Tumor Of The Cervix In Women - Symptoms And Treatment

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

Tumor of the cervix in women

Malignant tumors of the cervix are widespread. Their share 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 cancer.

Medical statistics indicate that this disease has become "younger" and now is often found even in the age group of 20-35 years. The highest concentration of reported cases per 100,000 population is in Africa and Latin America.

Content:

• Causes of cervical tumors
• Symptoms of cervical tumors
• Stages of the cervical tumor
• Diagnosis of cervical tumors
• Treatment of a malignant tumor of the cervix
• Prognosis for cervical tumors
• Prevention of cervical tumors

• Answers to popular questions:

  • Is cervical erosion a condition that precedes the development of a tumor process?
  • Is the appearance of genital warts a symptom of cervical cancer?
  • Oncocytology smear revealed mild CIN1 dysplasia and inflammation. Do I need to conize the neck?
  • How long do they live with stage 2 malignancy of cervical changes?
  • What initial stage treatment can be given if pregnancy is planned?
  • After removal of the cervical tumor, is a gynecologist's examination twice a year sufficient?

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 into the depths of the cervical canal, it is in it that oncological tissue damage appears.

The reasons due to which the risk of cervical damage increases:

• A large number of postponed pregnancies and childbirth;
• Promiscuous sex;
• Uncontrolled use of contraceptives in the form of pills (as opposed to barrier methods of contraception);
• Early age of first sexual experience;
• Infection with a certain type of human papillomavirus (HPV) strain in combination with a sexually transmitted infection;
• Infection and disease with HIV infection.

How does HPV affect the development of a cervical tumor?

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 a scientific discovery - the human papillomavirus is to blame for the appearance of atypical cells. HPV infection leads to changes in tissues and the development of tumors.

Modern research has recorded over 100 varieties of the virus. Not all of them cause malignant tumors and have a high carcinogenic risk factor.

Types of viruses according to the degree of oncogenic potential:

• Low risk: 6, 11, 42, 43, 44 - are 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 the higher, the lower the age of the woman infected with the virus.

In girls and young women, it is inappropriate to carry out diagnostics by PCR (polymerase chain reaction). This analysis is done for suspicious changes in the cervical tissue (dysplasia, leukoplakia). Suspicious foci are detected using colposcopy, smear for oncocytology and the presence of characteristic signs of malignant changes.

HPV Facts:

• In more than half of the cases, the virus enters the body during unprotected sexual intercourse, 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 effects of oncogenic HPV types that cause malignant tumors is vaccination.
• It is inappropriate to test for the presence of the virus in women under 30 because of the high probability of self-healing from infection.

Symptoms of cervical tumors

Symptoms in the early stages of cervical tumor development:

• 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 intercourse.
• Bleeding during menopause.
• Acyclic bleeding not associated with the menstrual cycle.

Late symptoms of a tumor of the cervix:

• 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 growth of a tumor into the bladder and rectum, leakage of feces and urine from them into the vagina.
• Swelling.
• Dyspnea.

Stages of the cervical tumor

Cases of a pre-invasive form of a malignant tumor are not included in the statistics of diseases. This type of oncological process and grade 3 dysplasia are usually combined into one category, and the treatment is carried out according to the same standard. Tumors that are more common deeper into the cervical tissue are classified according to the following principle:

1. Stage 1 cervical tumor: The area of the tumor is limited to the uterus.

   • 1A - tissue changes penetrate deeper than 5 mm;
   • 1B - tissue changes penetrate deeper than 5 mm.
2. Stage 2 cervical tumor - The tumor process extends beyond the uterus (but does not penetrate the walls of the pelvis and the lower third of the vagina).
3. Stage 3 cervical tumor - The tumor spreads to the lower part of the vagina and the walls of the pelvis.
4. Stage 4 cervical tumor - The tumor process spreads to the abdominal organs, grows into the pelvic organs (rectum and bladder).

Diagnosis of cervical tumors

There are various ways to determine the characteristics of malignant changes in the tissues of the cervix:

• Pap smear for cytology. Screening of oncological degeneration of cervical tissue is performed by analyzing a smear for oncocytology. The Papacicolau swab (Pap test) is the world standard for this screening. From the surface of the cervix, cells are taken with a special device, their structure is studied under a microscope. Possible outcomes are atypical cells, changes indicating an inflammatory process, altered cells that cause cancer alertness. If necessary, the negative results are clarified.
• Colposcopy. The study of the structure of the cervix using a special device (colposcope) allows you to see, with multiple magnification, the state of its vessels and cells. Colposcopy allows you to see early changes at 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 coincide with the data of a cytological study, a diagnostic curettage procedure is performed. So you can find atypical cells that are inaccessible to examination with a colposcope. The study is rarely used, if there are special indications.
• Ultrasound diagnostics. The most informative and inexpensive method is transvaginal ultrasound. It is painlessly performed using a special sensor, it makes it possible to make a three-dimensional image of the tumor in 3 projections. Supplementing ultrasound with Doppler ultrasound allows even small tumors to be identified 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, helps the doctor to determine the treatment tactics. MRI is used more often, as CT sometimes does not differentiate between malignant tumor and adipose tissue.
• Methods for determining the prevalence of metastases (skeletal scintigraphy, chest X-ray, abdominal CT scan). They are used to determine the number and extent of metastases. They are carried out when a diagnosis is made, to monitor the state of health after treatment, when a relapse of the disease occurs 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 this purpose 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 of this pathology is possible. Modern methods preserve the uterus for women and the ability to have children in the future. In advanced cases, complex treatment methods are used. At the same time, the woman's reproductive function is irretrievably lost, but life is preserved, its duration and quality does not suffer. The choice of treatment tactics is determined by the stage of the tumor process and the data of histological analysis of the tumor tissue.

Methods for treating cervical tumors:

• Conization of the neck. Surgical removal of a part of the neck is carried out with a non-invasive tumor process (in situ), with severe dysplasia. With mild to moderate dysplasia, conization is not performed. Anesthesia methods - epidural anesthesia, general anesthesia. Possible complications for nulliparous women are narrowing and clogging of the lumen of the cervical canal. This complication reduces the likelihood of a successful conception and pregnancy. However, the effectiveness of the conization of a non-invasive tumor process exceeds the possible risk to life and health. The removed fragment of the cervix 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 is a microinvasive type (stage 1), only the neck is removed. This method preserves fertility and the ability to plan for pregnancy.
• Radiation therapy. A method that complements surgical treatment in the early stages of the tumor process, and is the only method of therapy in an advanced process. Radiation is used in palliative care to relieve the suffering of hopeless patients. Complications of radiation therapy are 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 adjunct 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%.

The above data are relevant only if the disease is fully treated.

Prevention of cervical tumors

The incidence of this type of cancer of the female genital organs can be significantly reduced by simple preventive measures:

• Vaccination. It is considered the main method for the prevention of cervical tumors, carried out by the Gardasil vaccine, which is effective against 4 types of HPV. 16 and 18 types of the virus provoke more than 70% of cases of this disease, and 11 and 6 types - cause the appearance of genital warts. Clinical trials of the Gardasil vaccine lasted more than 15 years and ended with the 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 sex and who are not infected with HPV are subject to vaccination. The drug is administered three times over a period of 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. About a third of the remaining cases of cervical tumors are caused by rare HPV types or are of a non-viral nature. Vaccination does not relieve women from the need to undergo regular gynecological examinations with taking a smear for cytology.

• Treatment of diseases preceding the development of the tumor process. Changes in the tissues of the cervix, leading to malignant transformation, 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 100% safe.

Answers to popular questions

• Is cervical erosion a condition that precedes 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 is found in a quarter of young women. It consists in the outward displacement of the cylindrical epithelium from the cervical canal and its replacement of the cells of the stratified epithelium, which is normally 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.
• Oncocytology smear revealed mild CIN1 dysplasia and inflammation. Do I need to conize the neck? Dysplasia in the initial stage is not dangerous, it goes away without treatment and requires only regular examination by a gynecologist (at least 2 times a year). Cervicitis (inflammation) likely changed the smear results to cytology. For an adequate assessment, it is desirable to clarify the cause of the disease, conduct its therapy, and then take the analysis 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 criterion for conditional recovery.
• What initial stage treatment can be given if pregnancy is planned? The choice of the method of treatment is the prerogative of the oncologist. It assesses the woman's age and previous medical history, her age, and comorbidities. With a favorable set of circumstances, only the cervix is destroyed, which does not exclude subsequent pregnancy after surgery.
• After removal of the cervical tumor, is a gynecologist's examination twice a year sufficient? Such a periodicity of the survey is quite acceptable. If metastases appear, you should immediately consult a doctor, without waiting for a routine examination. Their symptoms are: headaches, sudden fainting, bone pain and fractures, pathological jaundice. Metastases in nearby lymph nodes may appear asymptomatic. With a planned examination, the gynecologist-oncologist prescribes an examination of the patient, taking into account the operation performed.

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"