Cervical cancer - Causes, symptoms and treatment. MF.
Cervical cancer is a malignant tumor that develops from the mucous lining of the cervix in the area of the cervical epithelium transition into the vaginal. Cervical cancer is one of the most common malignant tumors in women, ranking second in terms of frequency after breast cancer. Annually, more than 500 thousand new cases of cancer are detected. In a significant part of patients, the tumor is detected at a late stage, this is due to inadequate diagnostic coverage of the female population, as well as very rapid growth rates of the tumor.
Causes of cervical cancer
Usually a combination of several factors is encountered. Often, the tumor occurs in women aged 40-55 years from low-income social strata living in rural areas and having more than 6 children.
The following factors influence the development of cervical cancer:
- earlier onset of sexual activity - from 14 to 18 years, at this age the epithelium of the cervix is immature and is especially susceptible to damaging factors.
- frequent change of sexual partners( equal or more than 5 raises the risk of developing cancer by 10 times) both for the woman herself and her husband;
- smoking more than 5 cigarettes a day;
- reception of hormonal contraceptives and, as a consequence, rejection of barrier contraception( condoms and caps), thus there is a risk of infection with sexually transmitted infections;
- non-observance of sexual hygiene;sexual partners not subjected to circumcision( since cervical cancer can provoke smegma);
- immunodeficiency, deficiency in food of vitamins A and C;
- infection with viruses of genital herpes and cytomegalovirus;
- infection with human papillomavirus( HPV).
Currently, through international studies, a direct carcinogenic role of HPV in the development of cervical cancer has been proven. It was revealed that 80 to 100% of cervical cancer cells contain human papillomavirus. Once inside the cell, the virus is embedded in the DNA chains of the cell nucleus, causing it to "work on itself", creating new virus particles that, when exiting the cell through its destruction, are introduced into new cells. HPV infection is transmitted sexually. The virus can produce productive( formation on the genitals of genital warts, papillomas) and the transforming effect on cells( causes rebirth and cancer).
There are several forms of existence in the body of HPV infection:
- asymptomatic - despite the fact that the virus passes full life cycle in the patient's cells, it is practically not detected during examination and, in a few months, provided good immunity, can be excreted from the bodyspontaneously;
- subclinical form - when viewed with the naked eye, the pathology of the cervix is not determined, but in colposcopy, small multiple warts of the cervical epithelium are detected;
- clinically expressed forms of infection: genital warts are clearly defined in the area of the external genitalia, anus, less often on the cervix.
There are more than 80 types( variants) of the virus, about 20 of them are capable of affecting the mucous membranes of the genital organs. They all have different effects on the development of cervical cancer: high-risk viruses: 16, 18, 31, 33, 35, 39, 45, 50, 51, 52, 56, 58, 59, 64, 68, 70 types;viruses of "low risk": 3, 6, 11, 13, 32, 42, 43, 44, 72, 73 types.
It is established that 16 and 18 types are most often found in cervical cancer, 6 and 11 - with benign tumors and only occasionally with cancer. In this case, 16 type is found in squamous cell carcinoma of the cervix, and type 18 in adenocarcinoma and low-grade cancer.
Precancerous diseases( dangerous due to frequent transformation into cancer): dysplasia of the cervix( changes in the structure of the epithelium, not normal), erosion of the cervix, leukoplakia. Require mandatory treatment, most often, laser evaporation of the affected area.
1- Polyp of the cervical canal;2-erosion of the cervix.
Symptoms of cervical cancer
Symptoms of cervical cancer are divided into general and specific.
Common symptoms: weakness, weight loss, loss of appetite, sweating, unreasonable body temperature rises, dizziness, pallor and dry skin.
Specific symptoms of cervical cancer may be as follows:
1. Bloody discharge from the genital tract, not associated with menstruation, may be minor, smearing, or plentiful, bleeding is rare in rare cases. Often bloody discharge occurs after sexual contact - "contact discharge".Possible manifestations in the form of acyclic secretions or against the background of menopause. In the late stages of excretion, an unpleasant odor associated with the destruction of the tumor can be acquired.
2. Pain in the lower abdomen: may accompany spotting, or occur with advanced forms of cancer as a result of infection or tumor germination of other pelvic organs or structures( nerve plexus, pelvic wall).
3. The swelling of the extremities, external genital organs occur with the progression of the disease in neglected and far-reaching cases, arise as a result of metastasis into the nearby pelvic lymph nodes and blockage of large vessels that divert blood from the lower limbs.
4. Violation of the function of the intestine and bladder occurs when the tumor grows by these organs - the formation of fistulas( holes between organs that do not exist in the norm).
5. Urinary retention associated with mechanical compression of the metastatic lymph nodes of the ureters with subsequent exclusion of the kidney from work, the formation of hydronephrosis, the consequence of which is the poisoning of the body with waste products( uremia) with complete absence of urine - anuria.
In addition, the described changes lead to the penetration of purulent infection on the urinary tract and the death of patients from severe infectious complications. Possible hematuria( an admixture of blood in the urine).
6. Edema of the lower limb on the one hand - can occur in later stages, with metastases in the lymph nodes of the pelvis and compression of large vessels of the extremity.
Examination for suspicion of cervical cancer includes:
1. examination in mirrors and bimanual( manual) examination - a standard examination by a gynecologist, visual inspection allows to identify or suspect a tumor pathology in the appearance of the mucous membrane of the cervix( proliferation, ulceration);
In the mirrors, the appearance of the cervix
2. staining with Lugol( iodine) and acetic acid solution: allows revealing the indirect signs of both initial and developed cervical cancer - the tortuosity of the vessels, staining pathological foci less intensively than normal sites and others;
Section of altered epithelium( dark area, shown by an arrow)
3. Colposcopy - examination of the cervix with a magnification of 7.5- 40 times, allows a more detailed examination of the cervix, reveal precancerous processes( dysplasia, leukoplakia) and the initial form of cancer;
Cervical leukoplakia in colposcopy
4. Taking smears for cytology from the cervix and cervical canal - should be performed annually for each woman to detect microscopic, initial forms of cancer;
5. cervical biopsy and scraping of the cervical canal - taking a piece of the cervix under a microscope, is required for suspected cancer, can be performed with a scalpel or an electron knife.
6. ultrasound examination of pelvic organs - allows to estimate the prevalence of the tumor process in the small pelvis( stage), necessary for planning the volume of the operation;
7. computed tomography of the small pelvis - in unclear cases, with suspicion of tumor germination of neighboring organs;
8. Intravenous urography - is performed to determine the function of the kidneys, since in cervical cancer, ureteral compression is often accompanied by a tumor, followed by a disruption in the function of the kidneys and switching it off from work;
9. Cystoscopy and rectoscopy( or irrigoscopy - radiopaque examination of the intestine) - examination of the bladder and rectum with the purpose of revealing their germination by a tumor;
10. Chest x-ray and ultrasound examination of abdominal organs - performed to exclude distant metastases.
Cervical Cancer Stages:
Stage 0 - the initial stage - "cancer in place", the survival rate of patients, after treatment is 98-100%;
Stage 1( A, A1, A2-1B, B1, B2) - is divided into subgroups, stage A - the tumor sprouts in the cervical tissue no more than 5 mm, in the stage-tumor up to 4 cm;
Stage 2( A and B) - the tumor spreads to the uterus, but without involvement of the pelvic wall or upper third of the vagina;
Stage 3, a tumor sprouts the upper third of the vagina, the pelvic wall or causes hydronephrosis from one side( overlapping the ureter, the kidney turned off from work);
Stage 4- germination in the bladder, rectum or pelvic bone( sacrum), as well as the presence of distant metastases.
Metastases are cuttings from the primary tumor, having its structure and capable of growing, disrupting the function of those organs where they develop. The appearance of metastases is associated with the regular growth of the tumor: the tissue grows quickly, the nutrition does not suffice for all its elements, some cells lose contact with the rest, it breaks away from the tumor and enters the blood vessels, spreads through the body and enters the organs with a shallow and developed vascular network, lungs, brain, bones), settle in them from the bloodstream and begin to grow, forming colonies-metastases. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to death of patients from poisoning with the products of the tumor's vital activity and disruption of the organ's functioning. Cervical cancer most often metastasizes to the nearby lymph nodes - fatty tissue of the small pelvis, along the course of large vascular bundles( iliac);from distant organs: into the lungs and pleura( cover lining of the lungs), to the liver and other organs. If metastases are unique, they can be removed - this gives a better chance of recovery. If they are multiple, only supportive chemotherapy. Great problems are brought to the patients pleurisy - metastatic damage to the lining of the lungs, which leads to a violation of its permeability and accumulation of fluid in the chest cavity, leading to compression of the organs - lungs, heart, and causing dyspnea, heaviness in the chest and exhaustion of patients.
A favorable prognosis is possible only under condition of adequate treatment( surgery or radiotherapy or their combination) at the initial, 1-2 stages. Unfortunately, at stage 3-4 the survival rate is extremely low, does not exceed 40%.
Treatment of cervical cancer
The best treatment results are obtained with the initial cervical cancer( "cancer in place"), not growing into surrounding tissues. In young patients of childbearing age planning fertility, there are several options for organ-preserving treatment: excision of the affected area with a scalpel within the limits of healthy tissues or laser evaporation, cryodestruction( liquid nitrogen), ultrasound removal of the cervix.
In microinvasive cancer, tumor growth in the underlying tissues is not more than 3 mm, as well as with all other stages of the tumor, an operation is required - extirpation of the uterus without appendages in women of childbearing age and removal with appendages in women in the post-menopausal period. At the same time, from the 1st stage onwards, the removal of nearby lymph nodes is added to the treatment.
In addition, the operation can be supplemented with radiotherapy( irradiation).
In stages 1-2, independent radiotherapy is possible, without surgery: intracavitary( through the vagina) and remote( outside).
The choice of method of treatment depends on the age, general well-being, desire of the patient.
When the tumor grows into the surrounding organs, a combined operation( removal of the uterus with part of these organs) is possible.
For large inoperable tumors, radiotherapy is the treatment option, provided the tumor is reduced in size, the next step is surgery.
At large stages of the tumor process, palliative operations( relief of symptoms) are possible: removal of colostomy on the abdomen, formation of a bypass anastomosis.
A variant of treatment may be chemotherapy - surgery or chemo-radiation treatment without surgery.
In the presence of metastases in distant organs - only chemotherapy.
Complete recovery of the patient is possible as a result of using a surgical or combined effect.
After treatment, a dynamic observation is necessary: attendance to the gynecologist for colposcopy and smear taking every 3 months.
No way should self-medicate, as a favorable period for treatment will be lost during this time.
Complications of cervical cancer:
compression of the ureters, urinary retention, hydronephrosis, purulent infection of the urinary tract, bleeding from the tumor and genital tract up to profuse( fatal), the formation of fistulas( communication between the bladder or intestine and vagina).
Consultation of a doctor for cervical cancer:
Question: How often are women affected by cervical cancer?
Answer: This tumor is found quite often, it occupies the 2nd place after breast cancer in Europe. In Russia, 6th among malignant tumors and 3 among organs of the reproductive system. Women of all ages are ill, but more often 50-55 years.
Question: Is it possible to have children after cervical cancer treatment?
Answer: Yes, perhaps, provided the early stages of cancer and the performance of organ-saving operations.
Question: What is the alternative to surgical treatment of cervical cancer?
Answer: There may be many options for treatment, it all depends on the patient's desire and the possibilities of the medical institution: scalpel cutting( knife amputation) within healthy tissues or laser evaporation, cryodestruction( liquid nitrogen), ultrasound removal of the cervix and others.
Oncologist-doctor Barinova Natalya Yurevna