
• Safe sex: Using barrier methods like condoms during sex can protect you from sexually transmitted diseases, including HPV. Limit the number of sexual partners.
• Avoid smoking: If you smoke, stop. For those who don't smoke, don't take up smoking.

What is the hope for cervical cancer?

Cervical cancer is a serious disease, but as mentioned earlier, it is highly treatable, especially if detected early. It is normal to feel sad, scared, and angry when you find out you have cancer. Get help to deal with these feelings. Talk to your family and friends. Joining a cancer support group can also be very helpful. Even after treatment is over, your doctor will continue to monitor you to see if the cancer comes back. Even if you go into remission, it is normal to have a nagging fear that the cancer will come back. It is a good idea to talk to a counselor, a loved one, or your doctor about this. According to statistics from the National Cancer Institute, the five-year relative survival rates are as follows:

• If cervical cancer has not spread (localized): 91%
• If it has spread to nearby tissues (regional): 60%
• If it has spread to distant organs (distant): 19%

But remember, these are just statistics.It's impossible to say exactly what will happen to you from these. Only your doctor can give you the best information about your condition and your chances of recovery.

When should I see a doctor?

If you have any of the unusual symptoms we discussed earlier (irregular bleeding, abnormal discharge, pain during sex), see a doctor immediately. Also, if you can't remember when you last had a Pap smear, talk to your doctor about that too and start getting tested on a regular schedule. It's normal for a lot of questions to come to your mind when you're diagnosed with cervical cancer. "What's the best treatment for me?" "Will the cancer come back?" Discuss all these questions and concerns with your medical team.

Take-Home Message

Well, we've talked about a lot today, haven't we? It's normal to feel a little scared when you learn about cervical cancer. But, the most important thing is that it is a disease that is largely preventable and, if detected early, can even be completely cured.

Remember:

* Get the HPV vaccine (if you are eligible)

* Get your Pap test and HPV test done on time. This is the best thing you can do. Don't be shy or put it off.

* If you have any unusual symptoms (irregular bleeding, discharge with an unusual odor, pain during sex), see a doctor immediately.

* Avoid smoking.

* Practice safe sex.

Your health is in your hands. We hope this information is helpful to you. If you have any further questions, don't hesitate to ask your doctor. Stay healthy!