Cervical cancer: symptoms, treatment, prognosis

Cervical cancer or cervical cancer is one of the most common types of cancer in women. Approximately seven women per hundred thousand women develop cervical cancer per year and approximately three women die from it per hundred thousand women in the Netherlands. Cervical cancer can sometimes be prevented by having yourself checked regularly before symptoms appear. What are the causes and symptoms of cervical cancer, how can the cancer be treated and what is the prognosis?

Article content

  • The womb
  • Cervical cancer
  • Causes of cervical cancer
  • Symptoms of cervical cancer
  • Complications of cervical cancer
  • Cervical cancer diagnosis
  • Cervical cancer treatment
  • Cervical cancer prognosis
  • Smear from the cervix
  • The PAP scores
  • Vaccination against cervical cancer


The womb

The uterus, also called uterus, is one of the internal organs of the woman. The uterus is shaped like a pear, the size of a fist and is located in the lower abdomen between the bladder and the rectum. The fallopian tubes enter the uterus at the top, the narrow lower part is the cervix, also called cervix uteri. This protrudes into the vagina with the cervix (portio). The rest of the uterus is called the uterine body or corpus.

Cervical cancer

Cervical cancer or cervical cancer is a malignant tumor on the neck of the uterus. It mainly occurs in women between the ages of twenty-five and sixty-five. Heredity is not an important factor and cervical cancer is not contagious. In the preliminary stage, the cells in the neck of the uterus undergo a change, gradually from slightly to strongly abnormal, this is also called dysplasia. The changes can be detected by a smear test, treatment can then be started early, which is very important.

Causes of cervical cancer

It is not clear what causes cervical cancer. It is known that it is related to changes in the cells due to infections with certain types of the human papillomavirus (abbreviated: HPV). The virus is sexually transmitted. The risk of developing cervical cancer increases if you have had sexual intercourse at a young age without using a condom. Even if you have had many different partners, the risk of cervical cancer is greater. Also an increased risk when smoking, if resistance is somewhat lower, when using immunosuppressants.

Symptoms of cervical cancer

The main symptom is loss of blood after sexual intercourse. If the cancer increases, there may be discharge from the vagina that looks watery and bloody and does not smell fresh. Furthermore, pain may be felt in the pelvic region and there is significant blood loss during sexual intercourse and afterwards. You also have to be alert in case of bleeding after menopause, for example after two years of no period. Also for bleeding between two menstrual periods.

Complications of cervical cancer

If nothing is done about cervical cancer, the cancer can spread to the uterus and then to the pelvis (lymph nodes), bladder, rectum. At a later stage, the liver and lungs, for example, can also be affected.

Cervical cancer diagnosis

Cells are examined during a smear test. If the doctor thinks that there may be cancer in the cervix, a colposcopy will be performed. The cervix is viewed and checked for unusual places using a colposcope (a type of microscope). Tissue is removed and this is checked by the pathologist. If cancer is discovered, further testing is required to see whether the cancer has spread. A gynecological examination will be performed (this can be done under anesthesia), the bladder and kidneys will be examined, an X-ray of the chest (lungs) will be made, a CT scan of the abdomen (lymph nodes, liver) and blood tests.

Cervical cancer treatment

Which treatment is chosen depends on the stage of the disease, but also on the personal circumstances of the person. Conization may be chosen if the cancer is ‘only’ in the neck of the uterus, the person still wants children and the tumor is still microscopic. Another treatment is the removal of the uterus. A radical hysterectomy means that in addition to the uterus, the connective tissue around it and the lymph nodes in the small pelvis are removed. If someone has not yet gone through menopause, if possible, the ovaries will be left in place so that someone does not enter menopause too early. If someone has had surgery, radiation (radiotherapy) may be necessary afterwards. Radiation may also be the first appropriate treatment. Also possible: chemotherapy, sometimes in combination with hyperthermia.

Cervical cancer prognosis

If cervical cancer is detected and treated early, almost all women recover completely. After a radical hysterectomy, permanent complaints may occur, such as problems with urination. Irradiation can cause intestinal complaints.

Smear from the cervix

To check whether someone has cervical cancer, a smear test is taken. Sun smear is also called PAP test. The cells that are removed are examined in a laboratory for abnormal cells. If these are found, the result will be anomalous. This is quite common and does not automatically mean that there is cancer. It means that the cells have changed shape, size or structure and it is good to keep an eye on it. The GP can assess whether a referral to a gynecologist is necessary. It may also be decided to take another smear test after a few months.

The PAP scores

  • PAP 1 : no abnormal cells were found and after five years you will receive another invitation for a smear test. If there are complaints such as abnormal bleeding, it is wise to consult your doctor and have a smear taken sooner.
  • PAP 2 : cells were found with a slight deviation. Usually a smear test is done again after six months. If the result is normal, a smear test will be done again after a year (to be sure). If this is also correct, you will receive another invitation as scheduled.
  • PAP 3a : cells were found with a moderately serious abnormality. Either a smear test is made again after six months or a referral to the gynecologist follows. In most cases, no or only simple treatment is required.
  • PAP 3b : more abnormal cells have been found. Further examination by the gynecologist will follow and treatment is often required.
  • PAP 4 : more seriously abnormal cells can be seen than in PAP 3. Research is necessary and treatment is almost always required.
  • PAP 5 : very abnormal cells were found. In the short term, examination and treatment are necessary; cervical cancer may be present


Vaccination against cervical cancer

In the year they turn thirteen, all girls receive an invitation for vaccinations against cervical cancer. The vaccination has been included in the National Vaccination Program since 2009. The vaccination works against two variants of the HPV virus that together are responsible for seventy percent of cervical cancer cases. The vaccine therefore does not provide complete protection. The vaccine consists of three injections that are administered over a period of six months. The vaccinations are given in the upper arm. The vaccinations are free and not mandatory.

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