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Gynaecological cancers account for 20% of solid cancers in women. Gynaecological cancer is the general name given to cancers which occur in cervix, ovarian, uterus, fallopian tubes, vaginal, endometrium or vulva. Endometrium cancer, ovarian cancer and cervical cancer are the three most common gynaecological cancers in women.
It is the least common invasive cancer among other gynaecological cancers. 90% of cases are related to HPV. Other risk factors are smoking, race (more in the black race), weak immune system, first sexual intercourse at a young age, multiparity, multiple partners, oral contraceptives (OC), Chlamydia infections.
There are 2 main types of cells that cover the cervix. Squamous cells predominantly cover ectocervix. Columnar epithelial cells mainly form the layer that covers endocervix. These 2 cell types come together in a region called the transformation zone. The transformation zone is the starting place for most cervical cancers. Cervical precancer and cancers are classified according to their microscopic appearance.
There are two basic types of invasive cervical cancers;
Squamous cell carcinoma
About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers develop in squamous cells that cover the surface of the ectocervix. Squamous cell carcinomas most often begin in the transformation zone where the ectocervix joins the endocervix. Most other cervical cancers are adenocarcinomas. It is observed that cervical adenocarcinomas have become more common in the last 20-30 years compared to squamous cell cervix carcinomas since the use of Pap smears is largely due to the early diagnosis of early squamous cell carcinomas. Cervical adenocarcinoma develops from mucus-producing gland cells in the endocervix. Approximately 5% of cervical cancers, other than these two main types of cancer, are uncommon pathologies. These cervical cancers can bear the characteristics of both squamous cell carcinomas and adenocarcinomas, are called adenosquamous carcinomas or they may be neuroendocrine tumours.
The first and most common symptom of cervical cancer is vaginal bleeding. Postcoital bleeding, irregular vaginal bleeding and malodorous discharge may occur in the early period.
Several risk factors have been identified that increase the risk of developing cervical cancer. The most important risk factors include:
- Human papillomavirus (HPV) infection
In addition to these 3 risk factors, several other factors have been identified that are linked to an increase in cervical cancer rates.
HPV-16 is the most common and most important virus type in HPV infection. HPV-18 frequently causes malignant type cancers. HPV-16 and HPV-18 are HPV types causing cervical cancer approximately 70%. HPV can cause infection in cells and genital organs, cells covering the anus, mouth and throat on the surface of the skin. As a result, HPV can pass from one person to another through skin-to-skin contact. One way of spreading HPV is sexual intercourse that includes oral sex as well as vaginal and anal intercourse.
Although cervical infection caused by HPV is the most common cause of cervical cancer, not all women with an HPV infection will develop cervical cancer. However, sometimes the infection continues and becomes chronic. Chronic infection can eventually lead to some cancers such as cervical cancer, especially when it is caused by some high-risk HPV types. Therefore, HPV infection is necessary but not sufficient as a factor that causes cervical cancer.
Cervical cancer does not show symptoms in the preinvasive period. However, diagnosis can be made with vaginal cytology. In all suspicious cytology, biopsy or Endocervical Curettage should be performed with colposcopic control. If micro-invasive cancer, insitu adenocarcinoma or severe dysplasia is detected in the biopsy, the diagnosis is confirmed by conization. Instead, precancerous changes in the normal cells of the cervix develop gradually and eventually progress to cancer. Physicians use a variety of terms to describe these precancerous changes, including squamous intraepithelial lesion (SIL), cervical intraepithelial neoplasia (CIN), and dysplasia.
A case of invasive cervical cancer is cancer that can be prevented with adequate screening and follow-up programs. Two screening tests can help prevent cervical cancer or detect it early:
Pap smear test: Abnormal cells that can progress to invasive cervical cancer are being investigated.
HPV test: Evidence of viruses/viruses that can cause cell abnormalities are being investigated.
Pap and HPV tests are screening tests, not diagnostic tests. Abnormal test results may indicate that more tests are needed to confirm whether a person actually has precancerous or cancer.
This follow-up test includes a medical history and physical examination of the pelvis, colposcopy and biopsy. Instead of PAP classification, which is the first classification system today, a number of standard terms called Bethesda System are used to report Pap test results.