Cervical Cancer Risk Factors

Cervical cancer risk factors - Cervical cancer usually develops due to the human papillomavirus (HPV). The HPV is often transmitted through sexual contact.

Often the body cleans up an HPV infection itself and does not notice much of it. If this does not happen, abnormal cells may develop in the cervix. You can then have a precursor of cancer, which eventually can lead to cervical cancer.

HPV infections are actually unavoidable. You limit the chance of transmission of the virus by using condoms. Girls are also offered vaccination against HPV in the year they turn 13. The inoculation prevents infection of 2 high-risk HPV types.

Cervical cancer is more common in women who smoke. The contraceptive pill is not a risk factor for cervical cancer.

Who is most at risk of developing cervical cancer? DES daughters are more at risk of cervical cancer than other women. It is a different type of cervical cancer that is not caused by HPV.

Symptoms cervical cancer

Cervical cancer does not always cause symptoms in the beginning. Symptoms of this tumor type may be:

• bloody or brownish discharge, outside the normal menstruation
• blood loss during or just after sexual intercourse (contact bleeding)
• blood loss after the menopause

These complaints can also have other causes. But they are always a reason to go to the doctor.



Research and diagnosis of cervical cancer

At the GP
If you suspect cervical cancer you will first receive a physical examination from the GP. This also includes an internal examination with a smear test.

With a smear, the doctor or assistant removes cells from the mucous membrane on the boundary of the inner lining and outer cladding of the cervix.

Does the smear contain abnormal cells or your doctor thinks that you may have cervical cancer, then he/she refers you to a gynecologist?

At the gynecologist
In the hospital you will receive the following examinations:

• colposcopy
• vaginal examination

In a colposcopy, the gynecologist looks at the cervix with a colposcope (magnifying glass). During this examination, the doctor can remove 1 piece or a few pieces of aberrant tissue with the aid of a small forceps. This procedure is called a biopsy.

A vaginal examination consists of a number of parts. First, the gynecologist examines the vagina externally and looks at possible abnormalities of the labia. Then the research continues internally. The gynecologist can once again make a smear test. He can also perform a vaginal touch and/or a rectal touch. This gives the gynecologist an impression of the location and size of the organs in your lower abdomen.

Finally, the doctor usually makes a vaginal ultrasound scan to assess the ovaries and the inside of the uterus.

Does the gynecologist find a tumor in the cervix? Then often further research is needed in a specialized center.

In a specialized center
There the doctor determines how far the tumor has expanded and whether there are metastases. This way the doctor can determine which treatment is most suitable.

You can then receive the following tests:

• lung photo
• vaginal examination, sometimes under anesthesia
• CT-scan
• PET scan
• MRI scan

Stage classification
In cervical cancer there are 4 stages:

• Stage I: the tumor is only in the cervix.
• Stage II: the tumor has progressed from the cervix to the pelvic floor or to the upper part of the vagina.
• Stage III: the tumor has progressed further to the pelvic wall or into the lower part of the vagina.
• Stage IV: the tumor has grown outside the pelvis, or it has grown into the bladder or rectum.

With this stage classification, the doctor estimates the outlook and determines the treatment.

Metastases
In metastases, there is always stage IV, regardless of the size of the tumor itself.

If cervical cancer is sowing, it is usually via the lymphatic system and less often via the blood. Metastases often occur first in lymph nodes. And later in other organs such as liver and lungs.

*Image source : Gynaecologie - Slingeland Ziekenhuis

References :

1. National Cancer Institute
2. olijf.nl/
3. American Cancer Society