Cervical Cancer - The First Signs, Stages And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Cervical cancer

Content:

• Cervical cancer symptoms
• Causes of cervical cancer
• Stages of cervical cancer
• Consequences after cervical cancer
• Diagnosis of cervical cancer
• Vaccination against cervical cancer
• Cervical cancer treatment
• Prevention of uterine cancer

What is cervical cancer?

Cervical cancer (cervical cancer) is a virus-dependent oncogynecological disease. The primary tumor is a degenerated glandular tissue (adenocarcinoma) or squamous cell carcinoma of the epithelium of the genital organ. Women from 15 to 70 years old are ill. Between the ages of 18 and 40, the disease is a significant cause of early death. This type of cancer can be prevented by vaccination.

Epidemiology

The dependence of this type of cancer and the human papillomavirus (HPV) has been proven. Laboratory methods have established from 80 to 180 (according to various sources) human papillomavirus serotypes. Not all HPVs provoke the development of cervical cancer, although this virus is 99.7% associated with cervical cancer. Approximately 25 serotypes are generally considered dangerous.

Based on the ability to induce malignant transformation, it is customary to divide human papillomavirus serotypes of different oncological risk:

• Low (about ten serotypes, not indicated in this text);
• Medium (about seven serotypes, not indicated in this text);

• High (about 25), the most significant:

  • HPV-16 is associated with 50% of disease cases;
  • HPV-18 is associated with 10% of diseases;
  • HPV-33 is associated with 20% of diseases;
  • HPV - 31, 35, 39, 45, 51, 52, 58, 50 and others, together about 20%.

Patients may also have different combinations of HPV serotypes. Women with laboratory-confirmed HPV infection should undergo an annual examination by a gynecologist and laboratory tests in order to detect precancerous changes in the walls of the genitals.

Unfortunately, this medical norm is not regulated by anything. There is no cervical cancer screening program in Russia yet. A woman is forced, on her own initiative, to apply to a diagnostic institution to determine the disease.

Cervical cancer is detected in about 13 people per 100 thousand. This is quite a lot on a national scale, an increase of 12% over five years. In the structure of mortality, cervical cancer is one of the ten diseases with a high risk of early death.

Cervical cancer is staged. It is isolated in three stages CIN - cervical intraepithelial neoplasia. Stages CIN ₁ CIN ₂ CIN _{3 are} referred to as dysplasia (cell changes) without malignant characteristics. The stage of deep cell damage preceding malignant (invasive) cervical cancer is called carcinoma in situ.

Russian statistics of disease detection depending on the stage of oncogenesis:

• Precancer - carcinoma in situ is diagnosed in no more than 10% of patients;
• The first and second stages of invasive cervical cancer in 59.0%;
• The third and fourth stages of invasive cervical cancer in 25-90%.

The low detectability of early stages is due to the absence of:

• on-alertness of the majority of the female population, when signs of malaise, at the level of subjective sensations, are regarded as a variant of the norm or mild deviation without harm to health;
• clinical symptoms, allowing the doctor conducting preventive gynecological examinations to suspect dangerous signs, to issue a referral for in-depth diagnostics.

As a result of a combination of two factors - the absence of oncology vigilance and medical carelessness, patients are admitted to the medical record with pronounced clinical symptoms of stage III-IV oncology.

It is recognized by the medical community that cervical cancer is one of the diseases that can and should be controlled as a result of systematic screening activities.

On the subject: Selenium reduces the risk of cancer by 2 times!

Cervical cancer symptoms

Cervical cancer is an insidious disease, with a slow development of the disease, possible regression, or vice versa, rapid progress.

Approximately 15-20% of early stages of cervical cancer are asymptomatic.

The initial stages of precancer (CIN), from clinically significant ones, can be separated by a life span of ten or more years. All this time, the woman does not notice signs of serious illness, considers herself healthy, plans her personal life, the birth of a child.

Indeed, in the period of precancer and even in I, II stages of cancer, there is a high probability of stopping the development of carcinogenesis. The virus lends itself to elimination, without consequences it is excreted from the body.

Cancer alertness should be increased for women over 21-25 years old or three years after the first sexual experience, if there is a history of laboratory confirmed carriage of HPV-16, HPV-18, and other similar viruses of increased cancer risk.

An additional condition for increasing alertness is the presence in the history (more than three to four) of the following adverse factors, which are also markers of the development of cervical carcinogenesis:

• Infectious:
• chronic carriage of herpes viruses (HSV-2, Epstein-Bar, Cytomegalovirus), hepatitis B or C, sexually transmitted infections;
• periodic persistent violations of the vaginal saprophytic lacto- and bifidoflora.
• General clinical. Laboratory confirmed lack of vitamins A, C, beta-carotene, folic acid, reduced immunity, smoking, alcohol abuse, low living standards.
• Hormonal. Long-term use of oral contraceptives (more than five years), age and hormonal discrepancy (early, late menopause), the like.
• Gynecological. Early age of onset of sexual activity, more than two sexual partners per year, cervical trauma, including abortion, regular anal intercourse.
• Obstetric. From three to seven facts of pregnancy (according to various sources), excluding bearing the fetus.

Human papillomavirus infection is the most significant factor in cancer conversion. It is clinically manifested in a woman's body by the following symptoms:

• Multiple warts, rarely single, pink, gray. In the form of cauliflower, cockscomb are typical for patients with viral human papilloma, in combination with diabetes mellitus, immunodeficiency.
• Typical localization. In the labia, perineum, on the eve of the vagina, on the walls of the neck.
• Dysplasia of the cervical epithelium. Revealed by a Pap test, under a microscope, after staining a smear from the walls of the mucous membrane, there are CIN ₁, CIN ₂, CIN ₃ changes characteristic, respectively, of grade 1,2,3 dysplasia. Dysplasia is not cancer - it is a stage in its development. Stage 1, 2 dysplasia is relatively easy to treat, so early detection is a significant increase in the chances of recovery.

Clinical symptoms of early stages of cervical cancer are associated with unfavorable factors (infectious, general clinical, hormonal, gynecological, obstetric), but they do not have an important diagnostic value for detecting cervical cancer.

The most valuable signs are identified by methods:

• gynecological examination - colposcopy;
• cytological examination of cervical smears;
• virological research (typing).

Causes of cervical cancer

The predominantly sexual transmission of the human papillomavirus is the reason for much speculation on this topic.

Meanwhile, carcinogenesis is much more complicated.

• Indeed, the disease is almost always diagnosed in women with a history of laboratory confirmed human papillomavirus, early onset of intimate life, periodic change of sexual partners, or a frivolous partner in sexual behavior.
• It is also true that millions of women who have an early relationship, have a large number of partners, who are carriers of HPV never develop cervical cancer. According to numerous scientific evidences, more than 60% of the world's population, at different times of life, were latent carriers of the papilloma virus, without health consequences.
• There are known cases of the introduction of oncovirus into the body bypassing sexual intercourse, for example, during medical manipulations, by contact (from skin to skin), and the like.

The causes of cervical cancer are always a fatal combination of numerous, not fully understood by science, factors, the most significant:

• damage to the body, onco-aggressive serotypes HPV-16 and / or HPV-18 (the main, but not the only dangerous serotypes), carriers of these serotypes are approximately 35% of women aged 20 to 60 years, which significantly exceeds the prevalence of cervical cancer in the female population;
• combination of papilloma virus with persistence (latent carriage) in the body of genital herpes simplex virus of the second type (HSV-2), Epstein-Barr (EBV), cytomegalovirus (CMV), hepatitis B, C;
• the presence of latent genital infections of the anogenital zone (chlamydia, ureaplasmosis, trichomonadosis);
• violation of cooperation of the immune system, genetic predisposition, social and living conditions, other poorly studied factors requiring clarification.

See also: Other Cancer Causes and Risk Factors

Stages of cervical cancer

The disease, often, has no symptoms, however, it is detected much easier, relative to other gynecological forms of cancer. To determine the precursors, methods for determining the papilloma virus are used.

The stages of dysplasia (pre-cancerous form of pathology) in the walls of the uterine epithelium are designated by the abbreviation CIN and numbers from 1 to 3, depending on the depth of the integumentary epithelium lesion. There are several options for describing CIN wall changes. Using abbreviations makes professional communication easier.

The stages of dysplasia are described:

• there is no sufficient basis for assessing metaplasia, this condition is indicated by a combination of letters T _x;
• primary metaplasia is not detected by colposcopy and cytology, it is indicated by a combination of letters T ₀;
• Carcinoma in situ (precancer) is indicated by the combination of the letters T _is.

Stage 1 uterine cancer

The first stage can be described as:

• A tumor that does not go beyond the cervix, or (T ₁) - stage 1;
• Changes on the walls of the cervix are detected only by cytological methods, or (T _1a) - stage 1 _a;
• metastasis extending outside the body into the cavity up to 3 mm and 7 mm outside, or (T _1a1) - stage 1a1;
• Metastasis extending beyond the wall to a depth of 5 mm and outward to 7 mm, or (T _1a2) - stage 1a2;
• The tumor is visible to the naked eye, does not go beyond the uterus, or a large pathological formation visible under optical magnification, or (T _1b) - stage 1b.
• The tumor is less than 4 centimeters, or (T _1b1) - stage 1b1.
• The tumor is more than 4 centimeters, or (T _1b1) - stage 1b2.

Stage 2 uterine cancer

The second stage is designated as a combination (T2) with the addition of letters indicating the presence of metastases in the area around the uterus. For example, T _2a - stage 2a means the absence, and T _2b - stage 2b the presence, visualized by instrumental methods, of metastases outside the uterus.

Stage 3 uterine cancer

The third stage is designated as a combination (T3) with the addition of letters indicating the defeat of the genitourinary organs.

For instance:

• T ₃ - metastasis has spread to the pelvic wall, and the lower third of the vagina, there are signs of decreased renal function, stage (3).
• T _3a - metastasis in the lower third of the vagina, without damage to the kidney function and is not visualized on the pelvic wall, stage (3a).
• T _3b - metastasis on the walls of the pelvic bone, kidney damage is detected, up to the shutdown of its function, stage (3b).

Stage 4 uterine cancer

It is designated as a combination (T4). Means that metastasis has affected the bladder, rectum and / or distant organs. M1 - means the presence of distant metastases.

Consequences after cervical cancer

Cervical cancer, especially one that causes disease in young women, is aggressive. An individual prognosis of the outcome of the disease can be considered reliable only on the basis of a thorough examination and consultation with a qualified oncologist.

Meanwhile, statistics indicate different forecast options:

• High probability of recovery in the early stages of detection of the disease - carcinoma in situ, stage I cancer. There are known cases of successful pregnancy and childbirth in patients at these stages of the disease without consequences for health and progression of pathogenesis (consultation of an oncologist is required).
• Doubtful prognosis. In young women, in the presence of cancer-provoking factors - herpes viruses, sexual infections, a low social standard of living of the patient, a genetic predisposition (the presence of such diseases in blood ancestors in the female line), low immune status, including HIV.
• Poor prognosis. In elderly women, in the presence of concomitant diseases, in the diagnosis of the disease at III, IV stages of oncogenesis.

There is information about the occurrence of relapses, some time after the use of medical procedures (surgical, chemotherapy or radiation therapy) for cervical cancer:

• In 10-40% of cases, repeated carcinogenesis developed in nearby organs (peri-ocular zone);
• In 35% of cases, repeated carcinogenesis developed in distant organs (urogenital, regional lymph nodes and organs of the lung, bone tissue).

Diagnosis of cervical cancer

The most valuable information is obtained as a result of extended colposcopy. With its help, it is possible to identify signs of cervical cancer, as well as to carry out differential diagnostics from:

• dysplasia - the stages preceding cancer, occurring under the influence of the papilloma virus;
• erosive conditions of the integumentary epithelium - conditions similar to an ulcer in the form of ectopia, leukoplakia, they are often not considered a pathology.

Making a diagnosis is a complex process. Negative phenomena on the vaults of the cervix, revealed by colposcopy, are not necessarily signs of a serious illness, an oncologist's consultation is required. However, their presence should alert the patient about the possible consequences, since the detection of the first signs of cervical cancer in the late stages III, IV is not relevant.

The first signs indicating the presence of distant signs of a precancerous condition are determined as a result of extended colposcopy on the walls of the integumentary epithelium:

• Mosaicity of the walls of the mucous membrane.
• Areas of mucous membranes white after treatment of the walls with a weak solution of acetic acid indicates a subclinical lesion of the integumentary epithelium by the human papillomavirus. For clarification, a biopsy is done and a further cytological examination of the smear is carried out in the laboratory under a significant optical magnification;
• Areas of mucous membranes that are not stained with Lugol's solution (a weak solution of iodine on glycerin). Uncolored, light, areas against the background of brown epithelium indicate dysplasia. To clarify the stage of precancer, a biopsy is performed.
• Identification of atypical superficial blood vessels on the walls of the cervix is evidence of early stages of cancer.
• Keratinization of the integumentary epithelium of the mucous membranes - leukoplakia, a condition not typical for normal integuments.
• Genital warts (condylomas) on the walls of the cervix are the result of the pathological effects of a viral agent on cells.

Diagnostic measures are divided into basic and auxiliary ones with various research tasks:

I. The main direction of diagnostics includes activities within the framework of a gynecological examination:

1. Taking anamnesis to clarify the risk group.

2. Extended colposcopy to examine the condition of the walls of the vaginal fornix and cervix. Manipulation has limitations, taking into account the period of the monthly cycle, the time elapsed after sexual contact, the presence of pregnancy.

   If necessary, during the period of colposcopy, it is additionally carried out:

   • collection of material from the surface of mucous membranes for further microscopic (cytological) examination of the material after special staining
   • biopsy - obtaining a piece of tissue from the wall of the uterus for microscopic (histological) examination.
3. Virus typing taking into account their oncological aggression. The most dangerous types of HPV-16, HPV-18, related to type 16 - HPV-33. In some cases, vaccination may be recommended in order to create protective (protective) immunity to the virus.
4. Cytological, histological examination is carried out to determine the type and stage of pathogenesis, precancer, microinvasive, invasive cancer.
5. Ultrasound, MRI, sometimes CT, their modifications to detect damage to the cervix.

II. Ancillary methods include studies of neighboring organs:

1. Clarification of the nature of involvement in carcinogenesis. Usually, the organs of the respiratory system, genitourinary system, bone tissues, as well as the rectum are examined using ultrasound, MRI, and CT.
2. Laboratory tests (general and biochemical blood test, it is possible to determine some infections, other methods indicated on the eve of treatment).

Vaccination against cervical cancer

The papillomavirus is the only agent dangerous to humans that can provoke carcinogenesis. On the territory of the Russian Federation, two vaccines have been registered that meet the basic requirements of biological safety and have a high protective (protective) activity.

• Vaccine Gardasil (USA). A tetravalent drug capable of developing immunity against HPV-16, HPV-18, HPV-11, HPV-6. Gardasil contains an adjuvant - an immunity enhancer.
• Cervarix vaccine (Great Britain). Bivalent drug, inhibits the activity of viruses HPV-16, HPV-18, also contains an adjuvant.

Despite the fact that both vaccines contain antigens to oncoactive serotypes, the effectiveness has been proven against phylogenetically closely related dangerous HPV serotypes - 31, 33, 45, and others.

Vaccination can be combined with vaccinations against hepatitis B. Safety is an important condition for the use of biological products in medical practice.

Local and general reactions of the body to both vaccines are possible in the form of:

• swelling, soreness at the injection site.
• increased body temperature.
• headache.
• short-term disorders of the gastrointestinal tract.

It has been proven that these signs are a normal reaction to the introduction of a foreign protein and an adjuvant (chemical pharmaceutical preparation), which does not have long-term health consequences.

A limiting factor in the use of vaccines are defects in the cooperation of humoral and cellular immunity in cancer patients, which cannot be corrected with pharmaceutical immunostimulants.

Impaired immunity is one of the factors in the occurrence of cervical cancer, when a person's own immune system is unable to eliminate a foreign agent - the human papillomavirus.

Cervical cancer treatment

For treatment, surgical removal of the tumor, chemotherapy and radiation therapy are used. Usually a combination of these treatments is used.

Radiation therapy for uterine cancer

Cancer of the body of the uterus in the second stage of carcinogenesis is combined with the transition of the tumor to the cervix. Therefore, we will consider radiation therapy from the standpoint of a combined effect on the entire genital organ.

The most promising effect on well-differentiated cancer cells in the initial stages of the disease.

At the same time, it is possible to achieve a five-year survival rate of patients at different stages of oncology, including:

• the first stage - 85-95%;
• the second stage - 65-70%;
• third stage - 30%

The prospects for long-term survival after stage 4 combination therapy are slim. The indications for radiation therapy are:

• the inability to perform surgical intervention against the background of weakness of the body and the presence of distant metastases;
• poorly differentiated tumor of a large extent;

There are two main methods of radiation therapy.

• Intracavitary radiation exposure;
• Remote radiation exposure.

Intracavitary radiation therapy

The modern principle is based on adequate exposure to a source of gamma radiation directly in the area of the primary tumor. The technique allows achieving 85% survival rate, within five years, for patients with stage III uterine cancer.

Remote radiation exposure

Used alone or in combination with other methods. Irradiation can be mobile or static. The method has limitations and side effects, however, it is widely used in view of its versatility and availability.

Surgery to remove uterine cancer

The cervix is the initial part of the uterus, so the question of removing the entire organ is usually decided. Surgical removal is indicated if metastases are localized in her tissues or in the immediate vicinity.

The operation is contraindicated for:

• metastases in organs located at a great distance;
• concomitant diseases that significantly reduce the patient's vitality (diabetes mellitus, cardiovascular pathologies)
• old age patient.

There are relative and absolute contraindications. The decision on the expediency of the operation is made by the attending physician, taking into account the opinion of the patient. The operation can be associated with total removal or partial excision.

In the first case, the operation leads to infertility, in the second, it is possible to preserve fertility.

Removal of the uterus - hysterectomy does not apply to complex operations, it is possible to carry out in the form of abdominal or laparotomy surgery:

• Cavity interventions. Associated with the opening of the abdominal wall, it is carried out on an organ with a large excision of tissues - an absolute indication, or a small excision - a relative indication. The choice of the method is related to the desire of the patient or the technical capabilities of the surgical department of the clinic.
• Laparotomy intervention. Opening the abdominal wall through a small puncture is carried out with a small volume of the removed pathological organ.

Both methods have contraindications, for example, after laparotomy, there is a high probability of developing adhesions, and with total removal, one of the complications is the development of cystic formations in the abdominal cavity.

In some cases, hysterectomy involves performing plastic surgery of the urogenital opening, which the patient must be informed about before the operation. Plastic surgery of the urogenital opening can seriously complicate the course of the postoperative period.

Early postoperative complications:

• capillary bleeding, vascular;
• post-anesthetic conditions (hallucinations, agitation, lethargy);
• weakness.

Late postoperative complications:

• suppuration of the surgical wound;
• divergence of seams;
• postoperative adhesions.

Preparation for the operation and postoperative care is carried out in a clinic, the sutures by primary intention (without suppuration) are removed 7-10 days after the operation.

See also: Other treatments

Prevention of uterine cancer

Preventive measures for cancer include:

• conducting large-scale educational work in order to increase cancer alertness;
• the introduction of routine screening examinations, starting from the age of 21-25 in order to detect dysplasia of the walls of the genital organs;
• systematic vaccination against human papillomavirus, against cervical cancer, creation of a system for monitoring the safety of vaccine prevention;
• improving lifestyle, the most realistic recommendation concerns a careful attitude to the normalization of protein, carbohydrate metabolism

The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon

Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"