Cervical Cancer Treatment

Cervical (Cervix) Cancer

Cervical (cervix) cancer occurs when the cells of the cervix — the lower part of the uterus that opens into the vagina — proliferate abnormally and uncontrollably, forming a malignant tumor. This type of cancer differs from endometrial cancer, which originates from the inner lining of the uterus. The most important factor in the development of cervical cancer is persistent infection with high-risk Human Papillomavirus (HPV) types. Although HPV is a very common virus, most infections are cleared by the immune system, and only a small proportion progress over many years (typically 10-20 years) — first to precancerous lesions (CIN – Cervical Intraepithelial Neoplasia), and then to cancer.

One of the most important features of cervical cancer is that it is a largely preventable cancer. It is possible to achieve primary prevention through HPV vaccination, as well as to detect and treat precancerous lesions at an early stage through regular screening tests (Pap smear and/or HPV testing). When caught at an early stage, or while lesions have not yet turned into cancer, cervical cancer treatment is highly successful. Treatment is planned according to the stage of the disease and may include methods such as surgery, radiotherapy (radiation therapy), and chemotherapy. This process must always be managed by a multidisciplinary oncology team. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt provides services in cervical cancer prevention, screening, early diagnosis (colposcopy, biopsy), and treatment of precancerous lesions, and refers patients diagnosed with cancer to specialized oncology centers for the most appropriate treatment.

What Is Cervical Cancer? What Are Its Causes and Risk Factors?

Cervical cancer is a malignant tumor that begins in the cells forming the cervix. The most common type is Squamous Cell Carcinoma (approximately 70-80%), followed by Adenocarcinoma (15-25%).

Main Cause: High-Risk HPV Infection: Almost all (more than 99%) cervical cancers are caused by persistent infection with sexually transmitted high-risk HPV types. The body’s immune system usually clears HPV, but in cases where it cannot, the virus can cause changes in the cells. In particular, HPV Types 16 and 18 are responsible for approximately 70% of all cervical cancers.

Other Risk Factors: Although HPV infection is necessary for cancer development, it is not sufficient on its own. The following factors may increase the risk:

  • Smoking: Weakens the immune system and increases the risk of HPV infection becoming persistent and progressing to cancer.
  • Weakened Immune System: The risk is higher in patients with HIV/AIDS or those taking immunosuppressive drugs, for example following organ transplantation.
  • Early Onset of Sexual Activity: Increases the likelihood of encountering HPV at a young age.
  • Multiple Sexual Partners: Increases the risk of HPV transmission.
  • Other Sexually Transmitted Infections: Infections such as Chlamydia, Gonorrhea, and Herpes Simplex Virus (HSV) may increase the risk.
  • Long-Term Use of Birth Control Pills: Although the mechanism is not fully understood, a slight increase in risk has been reported with use lasting longer than 5 years.
  • Having Given Birth Multiple Times:
  • Low Socioeconomic Status and Poor Nutrition: Factors that can involve difficulty accessing screening programs and may affect the immune system.
  • Family History: Genetic predisposition may rarely play a role.

What Are the Symptoms of Cervical Cancer? Why Is the Early Stage Silent?

The most important characteristic of cervical cancer — and especially of precancerous lesions (CIN) — is that they usually cause no symptoms at all in the early stages. The only way to detect the disease before it progresses is through regular screening tests. For this reason, it is vitally important not to skip screenings just because you think “I have no complaints.”

As the disease progresses, the following symptoms may appear:

  • Abnormal Vaginal Bleeding:
    • Most common symptom: Bleeding or spotting after sexual intercourse (postcoital bleeding).
    • Irregular bleeding or spotting between menstrual periods.
    • Menstrual periods that are longer or heavier than normal.
    • Any vaginal bleeding after menopause.
  • Abnormal Vaginal Discharge: Continuous or increasing discharge that may be watery, pink, pale, bloody, or foul-smelling.
  • Pelvic Pain: Pain in the groin area or back (usually indicates disease progression).
  • Painful Intercourse (Dyspareunia).
  • Advanced-Stage Symptoms: When the disease spreads to surrounding tissues or distant organs, symptoms such as leg swelling (lymphedema), difficulty urinating or blood in the urine (bladder involvement), difficulty passing stool or rectal bleeding (rectal involvement), unintentional weight loss, and extreme fatigue may occur.

How Is Cervical Cancer Diagnosed? The Importance of Screening, Colposcopy, and Biopsy

Cervical cancer is diagnosed by confirming abnormalities found on screening tests with further examinations. Prof. Dr. Nuray Bozkurt plays an important role in this process:

  1. Screening Tests: Performed to detect cancer or precursor lesions early in women who show no symptoms:
    • Pap Smear (Papanicolaou Test): Examination of cells shed from the cervix under a microscope. Detects cellular abnormalities (ASC-US, LSIL, HSIL, etc.).
    • HPV Test: Looks for the DNA of high-risk HPV types in a swab sample taken from the cervix.
    • Current screening protocols generally include Pap smear, HPV testing, or both together (co-testing), depending on age. Prof. Dr. Bozkurt will determine the screening schedule appropriate for you.
  2. Colposcopy: The next step for women whose Pap smear or HPV test result is abnormal. Involves detailed examination of the magnified cervix using a special microscope (colposcope). Acetic acid and Lugol’s solution are used to identify abnormal areas.
  3. Cervical Biopsy: The definitive diagnostic method. Involves taking small tissue samples from suspicious areas identified during colposcopy and sending them for pathological examination. The pathology result determines whether the lesion is CIN (and to what degree) or invasive cancer.
  4. Endocervical Curettage (ECC): Involves taking a sample from the cervical canal. Performed when the inside of the canal cannot be seen on colposcopy or when there is glandular cell abnormality.
  5. Conization or LEEP: Sometimes, for diagnosis (if the biopsy is insufficient or the entire lesion needs to be assessed) or for treatment of precancerous lesions such as CIN 2/3, a larger cone-shaped piece of tissue may need to be removed from the cervix.

How Is Cervical Cancer Staged?

Once the cancer diagnosis has been confirmed pathologically, staging is performed to determine the extent of the disease for treatment planning. Cervical cancer is staged according to criteria set by the International Federation of Gynecology and Obstetrics (FIGO), primarily using clinical examination and imaging methods:

  • Detailed Pelvic Examination: Performed to assess tumor size and whether it has spread to the vagina or the supporting tissues alongside the uterus (parametrium). Examination under anesthesia may sometimes be needed for a better assessment.
  • Imaging Methods:
    • Pelvic MRI (Magnetic Resonance Imaging): One of the most sensitive methods for assessing tumor size, spread to surrounding tissues (parametrium, vagina, bladder, rectum), and the status of the pelvic lymph nodes.
    • CT (Computed Tomography – Chest/Abdomen/Pelvis): Used especially to investigate spread (metastasis) to lymph nodes or distant organs (lung, liver, etc.).
    • PET-CT: Can be used in addition to, or as an alternative to, CT and MRI, particularly for detecting lymph node metastases or distant spread.
  • Other Examinations (When Needed): Cystoscopy (examination of the bladder) or rectoscopy/colonoscopy (examination of the rectum) is performed if there is suspicion of spread to these organs.

Stages: According to FIGO staging, cervical cancer is classified as Stage I (cancer confined to the cervix), Stage II (spread to nearby tissues beyond the cervix), Stage III (spread to the pelvic sidewall or the lower part of the vagina, may affect the ureter, may involve lymph nodes), and Stage IV (spread to the bladder/rectum or distant organs).

Cervical Cancer Treatment Methods: A Multidisciplinary Oncology Approach

Treatment of cervical cancer depends on many factors, primarily the stage of the disease, and must always be planned and carried out by a multidisciplinary team consisting of a Gynecologic Oncologist, a Radiation Oncologist, and a Medical Oncologist. Following diagnosis, Prof. Dr. Nuray Bozkurt refers her patients to these specialist teams.

Treatment of Precancerous Lesions (CIN 2/3): (Usually performed by Gynecologists or Gynecologic Oncologists)

  • LEEP (Loop Electrosurgical Excision Procedure): Removal of abnormal tissue using a thin wire loop and an electrical current. The most commonly used method.
  • Conization: Removal of a cone-shaped piece of tissue from the cervix using a scalpel (cold conization) or laser. Provides both diagnosis and treatment.
  • Ablative Treatments (Rarely): Cryotherapy (freezing) or laser ablation (burning) can be used in selected cases.

Treatment of Invasive Cervical Cancer: (Usually performed by Oncology Teams)

  • Early-Stage Cancer (Stage IA1, IA2, IB1, sometimes IIA1):
    • Surgical Treatment: Usually the primary treatment option.
      • Radical Hysterectomy: Removal of the uterus, cervix, the supporting tissues around the uterus (parametrium), the upper part of the vagina, and the pelvic lymph nodes. Can be performed via open, laparoscopic, or robotic surgery. Requires Gynecologic Oncologist expertise.
      • Fertility-Sparing Surgery (Radical Trachelectomy): A specialized operation performed in very select, early-stage (small tumor) young patients who wish to have children, in which only the cervix and surrounding tissues are removed while the body of the uterus is preserved. Requires special expertise.
    • Radiotherapy: Can be used, either together with chemotherapy or on its own, in patients who are not suitable candidates for surgery or who have a high risk of recurrence after surgery.
  • Locally Advanced Cancer (Stage IB2, IIA2, IIB, III, IVA):
    • Chemoradiotherapy: The primary treatment method. Involves external radiotherapy and brachytherapy, usually combined with weekly low-dose chemotherapy (most commonly Cisplatin). The aim is to control the local tumor while also treating possible microscopic spread.
  • Advanced (Metastatic) Cancer (Stage IVB) or Recurrent Cancer:
    • Chemotherapy: Usually forms the basis of treatment. Different drug combinations are used.
    • Targeted Therapies: Bevacizumab, an angiogenesis inhibitor in particular, may be added to chemotherapy.
    • Immunotherapy: PD-1/PD-L1 inhibitors in particular (e.g., Pembrolizumab) may be used, in certain situations (PD-L1 positivity or MSI-high status), either alone or together with chemotherapy.
    • Palliative Radiotherapy: May be used to control symptoms such as bleeding or pain.

Post-Treatment Follow-Up and Quality of Life

After cervical cancer treatment is completed, regular, long-term follow-up is very important to detect any recurrence early and to manage possible long-term side effects of treatment. Follow-up visits are generally scheduled every 3-4 months for the first 2 years, every 6 months for the following 3 years, and annually after 5 years. Follow-up includes gynecological examination, Pap smear (from the vaginal cuff), colposcopy if needed, imaging studies, and blood tests.

Treatment (especially surgery and radiotherapy) can have effects on sexual function and bladder and bowel function. Problems such as lymphedema (leg swelling), early menopause (if the ovaries have been removed or exposed to radiotherapy), vaginal dryness, and narrowing can occur. Supportive treatments, counseling, and rehabilitation programs are important for these issues. Psychological support is also an important part of the treatment and follow-up process.

Prof. Dr. Nuray Bozkurt’s Role and Support in the Cervical Cancer Journey in Ankara

Prof. Dr. Nuray Bozkurt plays a critical role in Ankara in the prevention, early diagnosis, and management of the treatment process for cervical cancer:

  • Prevention and Awareness: Educates her patients about the importance of HPV vaccines and the necessity of regular screening.
  • Screening and Early Diagnosis: Performs Pap smear and HPV tests, and accurately evaluates patients with abnormal results through colposcopy and biopsy.
  • Treatment of Precancerous Lesions: Effectively treats precancerous lesions such as CIN 2 and CIN 3 using methods such as LEEP or conization (if she performs these procedures herself).
  • Cancer Diagnosis and Specialist Referral: When a diagnosis of cervical cancer is made, she informs the patient about the situation compassionately and clearly. To ensure the treatment process is managed in the best possible way, she refers the patient without delay to experienced multidisciplinary teams of Gynecologic Oncology, Medical Oncology, and Radiation Oncology specialists in Ankara and provides the necessary coordination.
  • Collaboration in Post-Treatment Follow-Up: Continues the long-term gynecological follow-up of patients whose treatment has been completed by the oncology team, in coordination with that team.
  • Supportive Approach: During the challenging process of cancer diagnosis and treatment, she offers her patients scientific guidance while also maintaining an empathetic and supportive approach. She answers questions and works to ease concerns. For contact, she can be reached by phone at (0538 983 18 78)(0312 284 00 12).

Remember: Cervical cancer is a disease that is largely preventable and, when caught at an early stage, highly treatable. Do not skip your regular screenings, and be sure to see your doctor if you have any abnormal symptoms. If you receive a cancer diagnosis, know that treatment must always be carried out by an oncology team specialized in this field. For early diagnosis and proper treatment management, you can receive consultation from Prof. Dr. Nuray Bozkurt at our clinic in Ankara. To make an appointment, call 0538 983 18 78

Frequently Asked Questions

No, they are different types of cancer. Cervical cancer originates from the cervix, the lowest part of the uterus, while uterine cancer originates from the inner lining of the uterus (endometrium). Their causes and risk factors are generally different.

The main cause is persistent infection with high-risk HPV types. However, cancer develops in only a very small proportion of people who have had an HPV infection. Most infections are cleared by the immune system.

Yes, its most important characteristic is that it usually causes no symptoms at all in the early stages and in precancerous lesions (CIN). This is why regular screening (Pap smear/HPV test) is so important. In more advanced stages, symptoms such as bleeding after intercourse, abnormal discharge, and bleeding outside of menstruation may occur.

You should always consult a doctor if you experience symptoms such as bleeding after intercourse, bleeding after menopause, changes in your menstrual pattern, abnormal or foul-smelling discharge, or pelvic pain.

A definitive diagnosis is made through pathological examination of a biopsy sample taken under colposcopy, performed following an abnormal screening test result or suspicious examination finding.

CIN (Cervical Intraepithelial Neoplasia) refers to precancerous changes in the cells of the cervix. CIN 1 is usually a mild change and most often regresses on its own. CIN 2 and CIN 3, on the other hand, are more advanced changes with a higher risk of progressing to cancer and must always be treated. These are not yet cancer, but they can progress to cancer if left untreated.

Treatment is determined based on the stage of the cancer (how far it has spread), its type, the patient’s age, and general health status. It is planned by a multidisciplinary oncology team (Gynecologic Oncologist, Radiation Oncologist, Medical Oncologist).

In early stages, surgery (radical hysterectomy) or, occasionally, radiotherapy is generally used; in locally advanced stages, chemoradiotherapy (radiotherapy combined with chemotherapy) is used; and in very advanced or recurrent disease, chemotherapy, targeted therapies, and immunotherapy are used.

In select young patients with very early-stage (small tumor) disease who wish to have children, a specialized operation called Radical Trachelectomy — in which the body of the uterus is preserved and only the cervix is removed — may be attempted. However, this is not a standard treatment and requires special expertise. In most invasive cancer treatments, the uterus is removed.

For cervical cancer screening, evaluation of abnormal test results (colposcopy/biopsy), or treatment of precancerous lesions, you can make an appointment at Prof. Dr. Nuray Bozkurt’s clinic in Ankara by calling 0538 983 18 78. If you receive a cancer diagnosis, Prof. Dr. Nuray Bozkurt will refer you to specialist oncology centers for the most appropriate treatment.

You can contact us for information about the diagnosis and treatment process.

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What Is Cervical Cancer (Cervix Cancer)?

Cervical cancer is a type of cancer that arises when the genetic structure of cells in the cervix — the lowest part of the uterus that opens into the vagina — becomes disrupted and the cells multiply uncontrollably. Although it is one of the most common gynecological cancers, it stands apart from other cancer types in one crucial respect: cervical cancer is a disease that can be prevented at a rate of nearly 100% through regular screening tests and vaccination.

In Ankara, Prof. Dr. Nuray Bozkurt conducts a comprehensive process covering screening programs against the risk of cervical cancer, treatment of precursor cell changes (CIN), and cancer surgery. The disease generally takes years to develop, which gives us the chance to intervene before cancer has even formed.

The Causes of Cervical Cancer and Its Link to HPV

In almost all cases of cervical cancer (more than 99%), the underlying cause is infection with HPV (Human Papillomavirus). HPV is a very common, sexually transmitted virus, and many of its types are naturally eliminated by the body’s immune system. However, the types classified as “high-risk” (especially Types 16 and 18) can cause persistent changes in cervical cells over the years, initiating the cancer process.

Besides HPV, other factors that increase the risk of cervical cancer include:

  • Smoking: The toxins in cigarettes damage cervical cells, accelerating the cancer-causing effect of the virus.

  • Weakened Immune System: A reduced ability of the body to fight the virus.

  • Early Sexual Activity: Exposure to the virus during the periods when cervical cells are most susceptible to change.

  • Neglecting Regular Screening: Cell changes going unnoticed until they reach the cancer stage.

Symptoms of Cervical Cancer: What Signs Should You Watch For?

Cervical cancer may cause no symptoms at all, especially in the early stages. The fact that cell changes (precancerous lesions) do not cause any pain or physical change makes regular screening tests all the more important. However, as the disease progresses, the following symptoms may appear:

  • Abnormal Vaginal Bleeding: Intermenstrual bleeding or spotting seen after menopause is the most common symptom.

  • Bleeding After Intercourse: Bleeding seen during or immediately after intercourse is an important sign of sensitivity in the cervix.

  • Change in Vaginal Discharge: Vaginal discharge that is different from normal, foul-smelling, watery, or bloody.

  • Pain: In more advanced stages of the disease, persistent pain in the pelvic area (lower abdomen) or pain felt during intercourse.

Having these symptoms does not directly mean you have cancer; infections or polyps can also cause similar complaints. However, in such cases, it is vitally important to consult a specialist gynecologist without delay.

The Power of Early Diagnosis: Smear and HPV Tests

Cervical cancer screening is one of the greatest advantages that modern medicine offers to women’s health. The screening methods we apply at our clinic in Ankara are as follows:

Smear Test (Pap Smear): Examines cells shed from the cervix to enable early detection of changes (dysplasia) with the potential to turn into cancer. It is recommended that all women have this test regularly starting from age 21. HPV DNA Test: Investigates the presence of HPV types with a high risk of causing cancer in the cervix. Today, performing it together with the Smear test (co-testing) maximizes diagnostic accuracy.

Thanks to these screenings, if the condition is caught at the “precancerous” stage before cancer has even formed, it can be completely eliminated with very simple surgical procedures (such as LEEP or Conization) without the need to remove the uterus.

Cervical Cancer Treatment Methods

Cervical cancer treatment is planned according to the stage at which the disease is detected, the size of the tumor, the patient’s age, and future desire to have children. The treatment process may involve one, or a combination, of the options of surgery, radiotherapy (radiation therapy), and chemotherapy (drug treatment).

Treatment of Precancerous Lesions (LEEP and Conization)

If screening tests show that cancer has not yet formed but serious cell changes (such as CIN 2, CIN 3) have been detected, only the at-risk area is removed, without removing the uterus. Through these procedures, called LEEP or cold conization, the problematic tissue in the cervix is cleared away. These methods both treat the condition and preserve the patient’s fertility.

Surgical Treatment

Surgery is the most fundamental treatment method for early-stage cervical cancer. Depending on how far the cancer has spread, complete removal of the uterus (hysterectomy) may be necessary. In some cases, the surrounding supporting tissues and lymph nodes are removed along with the uterus. In young patients, if the cancer is at a very early stage and the patient meets the appropriate criteria, the chance of having children can be preserved through an operation called “trachelectomy,” in which only the cervix is removed and the body of the uterus is preserved.

Radiotherapy and Chemotherapy

Radiotherapy is applied in more advanced stages of the disease or to reduce the risk of recurrence after surgery. Radiotherapy aims to destroy cancer cells using high-energy rays. Low-dose chemotherapy drugs are usually also added to the treatment to enhance the effectiveness of radiotherapy.

Preventing Cervical Cancer: The HPV Vaccine

Cervical cancer is the only type of cancer for which a vaccine exists. The HPV vaccine builds strong immunity in the body against the high-risk virus types most commonly responsible for causing cancer. Although it is ideally recommended before the start of sexual activity, vaccination is of great importance for prevention in women of any age. The vaccine does not replace regular screening tests (Smear/HPV); when both are applied together, a complete shield of protection against cervical cancer is achieved.

Frequently Asked Questions

Is cervical cancer hereditary? No, cervical cancer is not a genetically inherited type of cancer. The underlying cause is viral (HPV) infection.

If my Smear test result comes back abnormal, does that mean I have cancer? Absolutely not. Abnormalities on a Smear test usually indicate “precancerous” cell changes. Intervention at this stage can completely prevent cancer from developing.

Can cervical cancer recur after treatment? The risk of recurrence is low following early diagnosis and successful treatment. However, the first years after treatment are the most critical period for recurrence, which is why regular doctor check-ups are vitally important.

Does a woman who has had the HPV vaccine still need to continue with screening tests? Yes. The vaccine protects against the types most commonly responsible for causing cancer, but it may not provide protection against other, rarer types. For this reason, you should continue with screening tests even if you have been vaccinated.

Cervical Cancer Diagnosis and Treatment in Ankara

Cervical cancer is a disease that can be overcome when detected in time. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt follows her patients using current, evidence-based approaches to protecting cervical health, managing screening tests, and cancer surgery.

Don’t delay your health — you can contact us for regular screenings and preventive measures.

Information and Appointments: 0312 284 00 12