The best methods for diagnosing cervical cancer
Cervical cancer ranks 5th among “female” cancers. In this case, the disease is often detected already in the later stages. We will analyze what effective methods for diagnosing cervical cancer exist.

According to the World Health Organization, cervical cancer (CC) ranks 5th among “female” cancers.1. In 2018, 17 women in our country were diagnosed with cervical cancer, which is 766% more than in 22,31. Peak incidence occurs between 40 and 49 years of age1.

Unfortunately, in 26% of cases, the disease is detected only at stage 3, and in another 9% – at stage 4. Gynecologists consider these statistics extremely negative. Cervical cancer is one of the few cancers that can be prevented.

The malignant process does not develop in an instant – it is preceded by a condition called cervical epithelium dysplasia. With dysplasia, abnormal cells appear in the epithelium of the cervix, which can subsequently cause a cancerous tumor. Therefore, it is very important to detect changes as early as possible and start treatment, then the chances of success will be much higher.

Fortunately, modern diagnostic methods make it possible to detect the disease at an early stage, when it responds well to treatment.

smear for oncocytology

A smear for oncocytology (Pap test) is a mandatory annual examination for women from 21 to 65 years old. During the procedure, the doctor uses a special tool to take cell samples from the mucous membrane of the cervix. Then the biomaterial is examined under a microscope. The Pap test allows you to detect dysplasia, precancerous conditions and cervical cancer at an early stage.

There are two types of method – conventional and liquid cytology. Liquid cytology provides more accurate results and is considered the primary screening method for diagnosing cervical cancer.

Colposcopy

The study is carried out using a special device – a colposcope, which allows, with multiple magnification, to examine the epithelium and vessels of the cervix and vagina.

Thanks to colposcopy, the doctor can see the inflammatory process and epithelial dysplasia. If any areas look suspicious, the doctor will test with special reagents (this is called extended colposcopy). Pathological cells after treatment with reagents will look different than normal ones.

During colposcopy, it is possible to do a biopsy – take a small amount of abnormal tissue for examination, which will help distinguish a benign tumor from a malignant one and make an accurate diagnosis.1. Extended colposcopy with biopsy is recommended for all women with suspected cervical cancer.

Ultrasound of the pelvic organs

This diagnostic method is used when the diagnosis of cervical cancer is confirmed. The data obtained on ultrasound help to choose or adjust the treatment method.1. In addition to ultrasound of the pelvic organs, an ultrasound examination of the abdominal cavity, retroperitoneal, inguinal-femoral and subclavian lymph nodes is performed.1. Ultrasound allows you to determine how much the tumor process has spread.

MRI of the pelvic organs

MRI helps to identify the tumor, assess its depth and understand whether the pathological process has affected the uterus and adjacent organs1. The study can be performed with intravenous contrast. The accuracy of this method for diagnosing cervical cancer is 71-97%.

Cervical biopsy

A biopsy is usually ordered if a vaginal examination, colposcopy, or Pap test reveals an abnormality. Precancerous cells and the presence of a highly oncogenic type of human papillomavirus (HPV) are considered an anomaly.

A biopsy is a minimally invasive surgical procedure during which small pieces of tissue are taken from the cervix for further examination.2. After studying the biomaterial, it is possible to establish the type of tumor, size, depth of the lesion and other parameters that are needed for an accurate diagnosis.2.

Tumor markers in cervical cancer

Tumor markers are called enzymes, antigens and glycoproteins that are produced by cancer cells. These compounds can be detected in a blood test. An analysis for tumor markers is prescribed for women with suspected cervical cancer, as well as for patients diagnosed with cervical cancer, in order to evaluate the effectiveness of treatment, detect relapses and detect metastases.

CC is usually tested for squamous cell carcinoma antigen or SCC3. This antigen is detected in women with cervical squamous cell carcinoma, which occurs in 70-80% of cases.3.

PCR diagnostics for HPV

Human papillomavirus or HPV is considered the leading cause of cervical cancer.3. The virus is most commonly transmitted through sexual contact and is present in 70–80% of sexually active women.4. Many are re-infected because the human body does not develop natural immunity against the virus. At the same time, there are a lot of types of HPV, and not all of them cause cancer. The most dangerous are viruses of high oncogenic risk – 16 and 184.

However, the presence of the HPV virus in the body, even a highly oncogenic one, does not mean that a woman will definitely get cervical cancer. In most cases, the virus leaves the body within 1–2 years without causing harm. However, in 5-10% of patients, the virus uses the host cells to reproduce its DNA, which can lead to the development of a cancerous tumor.4. Therefore, women with HPV should be more attentive to their health and visit a gynecologist at least once a year, take a Pap test and undergo a colposcopy.

There is currently no specific treatment for HPV. The only reliable way to protect against the virus is vaccination4. According to WHO recommendations, HPV vaccination is recommended for all girls aged 9-13 years, that is, before the onset of sexual intercourse.4. However, the vaccine will also be effective in adulthood – it can be given to women up to 45 years of age.

Popular questions and answers

Our experts answer popular questions: Candidate of Medical Sciences, oncologist, radiotherapist Anastasia Dubinina, oncogynecologist Alexei Chichigin and director of the medical support service “Onkostrakhovanie” Yulia Tarasova.

What are the symptoms of cervical cancer?

– At the initial stage, cervical cancer may not manifest itself in any way. The development of a tumor may indicate:

• intermenstrual bleeding;

• pain and spotting during sexual intercourse;

anemia;

• weight loss without diet;

• causeless pain in the pelvis;

• pain that radiates to the lower back, thigh, perineum;

• swelling of the soft tissues of the legs;

• difficulty urinating, constipation.

The problem is that many of these symptoms are observed not only in cancer, but also in other diseases of the urogenital area. Therefore, it is better not to engage in self-diagnosis, but to consult a doctor as soon as possible.

How to determine the stage of cervical cancer?

– The stage of cervical cancer is determined by the clinical picture. First of all, the results of the study of the biomaterial taken during the biopsy or operation are taken into account. The stage is set before the start of treatment – this is necessary in order to choose a method and draw up a therapy plan.

There are several stages:

• zero – single precancerous cells are present on the surface of the cervix;

• first – the tumor is localized in the neck;

• the second – the pathological process goes beyond the uterus, extends to the upper part of the vagina;

• third – a malignant neoplasm affects the lower third of the vagina and the pelvic wall, can block the ureters;

• fourth – cancer cells are found in the bladder, rectum, and other distant organs.

How long does it take for cervical cancer to develop?

– Cervical cancer can develop for quite a long time – from precancer (epithelial dysplasia) to cervical cancer sometimes takes several years (5-10 or more).

What should be the examination algorithm for cervical cancer?

– At the first stage, the gynecologist conducts a visual examination, rectovaginal examination and palpation of the cervix. Mandatory colposcopy at 40x magnification. Thus, they look for a precancer – epithelial dysplasia. A biopsy of all suspicious areas of the cervix is ​​​​performed. The anamnesis is important, so careful collection of complaints is recommended.

After that, laboratory diagnostic tests are performed. A specific diagnostic method is the detection of a marker-antigen of squamous cell carcinoma – SCC in the blood. This examination is recommended for all patients with suspected cervical cancer. The doctor also determines the HPV status of the patient.

When dysplasia is detected, it is recommended to perform other instrumental studies: ultrasound of the pelvic organs, radiography of the lungs, cystoscopy, irrigoscopy, CT, MRI.

Mortality from cervical cancer is primarily associated with late diagnosis. That is why regular visits to the gynecologist are so important. All women over 30 years of age are advised to undergo an annual preventive examination, which should include liquid cytology.

Sources:

  1. Cervical cancer. Clinical guidelines 2020. “Association of Oncologists of Russia”, “Russian Society of Clinical Oncology”, “Russian Society of Specialists in the Prevention and Treatment of Tumors of the Reproductive System. https://disk.yandex.ru/i/3loOiCU7Z8bHXQ
  2. Practical guidelines for drug treatment of cervical cancer. 2021 Khokhlova S.V., Kolomiets L.A., Kravets O.A., Morkhov K.Yu., Nechushkina V.M., Tyulandina A.S., Urmancheeva A.F. https://rosoncoweb.ru/standards/RUSSCO/2021/2021-13.pdf
  3. Clinical laboratory diagnostics of oncological diseases. https://www.cardioc.ru/specialistam/informational_letter/doc/letter_2.pdf
  4. Vaccination of diseases caused by the human papillomavirus: positions of evidence-based medicine. Review of clinical guidelines. https://clck.ru/ek9Y9

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