Its fundamental cause is infection by one of the oncogenic viruses of the human papillomavirus (HPV) family, a sexually transmitted infection.
After the infection and its subsequent chronification, there is generally a long evolution until the appearance of the premalignant lesion and the development of the invasive cancer. Therefore, the best weapons we have for the treatment and eradication of this cancer (as well as others) are two:
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Prevention
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Early detection.
More than 600,000 cases of cervical cancer are diagnosed annually worldwide and more than 2,300 cases in Spain, according to the estimate contained in the report , presented by SEOM on the occasion of the
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In 2020, more than 340,000 women died from cervical cancer worldwide, and almost 700 in our country.
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Five-year survival is 65%.
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In Spain it is the third gynecological tumor in incidence and mortality, behind endometrial cancer and .
Symptoms of cervical cancer
As oncology specialists indicate, one of the problems with this type of tumor is that it does not show its face at the beginning, and generally the patient does not experience any type of discomfort.
In the event that it appears, the initial symptoms are usually:
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Irregular bleeding.
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Bleeding after having sexual intercourse or after a gynecological examination.
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Bad smell of the flow.
When the disease is more advanced, more symptoms appear:
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Pelvic or lower back pain.
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Discomfort when urinating.
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Continuous need to defecate.
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Gynecological bleeding after menopause.
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Pain during sexual intercourse.
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Blood in the urine or stool.
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Loss of appetite and weight.
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Swelling in the legs.
Papanicolau test, the great advance in early detection
One of the decisive discoveries to gradually reduce the percentage of deaths from this cancer is the pap smearbetter known as cytology.
This procedure has allowed that since 1940 the percentage of deaths has decreased by 70% in developed countries.
It consists of collecting cells from the cervix, the lower end of the uterus above the vagina, to detect changes in the cells that indicate that cancer could form in the future.
It is, therefore, the first step to stop the possible appearance of cervical cancer.
Doctors usually recommend that women start having this test at age 21 and repeat it every three years until they are 65.
This test is generally performed together with a pelvic exam, and the most common today is to combine it with the test that detects the human papillomavirus (HPV), a widespread sexually transmitted disease but for which there is already an effective vaccine. .
HPV test
Another of the great advances for early diagnosis was the HPV test (human papillomavirus), approved by the FDA in April 2014 and which has demonstrated its efficacy in reducing the mortality of this tumor. The development of rapid HPV tests and the improvement of specificity will optimize this valuable technique.
Specialists recommend that women perform these tests with a certain periodicity.
In the case of cytology, the recommendation is to do it every 3-5 years from the age of 25.
In the case of HPV tests by PCR, the recommendation is for asymptomatic women, from 30/35 years of age.
The Human Papilloma Virus (HPV) Vaccine
The chronification of the is an epidemiological problem of considerable magnitude. So much that they are associated with infection:
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More than 90% of cervical cancers
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60% of oropharyngeal cancers
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91% penile cancer
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75% vaginal cancer
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69% of vulvar cancers.
One of the great scientific advances of our era in the primary prevention of this tumor is the development of vaccines against HPV.
And in our environment, vaccination of girls between the ages of 11-14 years has already been included in the vaccination calendar.
The bivalent vaccines against serotypes 16 and 181 (CERVARIX) and tetravalent (6,11,16 and 18) 2 (GARDASIL) were the first vaccines to be developed. And here, too, great advances have been made, since the latest vaccine developed acts on 9 types of the human papillomavirus.
Its effectiveness is such that it has shown that its application would reduce the incidence of cervical cancer by up to 73%.
Less aggressive treatments
In the field of treatments applied when the disease has already appeared, there have also been great advances. Especially in surgical techniques, which have made it possible to offer more conservative surgeries to women with initial stages without risk factors and/or pregnancy desire, with lower morbidity and better quality of life.
In addition, advances in both conventional laparoscopysince the late 80s, as assisted laparoscopy by robot since the year 2000 offer the same radicality as conventional techniques with significantly less morbidity.
SEOM specialists also consider an advance with capital letters:
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“Concomitant treatment of platinum-based chemotherapy with radiotherapy for locally advanced tumors, which resulted in a 5-year disease-free survival of 58%, with an increase in overall 5-year survival of 6%.”
The technological improvement in planning techniques and radiotherapy treatment is also an advance in cervical cancer, since it allows higher doses to be administered to the tumor, avoiding…