Cervical Cancer

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Summary

Generally

Cervical cancer, which is the lower part of the uterus, usually develops slowly over many years. If you go on regular cell test checks, cell changesthat can lead to cancer can be detected and removed in good time.

The most common reason for getting cervical cancer is that through sex, you have been infected with a virus called HPV, human papillomavirus. There are many different types of HPV, but only a few cause cancer.

You can, to some extent, but not completely, protect yourself by using a condom. You can also vaccinate against a couple of the most common types of virus that cause the cancer.

Most people who get cervical cancer become completely healthy again after treatment.

symptoms

The most common symptom is bleeding from the abdomen, which can occur, for example, when you have intercourse. At an early stage of the disease it may be that you have no symptoms at all.

Investigations and investigations

The examinations are done in accordance with a standardized course of care p which is a way of organizing the investigation so that it goes as quickly as possible.

Treatment

If you have cervical cancer you can get surgery, or receive  radiation therapyin combination with  cytostatic drugs . Sometimes all three methods are combined.

Treatment often means that the uterus needs to be removed or irradiated. For those who want to get pregnant, it is a difficult consequence of the cancer treatment, but if the cancer is detected early it can sometimes be possible with a minor surgery that preserves the possibility of having a baby.

When to seek care?

If you have bleeding when you have intercourse or between your periods, you should seek care at a health care center or a gynecologist. This also applies if you get bleeding after you have stopped menstruating. 

What is cervical cancer?

Two different types of cancer in the uterus

There are several different cancers that can occur in the uterus . The two most common are cervical cancer and cervical cancer, often called uterine cancer .

The two diseases are different in several ways, not least in terms of the age when you become ill. Quite young women can get cervical cancer, while very rarely you get cervical cancer before the age of 40.

What is Cancer?

The human body is made up of many billions of cells. In order for the body to grow and live on, most cells must be replaced regularly with new ones. This is done by dividing the cells. When the cell is to divide, it doubles its entire content to become two cells. Then an exact copy of the cell is created and the first cell dies.

Most often, cell division works or the cell’s genetic material, DNA, itself manages to repair damage that occurs.

But at some point, the cell gets a damage that it cannot repair itself, and it then loses its ability to control its division and growth. It can cause cancer .

What characterizes cancer cells, among other things, is that they continue to multiply uncontrollably while not dying when their time is up. Often, the cancer cells clump together to form a tumor.

Cervical cancer develops on the uterus

The cervix is ​​the lower part of the uterus. It goes down into the vagina and ends with the uterus pin. The function of the cervix is ​​to resist the increased pressure created by the fetus during pregnancy. During childbirth, it is widened so that the baby can come out.

The cervix and uterine spine are covered by two different cell types that meet in an area of ​​the uterine spine. The mucous membrane is particularly sensitive to the attack of bacteria and viruses, which can damage the cells. Cell changes can then occur that can eventually develop into cancer.

Cell changes are usually divided into three degrees, light, moderate and difficult. Not all cell changes lead to cancer, but many heal themselves. Light cell changes heal more often than moderate and severe.

Cervical cancer usually develops slowly as cell changes progressively increase. From minor cell changes to a fully developed cancer tumor, it can take up to fifteen years.

If the cancer grows and spreads

If the cancer tumor is not treated, it eventually grows and spreads from the mucosa into the muscle wall of the cervix and further into the pelvis. Cancer cells can also be spread through lymphatic pathways to lymph nodes in the pelvis. It is the most common form of daughter tumors, so-called metastases. Dissemination can also take place via the blood to other organs such as the liver, skeleton and brain.

Seven out of ten will be completely healthy

Many women, about 30,000 a year, are told that they have cell changes. Of these 30,000, about a quarter need to undergo some form of treatment.

Cervical cancer is very uncommon before the age of 25. The most common is the disease in women between 30 and 40 years and in women over 70 years. This is probably because these older women have not regularly undergone cell testing. Seven out of ten women are now recovering from cervical cancer.

What is the cause of cervical cancer?

A virus causes the disease

The most common cause of cervical cancer is that it has at some time been infected with a certain type of HPV, human papillomavirus . HPV in the genital area is common and spreads through sex. In most people who become infected, the infection heals by itself. But some women get a permanent infection that can lead to damage to the cells of the cervical mucosa. Cell changes can then occur and eventually develop into cancer.

There are more than a hundred different types of HPV that can occur in different parts of the body. Some types cause warts on the hands and others cause warts in the abdomen, so-called condyloma. These diseases have nothing to do with cancer. The types of HPV that can cause cancer are mainly HPV 16 and 18. These viruses cause no visible changes and cause no symptoms.

What increases the risk of cervical cancer?

A permanent HPV infection is a prerequisite for a cancerous tumor to develop, but there are other factors that contribute. If you have a severely impaired immune system, have had repeated infections of the vagina or smoke, it can increase the risk of getting cervical cancer.

How to protect yourself?

Regular cell tests provide good protection

By submitting cell samples, cell changes can be detected and treated before cancer has developed. As the development of cancer usually takes many years, there are good opportunities to detect dangerous cell changes in time. All women between the ages of 23 and 50 are invited to gynecological cell test every three years. The checks are then slipped out every five years and cease when you turn 60. The routines may vary slightly depending on where you live in the country.

Vaccinations also protect

You can also protect yourself by vaccinating yourself . The vaccine protects against HPV 16 and 18 virus types, which cause about 70 percent of all cervical cancers. In order to make the best use of the vaccine, one should not be infected with HPV virus, which is why it is safest to get vaccinated before you start having sex. Vaccination against HPV is part of the general vaccination program for children .

Even if you get vaccinated, it is important to keep going for cell test checks, as the vaccine does not protect against all types of virus that can cause cervical cancer.

Condom provides some protection

Because HPV is sexually transmitted, it is partly possible to protect yourself by using a condom.

symptoms

Often no symptoms at the precursors

When there are precursors to cervical cancer, no symptoms are noticed, but the doctor can only detect them during a gynecological cell sampling. Even if you have fully developed cervical cancer at an early stage, you can be without symptoms.

Bleeding most common symptom

The most common symptom of cervical cancer is bleeding from the abdomen. They may initially come after intercourse or in conjunction with efforts such as when cruising during a toilet visit. After a while, they come more often, and eventually more or less daily. If the cancer has spread outside the uterus, you can get hurt in a way reminiscent of menstrual pain. The legs can also swell.

You can get bleeding for other reasons

You may have small bleeding that is not at all due to cervical cancer. For example, they may be due to the use of birth control pills, have a hormonal coil or fragile mucous membranes.

When to seek care?

If you have bleeding when you have intercourse or between your periods, you should seek care at a health care center or a gynecologist. This also applies if you have bleeding after you have stopped menstruating. Here you can find care .

Investigations and investigations

If you have symptoms, or if a cell sample has shown cell changes , you will need to undergo a gynecological examination , usually at a gynecological site. The doctor then uses a special microscope called a colposcope to better see any changes in the uterus. A tissue sample is also taken from there. The examination does not hurt, but the tissue sample can feel much like a stick in a blood test.

Investigation according to a standardized course of care

You need to find out more if the gynecological examination or tissue test shows that it can be cervical cancer. You will then be offered an investigation according to a standardized course of care.

Standardized care is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the surveys you may need to do.

The doctor who writes the referral tells you why you should be investigated according to a standardized course of care, what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any time.

Investigations if you have cancer

If it turns out that you have cervical cancer, a new gynecological examination is done when you are anesthetized or have a back anesthesia . The study is usually done by a team of doctors who are experts in gynecological cancer diseases. You will also be examined with computer tomography and possibly also with a magnetic camera to find out if the cancer has spread. 

New medical assessment

If you have been diagnosed with cervical cancer and are unsure if you are receiving the treatment and treatment that is best for you, you may receive a new medical assessment.  You will then see another doctor, usually at another specialist clinic. Ask your doctor if you want to know more about how to get a new medical assessment.

Getting a cancer message

Good if a close relative can join

It may be good to have some relatives or friends as a support when meeting the doctor to find out the results of the tests. The related person can help remember what was said during the conversation, and can be a good emotional support.

Getting a message that you have cancer often awakens strong feelings and you need plenty of time to talk to your doctor and other healthcare professionals to understand what the message means to yourself.

Although cancer is a common disease, the cancer message can often be daunting, as many associate cancer with death. Although cancer is a deadly disease if it is not treated, today there are treatments that can make you healthy. For many who do not become completely free of cancer, the chances of living longer and maintaining a good quality of life with the disease have increased.

A time of many questions

No matter how it goes, the message about the illness and the upcoming treatment means that life is turned upside down, not only for the sick person but also for many around. You have many questions, while there may be time between the message of cancer and until you know more about the treatment.

The information that the cause is a virus that is transmitted sexually can also raise questions. Many people wonder how and when they may have become infected. Concerns about how treatment will affect sexuality and the ability to have children are also common.

If the uterus has to be removed or irradiated, it is for younger women who want to have children a very severe and serious consequence of the treatment. It often means a great sadness to not be able to get pregnant. It is important that you have the opportunity to discuss these issues in peace with the physicians before starting treatment. It is also important to discuss possible alternatives to preserve fertility.

Help is available both within and outside the care system

For many, it usually feels easier once the treatment has begun and you know what is going to happen and have close contacts with the healthcare staff.

Already at the first visit to the cancer clinic there are often so-called contact nurses that you get to meet and whom you then contact during the treatment. There are also curators that you can talk to and who can help with practical things. If you need to, you can get help and support with your thoughts and feelings about cancer .

There are also patient associations for gynecological cancer. There are support people you can talk to. You can also contact the Cancer Foundation or Cancer Counseling. Here you will find contact details , and more about  cancer advice and support .

Treatment

The treatment depends on how the cancer tumor has developed

The treatment you receive depends on the size of the cancer tumor and whether it has spread to other parts of the body. If the tumor is confined to the cervix, surgery or a combination of radiotherapy and cytostatic drugs can be cured. If the tumor grows outside the uterus, you cannot be operated on, but you can still recover with radiotherapy.

The uterus is removed

If the cancer tumor is confined to the cervix, it is most common to have surgery and the uterus removed.

When undergoing surgery, the uterus is removed along with the upper part of the vagina and the lymph nodes located outside the uterus. Sometimes lymph nodes are also removed higher up in the stomach. The ovaries can usually be left if you are younger to avoid entering the menopause.

Tissues removed during surgery are sent to microscopic examination in the laboratory. It usually takes 3-4 weeks to get an answer.

Eyelid surgery or incision

Today, they are usually operated with peephole technique, so-called laparoscopy. Through a small incision in the navel, a camera is inserted into the abdomen and connected to a monitor. The doctor can then operate by inserting surgical instruments through additional small holes in the abdominal wall. In some clinics, such a procedure can also be done with the help of a robot.

After a laparoscopic operation, you can usually go home after a few days.

One can sometimes be operated on by an incision in the abdomen. It usually takes two to four hours and is taken care of afterwards in the hospital for up to one week.

After the surgery

After the operation, you usually bleed a little from the vagina for two to three weeks. During that time, do not use a tampon and shower instead of bathing. You should not have intercourse in 4-6 weeks.

Before leaving the hospital, you are given a return visit for examination and for answers to the microscopic examination of the uterus and lymph nodes.

A smaller operation can save the uterus

If you have a small cancerous tumor, you can sometimes undergo a minor surgery to preserve the possibility of becoming pregnant. The operation, called trachectomy, means that almost the entire cervix is ​​removed, but the rest of the uterus is saved. A kind of thread is inserted to hold the shortened cervix together if one becomes pregnant.

The procedure begins with the removal of lymph nodes in the pelvis, usually with peephole technique. The lymph nodes are then examined under a microscope during surgery. If there is no spread of the cancer there, this limited operation is done from the vagina.

Many such operations have now been performed. It is considered a safe method, which does not increase the risk of the disease coming back. After the operation, it is often possible to have children, but there is an increased risk of late miscarriage and premature delivery.

radiotherapy

If the answer to the microscopic examination shows that the cancer is spread to the lymph nodes or that it grows deep in the cervix, radiation therapy is given after the operation, often together with cytostatic drugs to increase the chance of recovery.

If the tumor in the cervix is ​​large or grows outside the cervix, surgery is not suitable, but then radiation therapy in combination with cytostatic drugs is obtained. Although the tumor is more widespread, there is the opportunity to be cured that way.

If you cannot get surgery because you have other diseases, for example, you can also receive radiotherapy in combination with cytostatic drugs to get rid of the cancer.

You can get different types of radiation treatment

There are two types of radiation therapy. One type is called braky treatment and means that the radiation source is placed inside the vagina. Via a special instrument, a radioactive preparation is introduced into the vagina against the tumor. In this way, the cancer tumor itself receives a high radiation dose while the radiation becomes weaker against the tissue outside, which is then spared. When the radiation source is inserted into the vagina, you are either anesthetized or have anesthesia. You can get the treatment for a variety of time, from five to ten minutes to half an hour. Between each treatment, the radiation source is removed from the vagina.

The second type of so-called external radiation treatment is obtained by directing an instrument outside the body towards the genital area. Then also surrounding tissue is irradiated where there may be cancer cells. This treatment is given for a few minutes each time, but it is repeated five days a week for five to seven weeks.

External radiation therapy and braky therapy are most often combined, especially if you only receive radiation treatment for your cervical cancer.

Radiation treatment is provided in special radiation-protected rooms so that the surroundings are not affected. There are always staff nearby that you see and can get in touch with. For the most part, you can stay home and come to the hospital just for the treatments.

Treatment with cytostatics

If you receive external radiotherapy, you usually get cytostatic once a week to increase the cancer tumor’s sensitivity to radiation. Other times when you can get cytostatic drugs are if the disease comes back after treatment.

Side effects

The treatments for cervical cancer are effective, but you can get some side effects. Some problems are experienced during or immediately after the treatments. Others may come a little later. Often there is good help in getting to the trouble.

As with all surgeries, for example, there is a risk of getting an infection in the wound and bleeding, which can take an extra long time to recover after surgery. Serious complications are uncommon.

If the ovaries need to be removed before you have stopped having menstruation, you will arrive in menopause prematurely as hormone production stops. Then you can have trouble with hot flashes, sweating and dry mucous membranes. But there is effective help to get through hormone therapy, when you get estrogen.

Disorders during and soon after radiation therapy are common. You can get sweaty when you kiss, feel nausea, get diarrhea and get tired. Intestinal problems can often be alleviated by keeping a certain diet, such as refraining from fatty foods. There are also medicines to take. The trouble usually goes away after a while. If you have problems for longer periods you can contact a dietician.

The type of cytostatic that you get in cervical cancer rarely causes you to lose your hair, but you can feel sick and tired. Because there is good treatment, the problems are usually not that great. However, one can become more sensitive to infections because white blood cells and platelets can be reduced by affecting the bone marrow. You can then more easily bleed nosebleeds. During treatment, you are therefore regularly checked for blood tests and information and advice on how to behave.

Swollen legs

After surgery or radiotherapy you can get something called lymphedema in the legs. The risk of this is greater if you have received both treatments. The legs swell because lymph nodes have been removed and lymph vessels are damaged. The swelling can come right after the treatment, but also later. Support socks can be used to reduce the problems. If you have a lot of trouble you can also get referral to special physiotherapists or lymphotherapists to get lymph massage. Such treatment is given for a limited time, but it can be repeated if needed.

life together

If the ovaries are removed or irradiated, the moisture in the vagina decreases just as after the menopause. Against such inconveniences, it can help to use estrogen in the form of creams or vaginas. During surgery, the vagina is shortened and radiation treatment can cause it to become less elastic. In order to prevent the sheath from getting tighter it is important to stretch it. It can be good to start having sex as soon as you recover. You can also get a dilator, a vaginal rod, to stretch the vagina yourself. In both intercourse and dilator it is important to use slip ointment.

You should not hesitate to raise issues regarding sex and cohabitation with your doctor and contact nurse during the treatment period, and not least after the treatment is completed. They can provide support and advice. If you have special needs you can get a referral to a sexologist, who is available at some clinics.

The risk of relapse

The risk of getting sick again is greatest during the first three years after treatment. If the cancer comes back after surgery, there are good chances that it can be treated with radiation. In the same way, surgery can be good if you have relapses after radiation therapy alone.

Spread of cancer

If the cancer recurs in lymph nodes or other organs, the chance of recovery is much less, but treatment with radiation or cytostatics can provide good relief for a long time. If you are in pain you can get help from different types of painkillers. You can also come to doctors who specialize in pain.

How is life affected by cervical cancer?

Regular checks for five years

Cervical cancer is a serious disease and the treatments may have been extensive and prolonged. Although it can often feel heavy and much different afterwards, many can nevertheless regain a good quality of life.

After treatment for cervical cancer, regular checkups are performed for five years. The first two years are revisited every three to four months and then twice a year. You then have to go through a regular gynecological examination. Other investigations may also be required if necessary. The checks are made to detect in time if the cancer is coming back and to detect any complications that may have been caused by the treatment.

Back at work

For those who work, the illness can mean being sick for a longer period of time. The employer is obliged to facilitate the return to work and many times you need to get a gradual rehabilitation.

To recover mentally

Going through a cancer illness can also involve great stress mentally. You can recover in different ways. Some may often want to talk about the disease with their friends, others may want to keep this to a smaller circle. It is important to be able to recover in the way that corresponds to who you are as a person. For many, the illness and time of treatment means stopping, re-evaluating and changing things in one’s life.

People close by are often a good support, but it may not always be enough. It may also be that you have no one to talk to. In most clinics where you get treatment for cervical cancer, there is a special reception for rehabilitation after cancer treatment. There are teams of psychiatrists, psychologists, nurses, curators and dietitians. Individual conversational therapy can be obtained, but group activities are organized such as “Getting started groups”. You can also contact the Cancer Foundation or Cancer Counseling for support or answers to questions.

To get in touch with others in the same situation and get advice and support, you can also contact a patient association. Here you will find contact information for  advice and support in cancer 

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