Dr. Leila Pirzadeh
Surgeon and Specialist in Gynecology, Obstetrics, and Infertility
Dr Leila Pirzadeh, Surgeon and Specialist in Gynecology, Obstetrics, and Infertility, Fellowship in Gynecologic Oncology, explains about cervical cancer.
The text of Dr. Pirzadeh’s speech
In the name of God. I am Dr. Leila Pirzadeh, a specialist in gynecology and obstetrics, and a fellowship in gynecologic oncology. I want to talk to our audience at Noor Charity about cervical cancer, also known as cervical carcinoma.
Cervical cancer, or cervix cancer, is preventable and treatable if diagnosed on time. Nearly 90% of deaths in 2018 were in low-income or middle-income countries. Thus, with better access to public health services, we can take steps to reduce the prevalence of this disease.
How should we help eradicate this disease? By vaccinating girls under 15 up to 90%. Vaccination against HPV. 70% of women should be screened using high-quality HPV tests And 90% of women with precancerous lesions and 90% of women with cervical cancer should be treated.
Every country should achieve these three goals to move towards eradicating cervical cancer in the next century. The cervix is the entrance of the uterus from the vagina, and it slightly extends into the vagina. Nearly all cases, 99%, of cervical cancer are caused by HPV infection, the human papillomavirus, which is mostly transmitted through sexual contact.
Although most HPV infections resolve on their own and do not cause symptoms, persistent infection can lead to cervical cancer in women. Prevention through vaccination, screening, and treatment of precancerous lesions can prevent most cases of cervical cancer. This cancer, if fortunately diagnosed on time, is one of the most successfully treatable cancers. Even in advanced stages, appropriate treatment is available.
Vaccination for all girls under 15 years old in two doses is highly effective and can prevent 90% of HPV infections. However, in general, it is better for vaccination to be done at younger ages and before the start of sexual activity to be more effective. For individuals over 15 years old, vaccination is done in three doses. Even if vaccinated, cervical screening should continue as the vaccine does not provide complete protection against the disease.
The onset of the precancerous stage of cervical cells is usually caused by a prior HPV infection, which we can identify at this stage.
High-risk HPV types, especially 16 and 18, are responsible for most cases of cervical cancer. Some other types of HPV, which are less important to us, cause genital warts and are not associated with cancer. Having multiple sexual partners increases the risk of HPV infection, and consequently, the risk of cervical cancer.
What do high-risk HPV types do? They affect cervical cells and may transform them into cancerous cells over the years. However, most women infected with this virus do not develop cancer.
Other factors that increase the risk of cervical cancer progression, in addition to HPV, include smoking, as chemicals from cigarettes can cause cellular degradation in the cervix, especially if a smoker is also infected with HPV, increasing the risk of cervical cancer.
Another factor is a weakened immune system or individuals using immunosuppressive drugs. If the body’s immune function is insufficient, the body cannot deal with HPV and precancerous lesions, and the risk of cervical cancer remains.
Regarding the long-term use of hormonal pills, it is necessary to check for the possibility of HPV with a doctor.
What are the first symptoms of cervical cancer? There might be no symptoms initially, which is a significant factor for it to be discovered by a doctor. When the tumor is very small, but when it grows, many symptoms may arise, such as vaginal bleeding between normal periods, bleeding after sexual intercourse, any vaginal bleeding after menopause, vaginal discharge with an unpleasant odor, discomfort or pain during intercourse, or any pelvic or back pain.
These symptoms are common in benign conditions and should not cause much worry. However, if these symptoms persist continuously, it is essential to see a doctor. In case the cancer spreads, other symptoms and signs will also appear.
For diagnosis, a doctor usually performs a vaginal examination and uses a tool for examination, where an abnormal cervix may be felt or seen during the examination. As I mentioned, a speculum is used for the examination. If there is suspicion of cancer, a referral for colposcopy is necessary.
Colposcopy is a detailed examination of the cervix with magnification. For colposcopy, a speculum is gently inserted into the vagina to see the cervix in more detail as I mentioned. It takes about 15 minutes, and during colposcopy, a small part of the cervix is usually taken as a biopsy, then examined in the laboratory. If the lab pathology confirms it, further tests such as CT scan, MRI, etc., are requested by the doctor to assess the spread of cervical cancer. To determine the next stage of cancer, imaging must be done based on the examination and assess the spread to adjacent organs of the cervix and provide appropriate treatment.
Treatments are chosen based on the extent of cervical cancer, including surgery, chemotherapy, and radiotherapy. Chemotherapy and radiotherapy may completely destroy cancer cells or stop their growth.
Who has a better prognosis for cervical cancer? Those with early diagnosis. That is, the disease is confined only to the cervix and has not spread to the pelvis and abdomen. Usually, young women have a better prognosis. In recovery, there are no signs of cancer after treatment, and regular follow-ups are done according to the relevant doctor’s advice.
So we conclude that if abnormal cells are found in Pap smears or biopsy during colposcopy, or with regular follow-ups for positive HPV diagnosis, we can prevent cancer. Generally, for primary prevention of cervical cancer, regular screening with Pap smears and, where available, HPV tests should be performed.
Therefore, we have primary prevention and secondary prevention. Primary prevention with Pap smear tests and HPV tests and secondary prevention after an abnormal Pap smear or a positive HPV which includes further examinations.
Thank you. I hope we have no problems for future generations with primary prevention.
