Cervical cancer: the importance of prevention

By Cristiano Antonino On Jan 14, 2023

Cervical cancer (or cervical cancer) is a neoplasm that still has a very important epidemiological and social relevance: it is the third most frequent cancer in the female population despite the fact that, for many years, extremely effective prevention programmes have been planned

The main cause of cervical cancer

We know that the main cause of cervical cancer can be ascribed to the Human Papilloma Virus, HPV (Human Papilloma Virus), now widely recognised as a necessary factor in the development of invasive carcinoma and identified in 95-98% of all diagnosed cases in women.

The Human Papilloma Virus is, therefore, the unavoidable cause of this disease, but it alone is not sufficient to determine the origin of cervical cancer.

An extremely important role is played by the immune system of the person who comes into contact with HPV.

Healthy individuals manage to rid themselves of Papilloma Virus contamination in even short periods of time; when, on the other hand, there are deficiencies in the effectiveness of the immune response, the virus remains in the female genital tract for longer, and the persistence of the viral infection becomes the real risk factor.

Symptoms of cervical cancer

The age of maximum incidence of cervical neoplasia is the 45-55 age group, a young age considering what is currently the social age of women.

Very often the tumour does not have a typical symptomatology, but in most cases it takes the form of several, very common, aspects that are often underestimated.

They are indicated as signs of suspected disease:

atypical bleeding
persistent cervical or vaginal discharge, often with characteristics very similar to infection;
pelvic pain during intercourse;
bleeding after intercourse.

These are all situations that must not be underestimated, but on the contrary must be properly reported to one’s gynaecologist and, above all, must be investigated, knowing that often a modest symptom can hide a very real problem.

Screening: a weapon against cervical cancer

Through prevention, not only is early diagnosis of cervical cancer possible, but even more importantly it is possible to identify the lesions that precede the actual tumour; moreover, through primary prevention, i.e. vaccination against HPV, we have an extremely effective weapon against this type of disease.

To date, cervical carcinoma screening, the third screening on a national scale, is essentially based on the recognition of the main risk factor, i.e. the Human Papilloma Virus, by means of the so-called HPV test: a biomolecular test that identifies whether the DNA of the virus is present and, consequently, whether the subject is exposed to the risk of developing the disease.

The HPV test in primary screening is a fairly recent concept

Patients start screening at the age of 25 by having a Pap test, from the age of 30 onwards the HPV test becomes the primary test and the Pap test is reserved in case the latter is positive.

One very important thing to emphasise is that HPV positivity absolutely does not mean disease, but rather means exposure to a certain risk quota.

This share of risk is variable depending on the characteristics of the subject and above all is variable in relation to whether the immune system is able to rid itself of this infection more or less quickly.

Adequate prevention is extremely feasible and effective, but despite this, cases of advanced cancer are still observed.

This means that there are objective difficulties in achieving effective and complete primary and secondary prevention.

That is to say, not all women adhere to an adequate screening programme or do not carry it out with the regularity and criteria that are now identified worldwide.

The diagnosis and treatment pathway

Once a positive HPV test has been identified, the patient begins an in-depth investigation.

This path continues with the Pap test and, should this also indicate the presence of atypical cells, it continues with second-level tests, which often involve a biopsy of the cervix and, if necessary, confirmation of the presence of a neoplastic problem.

If the presence of neoplastic cells is diagnosed, clinical management of the case must be proceeded with in relation to the histological test.

2 explanatory cases:

if the biopsy indicates a lesion that precedes the tumour, the so-called Cervical Intraepithelial Neoplasia (CIN), localised therefore only on the surface of small portions of the cervix, one proceeds with small conservative interventions, such as, for example, conization, which preserve the integrity of the uterus and preserve the patient’s reproductive capacity
if the neoplasm is no longer at an early stage, it is necessary to assess the case from a general point of view. This involves a broader clinical assessment, imaging of the female pelvis and a series of tests that precede the choice of treatment.

Surgical removal of the uterus is the standard of care in so-called locally advanced tumours.

They are no longer amenable to a small conservative operation, but not so extensive or spread to other organs.

Should the disease, in the worst case, become more widely disseminated, combined treatment pathways will have to be established.

Survival and the importance of the prevention pathway

Survival from these tumours changes greatly depending on the extent of the disease: early stages have a very good survival rate, i.e. in the order of 90%, because the patient is cured by the removal of the uterus that has been transformed into a neoplasm.

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This makes it all the more important to ensure all options are available to women in order not to waste time and to catch the tumour at its first sign of development, or rather, before it gives any sign of its presence.

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