Dr Vladimir Vukov, oncologist was guest of the TV episode “Prevention is better than cure” on TV “Health”. You can hear the newest would statistics, number of patients in Serbia and Belgrade, the way the disease is diagnosed, symptoms and the methods of treatment of this type of cancer.
Epidemiology of cervical cancer in Serbia
Epidemiologic picture is not positive. Cervical cancer is the second most common malignancy in women, fourth cause of death in cancers. Each year new 1500 women are diagnosed with this disease, and 500 of them will die. Women are mostly between 45 and 59 years old. Unfortunately, women younger and younger get sick. In Serbia cervical cancer takes toll on daily basis when one woman dies and four new cases are diagnosed.
Cervical cancer develops during malignant transformation of cells that form the cervix of uterus. Cause in 97 percent is human papillomavirus. There are over hundred types of this virus from which 40 of them cause changes on mucosa of cervix of uterus and 20 to 30 of them are potentially oncogenic. According to pathohistological classification of cervical cancer are divided into squamocellular that are most often seen in patients and adenocarcinomas that are 15 to 20 percent of all cases. In rare cases there could be microcellular carcinoma and sarcomas.
Symptoms that can signal a serious disease
In the beginning of disease symptoms usually are not visible. Patients that can see some symptoms in most cases have disease that is advanced. In particular, they have increased bleeding, bleeding that is not related with menstrual cycle and postcoital bleeding. Usually it is spotty bleeding that occur first.
Can a doctor see cervical cancer during pelvic exam?
Gynecological examination is elementary and is base for further diagnostic. I would like to emphasize the role of family doctor, or MD that should send patients to do regular gynecological examination, or to educate people to do regular check ups. It includes also Papanicolaou test and cervical ectopy that is examined by a pathologist where example is seen under a microscope and changes are then qualified. Where neoplasms changes are observed, patients are sent to perform further check ups. If colonoscopy examination are not seen any changes, in patients with highly positive finding of Papanicolaou test, it should be taken also endocervical sample. If finding is positive-we have invasive carcinoma, it is necessary to evaluate how expanded disease is. There are different methods that can be performed. Different radiological methods like MRI of pelvis, CT or ultrasound can be done. There is also a bimanual gynecological exam when it is estimated how much disease is expanded. Then through chemical analysis of blood there can be seen kidney, liver functions. Then everything is classified according to FIGO classification and further conclusion about diagnostic-therapeutic treatment is made.
What is happening when patient discovers that is suffering from cervical cancer?
When all analysis are collected patient is presented to interdisciplinary consilium where should be radiation oncologist, gynecologist-oncologist, medical oncologist and pathologist. Based on disease spreading further treatment is considered-surgery, chemotherapy or combination of these methods.
What is most common site of metastasis of this type of carcinoma?
Cervical cancer is spreading on three ways: directly on local structures, lymphatically on local lymph nodes and via hematogenous route on lungs, liver, bones and brain.
What is percentage of survival in sick women?
In zero stage cancer when cancer still haven’t broken basement membrane, or when treatment is basically only with removal of cervix, five year rate survival is around 93%. At the first stage when disease has invaded in cervical stroma, survival rate is between 80 to 90 percent. In stage IV five year survival rate is only 15 %.
Do you have possibility to send samples abroad?
Oncology tends to personalize therapy for oncologic diseases. Atlas General Hospital cooperates with the Institution from Brussels OncoDNA where we send tumor and blood samples of the patients for specific analysis. With genetic tests it can be determined if patient can be given specific cytostatic, immunotherapy and biologic therapy.
Is there a specific protection from cervical carcinoma? Do you recommend HPV vaccine?
I do recommend HPV vaccines that boost immunity against human papillomavirus. Thus, it can be minimized spreading of infection. In order to be effective, this vaccine should be given prior to sexual relations. That doesn’t mean that women do not have to take care about other measures to prevent spreading of disease.