About cervical cancer with Prof. Dr. Alexander Reinthaler

1.  How does cervical cancer differ and what are the main factors in its occurrence?

It is a type of malignancy that involves the lower part of the uterus where it connects to the vagina, i.e. the cervix. Squamous cell carcinomas occur in most cases of the cancer, at about 70% of the total. Adenocarcinomas occur in 25% of cases, and a rare histological type of cervical cancer is possible in the remaining 5%. Typically, in almost 99% of cases, the disease is associated with HPV infection, i.e. Human papilloma virus.

2. What are the main symptoms of the disease?

When cervical cancer is at an early stage it is difficult to detect as there are no accompanying symptoms. In order to make a diagnosis, it is necessary to perform one of the following medical procedures: biopsy, Pap smear or colposcopy. When the cancer is at a more advanced stage, it can cause pelvic pain, irregular periods and also vaginal infection. The cancer can affect the patient's bladder and rectum and lead to the disease hydronephrosis when the tumor is already at a very advanced stage.

3. Where does the development of the disease start and can cervical cancer be felt?

The disease begins to develop where squamous epithelium is transferred to the lining of the cervix. The development in adenocarcinomas most often starts from the cervical canal. Self-palpation is not a reliable option for detecting the disease in most cases.

4. At what age does cervical cancer develop?

Human papillomavirus infection is most common among young women leading an active sexual lifestyle. The infection develops slowly in the body, over a period of 5 to 10 years, until malignancy forms. Therefore, cervical cancer is most common in women between the ages of 45 and 55. As women get older and reach their 30s, their immune system becomes less effective at fighting infections and may lead to an increase in unresectable HPV infections. They can remain in the body for a long period of time without showing symptoms, so they often lead to the development of cancer in middle-aged women.

5. Can cervical cancer treatment cause side effects?

One possible treatment for cancer is by taking chemotherapy drugs combined with radiation that is applied to the tumour (primary chemotherapy radiation). Another treatment option is to perform surgery to remove the lymph nodes located in the patient's pelvic area (pelvic lymphadenectomy). Surgical removal of the uterus by radical hysterectomy is also one of the treatment options for the disease. It is not advisable to apply radiotherapy in combination with surgery, as this option is highly toxic. In patients who have lymphatic morbidity, removal of the sentinel lymph nodes is recommended. If this is necessary, surgery to remove the uterus is stopped to add para-aortic lymphadenectomy. This procedure aims at adapting the scope of the field under radiation.

In our clinic we use the surgical treatment laparascopy for the removal of sentinel lymph nodes in the patient. In cases where there are no sentinel lymph nodes in the woman, the uterus and surrounding organs are removed, sparing the nerves (radical hysterectomy by laparotomy). In women who wish to reproduce, we can perform the operation radical trachelectomy, in order to preserve the ferthelium and the uterine body. In this type of manipulation, difficulty in emptying the bladder may occur. This discomfort usually lasts only a few weeks after the procedure. There are rare long-term side effects after the surgery itself.

6. Is it possible to perform preventive surgery when at risk of developing cervical cancer?

To avoid cervical cancer, the best option is prevention against the human papilloma virus through vaccination. If a large proportion of young people get vaccinated before they start having sex, this could help eliminate this disease altogether. Most cases of cervical cancer are precisely because of HPV infection, so performing preventive surgery would not be beneficial.

7. How is this disease most effectively treated?

In patients with early stage cervical cancer, surgery is used to remove the sentinel lymph nodes combined with removal of the uterus by radical hysterectomy. When a woman wishes to have children, radical trachelectomy surgery is recommended. If the disease is advanced (stage II and above), treatment including both radiotherapy and chemotherapy may be prescribed if the patient wishes. External beam treatment methods are used along with brachytherapy.

8. What percentage of women who get the disease are able to continue their lives after treatment?

When cervical cancer is detected early, the tumour has only reached the cervix, i.e. the sentinel lymph node is not affected. In these cases, the chances of survival for the patient for 5 years after treatment are over 90%.