Proper tracking allows less aggressive treatments and preserves the dream of motherhood
O is a tumor (abnormal cell multiplication) that develops at the bottom of the uterus, called “lap”, which is at the bottom of the vagina. This is still a worrying reality in Brazil, because, despite being highly prevenable and treatable when diagnosed early, it continues to affect thousands of women every year, many of them in childbearing age, with the dream of motherhood yet to realize.
According to the National Cancer Institute (), cervical cancer is the third most common malignant tumor among Brazilian women, behind only breast and colorectal cancer, that is, it is a public health problem. More than 17,000 new cases are estimated to be diagnosed annually in Brazil. It affects about half a million women each year in the world, most of them occurring before the age of 50. This type of cancer is mostly caused by persistent infection by human papillomavirus (), especially types 16 and 18, which can be transmitted during sexual intercourse. Women who smoke are more likely to have cervical cancer, as smoke facilitates virus infection.
In most cases, cervical cancer does not cause symptoms in its early stages. It is therefore so important to keep routine exams up to date. With the evolution of the tumor, symptoms and signs may arise, such as: bleeding outside menstrual period, pelvic pain and abnormal vaginal secretion. These symptoms, as they are also common to other gynecological conditions, often go unnoticed. However, it is essential that the woman seeks a doctor when she noticed any changes as these described.
The good news is that, when detected early, the chances of healing reach 90%, as well as allowing therapeutic approaches that preserve the uterus and ovaries, maintaining the reproductive potential of women.
Pap smear and treatment alternatives
The exam that makes the early diagnosis is named after Pap smear. It is simple and fast and can detect injuries even before they become cancerous. The recommendation is that it is performed annually from the age of 25, or even before, if the woman has already started sex life, as this is the main form of contamination by the HPV virus. Regular screening allows us to identify initial changes in the often asymptomatic cervix, which can be treated less invasively. To perform the exam, the ideal is not to be during the menstrual cycle or have had sex or made use of showers or vaginal lubricants within 24 hours prior to the collection of the material.
Cervical cancer staging goes from stage 0 (pre-worm injury) to stage IV (advanced disease) and is essential to define the type of treatment.
In initial cases, it is possible to perform less aggressive procedures, such as:
- Cervical connination: removal of part of the cervix, indicated in pre-invasive or microinvasive lesions.
- Radical trachelectomy: The entire cervix is removed, preserving the uterine body, suitable for small tumors in women who want to get pregnant.
- Total hysterectomy: complete withdrawal from the uterus.
In the most advanced cases, the indication is from more radical surgeries and treatments, such as:
- Extended hysterectomy (Wertheim-Meigs): Removal of the cervix and the uterine body, accompanied by the removal of the top of the vagina, the tissues around the lap (parametric) and the lymph nodes inside the basin.
- Chemotherapy and ovarian preservation radiotherapy: It is often possible to protect ovaries from damage during treatment with specific techniques such as ovarian transposition.
In both early and advanced cases, surgeries can be performed by videolaparoscopy, as well as through robotic technique, which brings more accuracy, less surgical trauma and faster recovery.
Fertility, preservation and prevention
The approach of fertility in women diagnosed with cervical cancer should be part of the therapeutic strategy, especially when it comes to reproductive age patients who have no children or who want future pregnancies.
It is essential that, before the onset of cancer treatment – whether surgical, radiotherapy or chemotherapy – patients are informed of the potential deleterious effects of these therapies on the female reproductive system. Interventions such as hysterectomy, pelvic radiotherapy and cytotoxic chemotherapy agents may irreversibly compromise ovarian and uterine function.
In such cases, fertility preservation techniques, such as egg or embryo freezing, should be considered. Crypreservation can be performed in an ovarian stimulation cycle with an average duration of 10 to 15 days, a time considered safe according to recent evidence, without negative impact on the prognosis or effectiveness of cancer treatment.
In addition to the medical aspect, the possibility of preserving fertility represents an expanded care that respects the patient’s autonomy and protects his life projects. Therefore, it is essential that the multidisciplinary team involved in cancer treatment offers individualized cancer reproductive counseling, considering the stage of the disease, the time available before treatment and the patient’s desires for future maternity.
How to prevent cervical cancer:
- Expansion of access to preventive examination.
- The use of condoms contributes to reducing HPV transmission. This protection is not total, as the virus passes into intimate contact during sex, even without penetration and between same -sex people.
- HPV vaccination campaigns: The vaccine protects against the main types of cervical cancer viruses, but not all. Therefore, even vaccinated, the woman must take the preventive exam at the recommended age. Vaccination should start in girls from 9 to 14 years old and boys from 11 to 14 years old, as protection in these groups is higher than in adults.
The final message: prevent, diagnose and care with empathy. Taking care of gynecological health is an act of self -love. Cervical cancer has a cure, and often treatment can be done without preventing the plans from being a mother. Information saves lives, and reception can transform trajectories.
Maria Cecília Erthal (CR 408660 RJ – RQE 30301
Medical Specialist in Assisted Reproduction and member of Brazil Health
