Cervical cancer

Pathology

Cervical cancer (or cervical carcinoma) is a neoplasm that develops in the lower part of the uterus, called the cervix. Thanks to screening programs and vaccination against Human Papillomavirus (HPV), this disease is now much less frequent than in the past, and the goal of the scientific community is to achieve its complete elimination.

Today, thanks to early detection and targeted therapies, cervical cancer can be treated with a high chance of success. Regular checkups and prevention remain the most effective weapons to protect health.

Types

Cervical cancers based on the cells from which they originate are predominantly of two types:

• Squamous (85%): cancer arising from the cells lining the exocervix i.e., the outermost part of the cervix. Associated with HPV 16, 18, 58,33 and 45;
• Adenocarcinoma (10-12%): arising from the cells of the endocervix i.e., the innermost part of the cervix. Associated with HPV 16, 18, 45, 31 and 33.

Rarer cancers are:

• Adenosquamous (3-5%): rarer with mixed origin;
• Adenocystic (3-5%);
• Undifferentiated.

This classification is important because it helps physicians choose the most appropriate course of treatment, ensuring targeted and individualized therapies.

The numbers in Italy

According to the AIRTUM registry (Italian Association of Cancer Registries), 2,382 new diagnoses of cervical cancer were registered in Italy in 2024. This neoplasm is most frequent in the young (4% of cases, fifth most frequent neoplasm).

Risk factors

Cervical cancer can be related to:

• human papilloma virus (HPV), which accounts for the majority of diagnosed cases;
• Cigarette smoke;
• Familiarity for this type of cancer;
• Use of oral contraceptives;
• Low socioeconomic status.

Regarding HPV, it should be emphasized that most infections regress spontaneously; when the infection persists over time, lesions form at the cervix that can evolve. This clarifies theimportance of prevention with regard to screening by Pap test or HPV-DNA test.

Symptoms

In the early stages, cervical cancer usually causes no symptoms. When they appear, they can be similar to those of other benign conditions, so they should not cause immediate alarm but should always be evaluated by a physician.

Possible signs to watch out for include:

• Abnormal bleeding (after sexual intercourse, between menstrual cycles, or after menopause);
• Vaginal discharge not accompanied by blood;
• Pain during sexual intercourse.

The presence of any of these symptoms does not automatically mean you have cancer, but it is important to talk to your gynecologist to rule out or treat any problems early.

Diagnosis and examination

Because it often causes no symptoms, cervical cancer is frequently detected during a screening examination, such as a Pap smear. If the Pap test shows alterations, the next step is colposcopy, a second-level examination that allows the cervix to be observed with a special microscope. During colposcopy, if the doctor notices suspicious areas, he or she may perform a biopsy, which is the taking of a small sample of tissue, which will then be analyzed by the pathology laboratory. In some cases, to better understand the extent of the disease, a larger sampling may be necessary: this procedure is called conization and involves the removal of a portion of the cervix.

Once the histological diagnosis has been made, in order to study the extent of the disease and plan subsequent treatment, the following examinations are performed:

• transvaginal and transabdominal ultrasonography: which allows assessment of the extent of disease at the pelvic level and its relationship to neighboring organs;
• Abdominopelvic MRI with contrast medium: which allows assessment of the extent of disease at the pelvic level and the presence of pathological lymph nodes;
• Total body CT with contrast medium: allows study of disease that has spread beyond the pelvis.

In cases deemed locally advanced:

• 18 FDG PET-CT: improves the definition of doubtful lesions and distant metastases;
• Gynecologic examination under narcosis: recommended by the International Federation of Gynecology and Obstetrics (FIGO) guidelines, it allows the gynecologic oncologist to directly assess the local extent of the disease. During the procedure, the vaginal fornices, parametrium (supporting tissues of the uterus), urethra and bladder are examined, including by cystoscopy. In some cases, diagnostic laparoscopy may be associated.

Stage classification

FIGO has defined a classification of cervical cancer ranging from stage I (disease limited to the cervix) to stage IV (disease with distant spread). Determining stage is critical to choosing the most appropriate and individualized course of treatment for each patient.

Therapies

Treatment depends on the stage of the disease, age and health status of the patient.

Ongoing support

At our institute, we ensure constant support before, during and after treatment to accompany each patient throughout the entire course of treatment and recovery.

Interdisciplinary Group

Every cancer requires, in all phases of disease management, a multidisciplinary approach that at the Candiolo Institute is guaranteed by a team of different specialists, belonging to the various clinical and surgical departments of the Institute: this team is called GIC (Interdisciplinary Care Group). The GIC ensures that each patient is taken care of throughout the diagnostic-therapeutic process, including prescribing and booking examinations and communicating with the patient and his or her family members. The GIC defines and shares a personalized care pathway for each patient, based not only on the type and stage of the tumor, but also on the patient’s own characteristics. The goal is to ensure that he or she has the best outcome both oncologically and functionally and the maintenance of a good quality of life.The Group also works closely with researchers at the Institute to ensure that patients have rapid access to the latest research-produced innovations in screening, diagnosis and treatment.

Clinical divisions

The diagnostic and therapeutic pathway of cervical cancer at Candiolo involves several clinical divisions, including:

• Ovarian Cancer Center
• Gynecology Oncology and Hereditary Tumors
• Medical Oncology
• Anesthesia and resuscitation
• Nuclear medicine
• Radiotherapy
• Radiodiagnostics
• Pathologic anatomy

Clinical studies

Researchers at the Candiolo Institute are involved in numerous projects, both nationally and internationally, dedicated to the study of gynecological cancers. These studies range from clinical and translational to molecular research, including numerous experimental clinical trials of new chemotherapy drugs, as well as innovative therapies such as immunotherapy and hormone therapy.

In addition, experimental surgical protocols on lymph node staging for cervical cancer and sentinel lymph node are active.

Access to clinical trials

In selected cases, patients may also have the opportunity to participate in clinical trials that aim to evaluate the efficacy and safety of new surgical techniques, drugs, or innovative therapeutic approaches. Participation in these studies represents an important opportunity to access cutting-edge treatments, always under close medical supervision.

Why choose us

At the Candiolo IRCCS Institute, every patient with cervical cancer is followed according to highly specialized standards, thanks to the synergistic work of a dedicated Interdisciplinary Care Group (ICG) .