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Malignant tumors of the cervix are quite widespread. Their proportion among all tumors of the female genital organs is 5%.
In terms of the number of deaths, this pathology is in 5th place among cases of oncological lesions.
Medical statistics indicate that this disease has become “younger” and is now often found even in the age group of 20-35 years. The highest concentration of reported cases per 100 population is in Africa and Latin America.
Causes of cervical tumors
The cervix occupies about 1/3 of the entire volume of this organ. Throughout a woman’s life, she regularly undergoes structural changes. Its most vulnerable part is the transformation zone, located at the junction of two types of epithelium. This zone moves deep into the cervical canal, it is in it that oncological tissue lesions appear.
Reasons for increasing the risk of neck damage:
A large number of pregnancies and childbirth;
promiscuity;
Uncontrolled use of contraceptives in the form of tablets (as opposed to barrier methods of contraception);
Early age of first sexual experience;
Infection with a strain of the human papillomavirus (HPV) of a certain type in combination with a sexually transmitted infection;
HIV infection and disease.
How does HPV affect the development of cervical cancer?
A malignant tumor of the cervix is a disease that can be prevented by effective prevention. A breakthrough in the study of the carcinogenic process was the scientific discovery that the human papillomavirus is responsible for the appearance of atypical cells. HPV infection leads to tissue changes and tumor development.
Modern research has recorded more than 100 varieties of the virus. Not all of them cause malignant tumors, have a high carcinogenic risk factor.
Types of viruses according to the degree of oncogenic potential:
Low risk: 6, 11, 42, 43, 44 – responsible for the appearance of genital warts;
Intermediate risk: 31,33, 35, 51, 52 – provoke the appearance of dysplasia, less often – the appearance of atypical cells;
High risk: 16, 18, 39, 45, 50, 53, 55, 56, 58, 59, 64, 68 – provoke the appearance of malignant tumors of the uterus.
In many carriers of the virus, it loses its activity in 1-2 years and does not show any symptoms. Rarely, HPV becomes the cause of infection in a woman’s body, resulting in dysplasia and a malignant tumor of the cervix. The chances of self-healing are higher, the younger the woman who has contracted the virus.
In girls and young women, it is not advisable to diagnose by PCR (polymerase chain reaction). This analysis is done with suspicious changes in the tissues of the neck (dysplasia, leukoplakia). Suspicious lesions are detected by colposcopy, a smear for oncocytology, and the presence of characteristic signs of malignant changes.
HPV Facts:
In more than half of cases, the virus enters the body during unprotected sexual contact, more often in sexually active men and women.
Statistics show that in 50% of cases of unprotected sex there is infection with sexually transmitted diseases, together with the human papillomavirus.
Most types of HPV do not manifest themselves in any way 1-2 years after infection.
Preparations designed to sanitize the body from the virus have not yet been created.
The only prevention against the negative impact of oncogenic HPV types that cause malignant tumors is vaccination.
It is not advisable to test for the presence of the virus in women under 30 years of age due to the high likelihood of self-healing from the infection.
Symptoms of cervical tumors
Symptoms in the initial stages of the development of a cervical tumor:
Watery discharge of the color of “meat slops” with an unpleasant odor. In most cases, they appear at the stage of tumor decay.
Pain during intercourse and bleeding after it.
Bleeding during menopause.
Acyclic bleeding not related to the menstrual cycle.
Late symptoms of a cervical tumor:
Excruciating pains of high intensity, the place of localization of pains is the lower abdomen, sacrum, lower back, rectum.
Frequent urination.
Symptoms in advanced cases:
Intoxication with tumor decay products: significant weight loss, lack of appetite, hyperthermia, anemia, loss of strength.
Violation of the process of defecation and urination, constipation, blood in the urine and feces.
The appearance of fistulas during the germination of the tumor in the bladder and rectum, leakage of them into the vagina of feces and urine.
Edema.
Dyspnea.
Stages of a cervical tumor
Cases of a pre-invasive form of a malignant tumor are not taken into account in the statistics of diseases. This type of oncological process and grade 3 dysplasia are usually combined into one category, and treatment is carried out according to the same standard. Tumors that are more common deep into the tissues of the neck are classified according to the following principle:
Stage 1 cervical cancer: The area of distribution of the tumor process is limited to the uterus.
1A – tissue changes penetrate less than 5 mm deep;
1B – tissue changes penetrate more than 5 mm deep.
stage 2 cervical cancer – The tumor process extends beyond the uterus (however, it does not penetrate to the walls of the pelvis and the lower third of the vagina).
stage 3 cervical cancer – The tumor process extends to the lower part of the vagina and the walls of the pelvis.
stage 4 cervical cancer – The tumor process spreads to the abdominal organs, grows into the pelvic organs (into the rectum and bladder).
Diagnosis of cervical tumors
There are various ways to determine the features of malignant changes in the tissues of the cervix:
Pap smear for cytology. Screening for oncological degeneration of cervical tissue is performed by analyzing a smear for oncocytology. The Papakikolau smear (Pap test) is the world standard for such screening. From the surface of the cervix, cells are taken with a special device, their structure is studied under a microscope. Possible outcomes are abnormal cells, changes indicating an inflammatory process, altered cells that cause oncological alertness. If necessary, clarify the negative results.
Colposcopy. The study of the structure of the cervix using a special device (colposcope) allows you to see the state of its vessels and cells with a multiple increase. Colposcopy allows you to see early changes in the initial stage of the tumor process. In the later stages, this study is impractical.
Biopsy. If tissue malignancy is suspected, a sample (biopsy) is taken for examination at multiple magnification.
Curettage of the cervical canal. In difficult cases, if the results of colposcopy do not match the data of a cytological examination, a diagnostic curettage procedure is performed. So you can detect atypical cells that are inaccessible to inspection with a colposcope. The study is rarely used, in the presence of special indications.
Ultrasound diagnostics. The most informative and inexpensive method is transvaginal ultrasound. It is painlessly carried out using a special sensor, it makes it possible to make a three-dimensional image of the tumor in 3 projections. The addition of Doppler ultrasound allows even small tumors to be determined by the changed blood flow. Possible difficulties for diagnosis are a running process, adhesions in the peritoneum and small pelvis.
Computed and magnetic resonance imaging. The study is carried out with a developed tumor process in the cervix, determines its prevalence, the presence and location of metastases, the state of nearby organs, and helps the doctor determine the treatment tactics. MRI is more commonly used because CT sometimes does not differentiate between malignancy and adipose tissue.
Methods for determining the prevalence of metastases (skeletal bone scintigraphy, chest x-ray, abdominal CT scan). They are used to determine the number and prevalence of metastases. They are carried out at the time of diagnosis, to monitor the state of health after the treatment, in the event of a relapse of the disease after surgery.
It takes a long time for a malignant tumor of the cervix to develop. This feature makes it possible to identify the disease at the very beginning of development and successfully resist it. The most successful method for these purposes is the Pap test (Papanicolaou cytology). It identifies a dangerous process in 90% of cases.
Up to 49 years of age, screening is carried out once every 3 years, after 50 years – once every 5 years.
Treatment of a malignant tumor of the cervix
In the early stages of the tumor process, a complete cure for this pathology is possible. Modern methods preserve the uterus and the ability of women to have children in the future. In advanced cases, complex methods of treatment are used. At the same time, the childbearing function of a woman is irretrievably lost, but life is preserved, its duration and quality do not suffer. The choice of treatment tactics is determined by the stage of the tumor process and the data of the histological analysis of the tumor tissue.
Methods of treatment of cervical tumor:
Neck conization. Surgical removal of a part of the cervix is performed with a non-invasive tumor process (in situ), with a severe form of dysplasia. With mild and moderate dysplasia, conization is not performed. Methods of anesthesia – epidural anesthesia, general anesthesia. Possible complications for nulliparous women are narrowing and infection of the lumen of the cervical canal. This complication reduces the likelihood of successful conception and pregnancy. However, the effectiveness of conization of a non-invasive tumor process exceeds the possible risk to life and health. The removed fragment of the neck is examined by conducting a histological examination to clarify the diagnosis.
Extended extirpation of the uterus. Treatment of a neglected tumor with this method is carried out with the removal of the uterus, appendages, part of the vagina and tissues surrounding the uterus. If the tumor process belongs to microinvasive species (stage 1), only the neck is removed. This method preserves the childbearing function and the ability to plan a pregnancy.
Radiation therapy. A method that complements surgical treatment in the early stages of the tumor process, and is the only method of therapy for a running process. Irradiation is used in palliative care to alleviate the suffering of terminally ill patients. Complications of radiation therapy – lesions of the skin and internal organs that are not dangerous for the general condition.
Chemotherapy. For the treatment of a malignant tumor of the cervix, the method is rarely used, as an addition to radiation therapy and surgical treatment. Cisplatin is used for chemotherapy.
Prognosis for cervical tumors
Survival at various stages of the disease:
Stage 1 – 95-58%;
Stage 2 – 65-75%;
Stage 3 – up to 30%;
Stage 4 – 10%.
These data are relevant only under the condition of a full treatment of the disease.
Prevention of cervical cancer
The incidence of this type of oncological lesions of the female genital organs can be significantly reduced by simple preventive measures:
Vaccination. It is considered the main method of preventing cervical tumors, it is carried out by the Gardasil vaccine, effective against 4 types of HPV. Types 16 and 18 of the virus provoke more than 70% of cases of this disease, and types 11 and 6 cause the appearance of genital warts. Clinical trials of the Gardasil vaccine lasted more than 15 years and ended with a statement of its safety and effectiveness.
The optimal category for vaccination is girls 11-13 years old. Young women under 26 who have not had sexual intercourse and are not infected with HPV are subject to vaccination. The drug is administered three times for 6 months. This scheme provides reliable protection for a period of 5-8 years to a long period.
The Gardasil vaccine is a reliable protection against the virus of 2 varieties. Approximately one third of the remaining cases of cervical tumors are caused by rare types of HPV or are non-viral in nature. Vaccination does not exempt women from the need to undergo regular gynecological examination with a smear for cytology.
Treatment of diseases preceding the development of the tumor process. Changes in the tissues of the cervix, leading to malignant degeneration, are present in the body for about 10-15 years. Basically, these are dysplasia, leukoplakia and other diseases. To avoid negative changes, you need to regularly undergo a gynecological examination and not ignore dangerous symptoms.
Use of barrier methods of contraception (condoms). This measure will significantly reduce the risk of transmission of the virus, although it will not be a XNUMX% guarantee of safety.
Answers to popular questions
Is cervical erosion a condition preceding the development of a tumor process? After clarifying the meaning of the term “cervical erosion”, it turns out that it means ectopia. This feature of the state of the epithelium occurs in a quarter of young women. It consists in the outward displacement of the cylindrical epithelium from the cervical canal and the replacement of the cells of the stratified epithelium, which is normal there. This transformation does not require treatment, does not show any symptoms and does not provoke the appearance of malignant tumors. Regular monitoring of the condition of the cervix by a gynecologist is required.
Is the appearance of genital warts a symptom of cervical cancer? Genital warts are a consequence of the penetration of non-oncogenic human papillomaviruses into the body. Genital warts do not become precursors of a malignant tumor of the cervix, although they cause discomfort.
A smear for oncocytology revealed mild CIN1 dysplasia and an inflammatory process. Is cervical conization necessary? Dysplasia in the initial stage is not dangerous, it passes without treatment and requires only regular examination by a gynecologist (at least 2 times a year). Cervicitis (inflammatory process) probably changed the smear results for cytology. For an adequate assessment, it is desirable to clarify the cause of the disease, conduct its therapy, and then take the test again.
How long do they live with stage 2 malignancy of cervical changes? The oncological process at stage 2 of the disease is limited to local manifestations. A timely operation, the results of which were supported by radiation therapy, regular monitoring of the woman’s health status guarantees a 5-year survival rate of 75% of women. This conditional indicator in oncology is considered a conditional recovery criterion.
What treatment of the initial stage can be carried out if pregnancy is planned? The choice of treatment method is the prerogative of the oncologist. He evaluates the woman’s age and previous illness history, her age and concomitant diseases. Under favorable circumstances, only the cervix is destroyed, which does not exclude subsequent pregnancy after surgery.
After removal of a tumor of the cervix, is it enough to have an examination by a gynecologist twice a year? Such a frequency of examination is quite acceptable. If metastases appear, you should immediately consult a doctor, without waiting for a routine examination. Their symptoms: headaches, sudden fainting, bone pain and fractures, pathological jaundice. Metastases in nearby lymph nodes may appear asymptomatically. During a planned examination, a gynecologist-oncologist prescribes an examination of the patient, taking into account the operation performed.