Cervical cancer

Disease Description (Causes and Symptoms)

• Definition summary: A malignant tumor arising in the cervix (the neck-like lower part of the uterus), commonly squamous cell carcinoma or adenocarcinoma. It is often asymptomatic in the early stages, while various local and systemic symptoms may appear as it progresses.
• Main causes and pathophysiology:
  • Key cause: Infection with high-risk human papillomavirus (HPV), especially HPV 16 and 18, is the most important cause. Persistent infection can lead to dysplasia and malignant transformation of the cervical epithelium.
  • Risk factors: Early sexual activity, multiple sexual partners, smoking, immunosuppression (e.g., HIV), multiple childbirths, low socioeconomic status, and others.
  • Pathophysiology: Persistent HPV infection in the transformation zone of the cervix → dysplasia (CIN) → progression to invasive cancer (from local invasion to lymph-node and distant metastases depending on the stage).
• Main symptoms:
  • Early stage: Asymptomatic or nonspecific symptoms.
  • As it progresses: Bleeding after intercourse and abnormal vaginal bleeding (bleeding outside of menstruation), foul-smelling vaginal discharge or bloody discharge, pelvic pain, difficulty urinating or defecating (when the bladder or rectum is invaded), leg pain and lower back pain (in the late stage), constipation, and others.

Treatment Methods and Precautions

• Diagnosis and staging:
  • Diagnosis is confirmed by biopsy (cervical biopsy, cone biopsy, or endocervical curettage).
  • Staging evaluation: MRI of the pelvis to assess local invasion; CT/PET-CT to evaluate distant metastases and lymph nodes; cystoscopy and proctoscopy when necessary.
• Treatment principles (stage-based summary):
  • Intraepithelial carcinoma (CIN III / CIS): Cone excision (conization) is used for treatment and diagnostic removal; the uterus may be preserved.
  • Early invasive disease (e.g., FIGO I, some IIA cases): Radical hysterectomy plus pelvic lymph-node dissection is standard. If fertility preservation is needed, radical trachelectomy may be possible in appropriate cases (limited by tumor size and stage).
  • Locally advanced disease (IIB–IVA): Radiation therapy (pelvic radiation) plus concurrent chemotherapy, primarily cisplatin-based combination therapy, is recommended.
  • Recurrent/metastatic disease: Combination chemotherapy (e.g., cisplatin + paclitaxel) and combined targeted or immunotherapy may be used. Bevacizumab contributes to improved survival in some metastatic or recurrent cases. Pembrolizumab (an immuno-oncology drug) may be used in PD-L1-positive recurrent or metastatic cases, in accordance with approvals and guidelines.
  • End-stage and palliative treatment: Symptom relief (pain and bleeding control), radiation and supportive care, hospice care, and others.
• Examples of medications:
  • Main anticancer drugs: cisplatin, paclitaxel, topotecan, and others.
  • Targeted/immunotherapy: bevacizumab (antiangiogenic agent), pembrolizumab (immune checkpoint inhibitor; indications must be confirmed).
• Lifestyle management and precautions:
  • Stop smoking (smoking increases the risk of cancer progression and recurrence), seek counseling regarding sexual activity and contraception (consider fertility before and after treatment), and prevent infection and care for wounds during treatment.
  • Monitor and manage postoperative complications (bleeding, infection, urinary tract injury) and adverse effects of radiation and chemotherapy (bone marrow suppression, gastrointestinal symptoms, urinary and genital fibrosis, and others).
  • If pregnancy is desired, discuss the suitability of treatment options that preserve the uterus with a specialist.
• Risk of complications:
  • Radiation-induced bladder or rectal fistulas, hydronephrosis (urinary tract obstruction), leg swelling (lymphedema), infertility and sexual dysfunction, and distant metastases (to the liver, lungs, or bones), among others.

Checklist Before an Outpatient Visit (Including Preparation Materials, Records, and Sample Questions)

• Materials and records to prepare:
  • A list of currently used medications, including prescription drugs, OTC drugs, and supplements.
  • Medical history: Previous cervical cytology (Pap) and HPV test results, biopsy or cone biopsy results, and pathology reports.
  • Results of recent imaging tests (MRI, CT, PET, etc.) and the dates of the tests.
  • A record of symptom changes: Bleeding (timing and pattern), discharge (color and odor), pain (location and intensity), and urinary or bowel problems.
  • Plans related to fertility (whether pregnancy is desired), previous childbirth history, and contraceptive use.
• Lifestyle changes to check before the outpatient visit:
  • Smoking status, recent infections (e.g., sexually transmitted infections), immunosuppressed status (e.g., HIV test results), and recent weight changes.
• Materials to show the doctor during the outpatient visit (printed copies or electronic copies recommended):
  • Previous pathology reports, imaging CDs (or radiology reports), and recent blood test results.
• Examples of questions to record for yourself at the outpatient visit (including questions to ask the doctor directly):
  • Changes in each symptom (e.g., has the recent bleeding pattern changed?), treatment goals (is the purpose of treatment curative or palliative?), and whether fertility preservation is possible.

Examples of General Questions to Ask the Doctor

• "What is the exact stage of my cervical cancer? What treatment options are recommended for this stage?"
• "What is the goal of my treatment (curative treatment versus control/palliation)? What are the expected effects and side effects of each treatment?"
• "How long will recovery take during and after treatment, and when can I return to daily activities such as work, driving, and sexual activity?"
• "What lifestyle changes can I make to reduce the risk of recurrence?"

Examples of Disease-Specific Questions

• "Based on my HPV type and pathology report results, are there indications for additional targeted therapy or immunotherapy?"
• "I want to preserve my fertility. Considering my stage and tumor size, would radical trachelectomy or conization be possible? If so, what are the risks and prognosis?"