Dr. Margarita Taushanova, PhD Doctor specializing in medical oncology and internal medicine. She graduated from Medical University – Sofia in 1989. She worked as a therapist, and in 2002 she started working as an oncologist at the Chemotherapy Clinic of the University Specialized Hospital for Active Oncology Treatment, Sofia. Currently, he is the Head of the Department of Medical Oncology at the Tsaritsa Ioana UMBAL, ISUL. He defended a thesis on the diagnosis and treatment of triple-negative breast carcinoma in 2012. He has a number of publications in the field of medical oncology, as well as co-authored textbooks in this field. Participated in the drafting of a consensus on conduct in gynecological diseases in 2015. He has experience as a principal investigator and sub-investigator of phase I, II, III and IV clinical trials in breast, ovarian, lung, colon carcinoma. Her research interests are in the treatment of breast carcinoma, gynecological tumors, lung carcinoma and other solid tumors. – Dr. Taushanova, what are the most serious and frequent predisposing factors to cervical cancer? The most common risk factors for the development of cervical carcinoma are HPV infection, with subtypes HPV 16 and HPV 18 associated with high-grade dysplasia and carcinoma. Other risk factors could be a high number of pregnancies, a large number of sexual partners, early age of first sexual contact, low socioeconomic status, smoking, long-term use of contraceptives. – Is it possible for the disease to be asymptomatic? Early cervical carcinoma is often asymptomatic. Signs of carcinoma can appear both in the early and advanced stages. Vaginal bleeding, abnormal vaginal discharge, pelvic pain, contact bleeding, pain during sexual contact (dysparuria) may occur. – What are the symptoms that women should watch out for? One or more of the above symptoms may occur. It is important to know that regular preventive examinations at a gynecologist can detect the earliest stage of cervical carcinoma without the manifestation of any of the indicated signs. – How is cervical carcinoma diagnosed? For the diagnosis, it is necessary to carry out a thorough clinical and gynecological examination and cervical cytology – the so-called pap smear and HPV test, which has a high degree of sensitivity and specificity. The next step is to perform a colposcopy – a non-invasive examination of the cervix. Conization can also be undertaken – an intervention in which part of the cervix is ​​cut and material is taken for biopsy. It may also be necessary to carry out other diagnostic tests – cystoscopy, rectosigmoidoscopy, CAT or MRI of the chest cavity, abdomen, small pelvis. A PET scan or CT scan is necessary to assess lymph node involvement,especially in an advanced stage – to detect retroperitoneal, para-aortic lymph nodes. This method has a high specificity of about 90-97%. From the correct determination of the stage of the disease, the correct treatment tactics are determined. – How is cervical cancer treated? Cervical cancer treatment is complex and should be planned by a multidisciplinary oncology committee. It is based on the stage of the disease. Initial treatment consists of surgery, radiotherapy or combined radiotherapy and chemotherapy. In advanced disease, the treatment is chemotherapy, targeted therapy, palliative radiotherapy. In the early stages of the disease – Stage IA, the tumor can be treated with conization – surgical removal of the cervix, without removing the pelvic lymph nodes, thus preserving the patient’s fertility. Lymphadenectomy – a procedure in which the pelvic lymph nodes are removed, is performed only when they are involved. Radiation therapy uses high-energy radiation to destroy cancer cells. Chemo- and radiation therapy is a combination of chemotherapeutic agents – cisplatin administered intravenously once a week and radiation therapy, which is external and brachytherapy. This combination prolongs both overall survival and progression-free survival. – What are the innovations in the approach against the disease? The application of targeting, also called target therapy, is an innovative approach in the treatment of cervical carcinoma. Targeted drugs stop the growth of tumor cells. They target specific genes and proteins found in cancer cells or cells associated with tumor growth. This therapy is often combined with chemotherapy. The introduction of immunotherapy in the treatment of advanced cervical carcinoma is also an approach that gives new hope in therapy. – If there is a genetic predisposition, is it possible to prevent the development of cervical carcinoma? The development and spread of cervical carcinoma can be prevented by early and effective prevention. – How is disease prevention carried out? Prevention of cervical carcinoma is primary – vaccination against human papilloma virus (HPV) and secondary – screening. HPV vaccination is highly recommended in a number of countries. Vaccination against HPV is a prevention and does not replace a pap smear, which must be carried out in accordance with the necessary recommendations from a specialist gynecologist. In secondary prevention, screening tests are essential. Routine screening programs can identify precancerous cells or cancer at an early stage, making it possible for the patient to be cured. – Does cancer complicate pregnancy? In cervical cancer and pregnancy, in addition to clinical examination and histological diagnosis, ultrasound diagnostics and nuclear magnetic resonance are also necessary. Depending on the stage of the disease and the gestational week of the pregnancy,treatment options should be discussed with the patient, including the risks and benefits of individual approaches – adaptive surgery to preserve the pregnancy, including removal of the tumor, also radical surgery or definitive radiochemotherapy, which is recommended according to the stage of the disease with or without interruption of pregnancy. Sometimes it is necessary to delay the oncological treatment until the viability of the fetus. – Does the disease damage the reproductive functions of the female organism? Preservation and preservation of the reproductive function depends on the selected treatment approach, which is directly related to the stage of the disease, taking into account the patient’s wishes. Each of the approaches leads to a violation of the reproductive function, but in this particular case it is important to preserve the patient’s life.