Cervical Cancer: A Global Effort for Prevention, Early Diagnosis, and Treatment

Cervical cancer is one of the most significant public health challenges worldwide, with thousands of new cases and deaths each year. It is a disease directly linked to infection with the human papillomavirus (HPV), and for which prevention and regular screening can play a decisive role in women’s health outcomes.

Cervical cancer is among the most common cancers affecting women internationally. According to statistical data, it is the fourth most frequent cancer in women globally, accounting for tens of thousands of deaths each year—particularly in countries with limited access to healthcare services and preventive screening programs.

HPV infection is the main causative factor in the development of cervical cancer. Transmission occurs primarily through sexual contact, and high-risk HPV types (such as types 16 and 18) are associated with the majority of cervical cancer cases.

The Importance of Prevention and Screening

Pap Smear (Pap Test): The Pap smear is a fundamental screening tool for cervical cancer. This cytological examination can detect precancerous changes in cervical cells long before they progress to invasive cancer.

HPV Test: The HPV test detects the presence of high-risk HPV strains. In many countries, it is now considered a superior or complementary strategy to the Pap test.

The combination of these two tests—Pap test and HPV test—significantly increases the likelihood of early detection of precancerous conditions and substantially reduces the risk of developing advanced cervical cancer.

The Role of HPV Vaccination

HPV vaccination is currently one of the most effective strategies for preventing cervical cancer. The vaccines aim to prevent infection from the most dangerous HPV types—primarily types 16 and 18—thereby significantly reducing the future risk of cancer development.

Many countries have incorporated HPV vaccination into their national immunization programs for adolescent girls and boys, offering protection before the onset of sexual activity, which represents the ideal framework for optimal prevention.

Main Symptoms of Cervical Cancer

Cervical cancer does not always present symptoms in its early stages. However, the most common symptoms include:

• Pain or discomfort in the lower abdomen and pelvis

• Bleeding after sexual intercourse or between periods

• Bleeding after menopause

• Unusual vaginal discharge

• Severe lower back or flank pain

• Menstrual irregularities

• Frequent urination, urinary or fecal incontinence

• Constipation

• Blood in the urine

• Swelling in one or both legs

  
  

Because the symptoms of cervical cancer may overlap with those of other gynecological cancers and conditions such as endometriosis or fibroids, medical evaluation is essential. Women experiencing such symptoms are advised to consult a specialized gynecologist to investigate their cause.

Diagnosis of Cervical Cancer

Early diagnosis of cervical cancer is achieved through screening, specifically the Pap smear. If suspicious cells are detected on the Pap test or if the HPV test is positive, the gynecologist will recommend colposcopy to closely examine the cervix and vagina. Biopsies are taken from any “suspicious” areas.

If these biopsies reveal invasive cervical cancer, a series of examinations will be proposed to stage the disease. These include:

• Magnetic resonance imaging (MRI) of the lower abdomen to determine the extent of the disease and possible invasion of adjacent structures such as lymph nodes, bladder, or rectum

• Computed tomography (CT) of the chest and upper abdomen or a PET scan (Positron Emission Tomography) to assess the likelihood of distant metastases

Therapeutic Approach

Treatment is determined by the stage of the disease, the patient’s age, fertility considerations, and overall health status.

Surgical Management:

In early-stage disease, cervical cancer can be treated with either conization or simple hysterectomy (removal of the uterus and cervix, with or without parametrial tissue and lymph nodes).

Definitive Radiotherapy and Chemotherapy:

This constitutes the mainstay of treatment for intermediate to advanced stages of cervical cancer and is often combined with chemotherapy.

Radiotherapy is administered in two forms:

• External Beam Radiation Therapy (EBRT)

  Radiation is delivered from an external source targeting the cervix and pelvic lymph nodes. It is typically administered daily, five days per week, for 5–6 weeks.

  
  

  In addition, the patient undergoes weekly chemotherapy to enhance radiosensitivity of cancer cells.

  
  

• Intracavitary / Interstitial Brachytherapy

  This is a cornerstone of cervical cancer treatment and cannot be replaced by any other technique. The radiation source is placed directly inside the cervix, delivering a high radiation dose precisely to the tumor. Brachytherapy is usually administered in multiple sessions following the completion of external beam radiotherapy.

  
  

Targeted and Immunological Therapies

Immunotherapy represents a relatively newer therapeutic approach for cervical cancer, particularly in advanced or recurrent disease. Currently, the most commonly used agents are immune checkpoint inhibitors (PD-L1 inhibitors), such as pembrolizumab.

Conclusion

Cervical cancer is a serious but largely treatable disease when detected early. I would like to conclude by emphasizing the value of preventive screening in the early diagnosis and complete therapy. Cervical cancer is one of the few cancers for which medical science has provided two powerful allies: vaccination against the human papillomavirus (HPV) and the Pap smear.

Editor: Dr. Maria Stylianou - Radiation Oncologist