The cervix

The cervix, or neck of the uterus, is the lower part of the uterus (Figure 1), and defines the transition between the uterine body and vagina. The cervix is traversed by a spindle-shaped channel called the cervical canal (fig.2). 

 

The cervical canal is bordered with the uterine internal orifice (OUI) and the external uterine orifice (OUE).  At the level of the cervix there are also the fibrous structures that anchor the uterus to the wall of the pelvis bone. The uterine arteries and the ureter, the stretch of the urinary tract that connects the kidney to the bladder, cross the fibrous structures. Moreover, the squamo-columnar junction (SCJ) of the cervix refers to a transitional area between squamous epithelium of the vagina and the columnar epithelium of the endocervix.

 

Cervical cancer

Cervical cancer is a disease caused by the uncontrolled multiplication of some cells located at the squamo-columnar junction that become malignant.

 

Cervical cancer is the leading cause of death from gynaecological cancers in the world and almost half of the cases occur among women aged between 35 and 55 years. An early diagnosis is important for treatment because the chances of recovery are higher.

Risk factors

 

Infection with Human Papilloma Virus (HPV)

 

Infection with Human Papilloma Virus (HPV) (Figure 4) is the most important risk factor associated with cervical cancer. Unfortunately, it is difficult to prevent infection for adults with an active sex life, considering the insufficient effectiveness of condoms in preventing the spread of this virus. To date, we recognize almost 100 different genotypes of HPV; 40 of these have a predisposition (tropism) to proliferate in the typical environment of the genital tract.

 

Other recognized risk factors:

 

  • An early onset of sexual activity (during early adolescence, ending roughly with the completion of 16 years of age) and sexual promiscuity are considered risk factors in HPV and other infections of the genital tract, mainly responsible of cervical cancer
  • Have given birth multiple times, or at an early age (adolescence)
  • Infections with chlamydia or herpes simplex, for example, by insufficient sexual hygiene
  • Cigarette smoke
  • The use of oral contraceptives, especially prolonged use beyond the doctor's advice. The evidence shows that taking oral contraceptives for more than 5 years increases the risk of cervical cancer considerably.
  • A weakened immune system (immuno-suppressive syndromes)

 

What are the symptoms of cervical cancer?

Cervical cancer is often asymptomatic in the initial stages; therefore, it is important to perform regular pelvic examinations and annual exams (such as the PAP test), which in most cases serve to diagnose this disease in the early stage of its development. Symptoms, when present, may be subject to different interpretations, since they are similar to many diseases of the genital tract and occur occasionally even in healthy individuals. In the event of one or more of the symptoms listed below, it is still important to perform a gynaecological exam, at least to rule out other diseases.

 

  • Abnormal vaginal bleeding (outside the menstrual cycle)
  • Unusual vaginal discharge (colour and texture)
  • Pelvic pain
  • Pain or bleeding during sex