Cervical cancer

Cervical cancer ranks second in the structure of oncological diseases of female genital organs (after cancer of the uterus (endometrium)), although in the age group 15 to 54 years is dominant among the female genital cancer.
More than 70 cases, regardless of stage of disease, cervical cancer is curable, and diagnosing it in its early stages can cure patients in more than 90 of cases.
Cervical cancer occurs mainly in women of middle age (35-55 years). These tumors are rarely diagnosed in women younger than 20 years. In 20 cases the tumor is diagnosed in women over the age of 65 years.
5-year relative survival rate for early stage cervical cancer is 92. Total (including all stages) 5-year survival rate for cervical cancer is 71.

Cervical cancer never develops in the unchanged epithelium (layer of cells lining the cervix). In other words, it is always preceded by precancerous epithelial changes called dysplasia or CIN (cervical intraepithelial neoplasia). Most often, cervical cancer develops in the transition zone – the junction of the squamous epithelium (which lines the outer part of the cervix – the ectocervix) and glandular (which lines the cervical canal, endocervix).
Proved the role of virusinfection in the occurrence of dysplasia and cervical cancer. In 2008 the Nobel prize in medicine and physiology was awarded to Harald the LRC Houseno for linking the human papilloma virus (HPV, HPV) and cervical cancer. Modern research has shown that more than 90 of cases of cervical cancer caused by HPV, a common virus that infects more than two thirds of sexually active women during their lives. HPV can cause precancerous condition – dysplasia of the cervical epithelium of varying degrees –CIN I – CIN III, which in the absence of adequate treatment eventually progresses to invasive cancer. It is therefore very important to apply competent etiotropic treatment (including bacterial and viral infection that caused the dysplasia), with the aim of a regression of dysplastic changes in the cervical epithelium and thereby prevent the development of invasive cancer.
Risk factors for cervical cancer
The probability of HPV infection increases if:
• Early onset of sexual activity (at a very young age), when the cells of the epithelium of the cervix - the cervix are immature, and therefore susceptible to virus infestation-
• Having many sexual partners or sexual contacts (present and past)-
• Failure to use mechanical contraception - condoms.
The use of condoms can significantly reduce the chances of Contracting HPV. Research the American Cancer Society showed that condom use reduces the probability of infection of approximately 70. Incomplete protection because HPV can be transmitted by physical contact with any infected part of the body.
Additional risk factors for cervical cancer are:
Smoking. Women who smoke are twice as likely to develop cancer of the cervix. Carcinogens tobacco products an impact not only on the lungs. They are absorbed by the lungs through the bloodstream and spread throughout the body. Tobacco products found in a mucous discharge cervix. These substances damage the DNA of cervical cells that may contribute to the development of cancer.
concomitant bacterial and protozoal urogenital infection,
HIV (human immunodeficiency virus) . The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). As a result of violations of the immune system a woman's body becomes susceptible to HPV, which increases the risk of cervical cancer. The immune system can destroy cancer cells and slows their growth and spread. In women with AIDS precancerous condition of the cervix can develop into an invasive cancer faster than other women.
Chlamydial infection. Chlamydia is a relatively common type of bacteria that affects the female reproductive system. It spreads through sexual contact. Many women are unaware that they have this infection until then, until it was revealed in the smear from the cervix. The presence of chlamydial infection increases the risk of developing cervical cancer.
Diet. Insufficient intake of fruit and vegetables may increase the risk of cervical cancer. Overweight also increases the likelihood of developing cancer.
Contraceptives.
Prolonged use of oral contraceptives (5 or more years) increases the risk of developing cervical cancer. Among women who used these drugs for 10 or more years, the risk of cervical cancer increased by 4 times.
Multiple gestation. Women with multiple pregnancies who gave birth, and the risk of developing cervical cancer is increased.
Low socio-economic status is also accompanied by an increased risk of cervical cancer.
The cervical cancer cases in the family. In women whose mother or sister was afflicted with cervical cancer, there is an increased risk of developing this cancer.
Avoiding these risk factors, women can significantly reduce the incidence of cancer of the cervix.

Cervical cancer usually develops slowly over several years (although in some cases its development can occur quite rapidly). Before developing tumor cells of cervical tissue undergo changes at the cellular level – there is dysplasia of the epithelium. If untreated, dysplasia progresses from mild (CIN I) to moderate (CIN II) and severe dysplasia (CIN III). CIN III includes both severe dysplasia and intraepithelial carcinoma or carcinoma in situ. It's early non-invasive cancer that requires special treatment of cancers, which is held in conserving volume and, as a rule, lies in the conization.
Progression of the pathological changes on the cervix invasive cancer is at the stage of invasive cancer, which can only be determined by histological examination of tissue. The experience of our doctors allows the young women to preserve the generative and menstrual function, we can also sparing (organ) treatment.
Depending on the prevalence of cervical cancer is divided into clinical stages.
• Stage 0 - carcinoma in situ.
• Stage I - tumor confined to the cervix.
o 1A - microinvasive cervical cancer, which is subdivided:
o 1A1 - depth of invasion up to 3 mm (metastases occur in less than in 1)
o 1A2 - depth of invasion from 3 to 5 mm in diameter tumor 7-10 mm (frequency of metastases 4-8)-
o 1b - invasive cervical cancer (depth of invasion greater than 5 mm).
• Stage II - the tumor extends beyond the cervix:
o IIA - infiltration of the upper and middle third of the vagina or uterus-
o IIb - infiltration parameters, not reaching to the wall of the pelvis.
• Stage III - the tumor outside of the cervix:
o IIIA - infiltration of the lower third of the vagina-
o IIIb - spread infiltration of the pelvic wall infiltration with hydronephrosis or secondary wrinkled kidney.
• Stage IV - the tumor invades adjacent organs or spreads beyond the pelvis.
o IVa - germination of the bladder or rectum-
o IVb - distant metastases.

In the early stages (intraepithelial, microinvasive) cervical cancer is usually asymptomatic and may be detected only when Cytology with cervical cancer and colposcopy. That is why it is so important to regularly visit your gynecologist and undergo screening.
The primary symptom of cervical cancer may be the emergence of contact bleeding (during intercourse or after), rare watery discharge, which is caused by destruction of lymphatic capillaries adjacent to the epithelial layer. Later recurrent bleeding in connection with the destruction of the deeper lying blood capillaries.
When clinically significant and common forms the main symptom is the appearance of vaginal bleeding of varying intensity and nature (contact and independent). The decay of the tumor, the discharge becomes pus-like and smelly. Pain indicates the spread of the cancer process at parametersyou tissue and compression of the nerve plexus in the sacrum. Compression of the ureter leads to disruption of monotoca and renal failure, and compression of the lymphatic vessels to the lymph in the legs (lymphedema).

Diagnosis of cervical cancer in the developed process is not difficult: the presence of typical complaints of patients on leucorrhoea, bleeding and pain, examination of the cervix with the aid of mirrors, a biopsy of the suspicious area and subsequent histological examination in all cases allow you to make the correct diagnosis.
During the inspection of the cervix with the help of mirrors, that the samples of the Worm (the pressure on the affected area of the neck bellied probe), to differentiate tumor infiltration of the cervix from inflammatory.
When endophytic form of cervical cancer the probe easily penetrates through the fragile tumor tissue, in the presence of changes of an inflammatory nature that is not happening.
Also applies Schiller, which consists in treating the surface of the cervix 2-3 Lugol's solution. Normal cervical epithelium (stratified squamous non-keratinizing) is painted in dark brown color due to the presence of large amounts of glycogen. The areas, affected by cancer, due to the poverty glycogen, remain unstained.
During bimanual examination the patient with cervical cancer there is an increase in the density of the cervix, limiting her mobility.
Significant the distribution process determines the presence of severe hypertrophy of the cervix and infiltration of the walls of the vagina (vaginal), an increase in the body of the uterus (uterine), tumor formation in parametreleri tissue (parametreleri option).
A more accurate picture of the distribution process usually manage to get at rectovaginal the investigation of the patient.
Diagnosis of early stage cervical cancer is possible with careful examination of the patient and application of additional methods of research of particular importance among them are Cytology and colposcopy.
In the anamnesis the patient with cervical cancer can often be found indications of inflammatory diseases of internal genital organs, the presence of recurrent pseudo-cervix, cervical polyps.
You must pay attention to the number of births and abortions, the nature of sexual life.
It is known that cervical cancer is more common in parous and with a history of abortion women.
During questioning it is necessary to clarify the characteristics of menstrual and secretory functions.
The leading role in the early diagnosis of cervical cancer belongs to colposcopy and Cytology.
Colposcopy - examination of the vaginal portion of the cervix using a special optical device that gives manifold increase.
During the inspection pay attention to the shape of the cervix, the presence of deformation, the condition of the epithelium, blood vessels of the cervix.
Special processing allows to clarify the nature of changes in the cervix. A cotton or gauze to make processing of the vaginal portion of cervix 3 acetic acid and 2 water Lugol's solution. The treatment with acetic acid reveals sections of the ectopic epithelium of the cervical canal and to determine the reaction vessels of the cervix (process in tumor vessels are often dilated, stopovers convoluted and not narrowed under the action of acetic acid). Lugol's iodine stain stratified squamous non-keratinizing epithelium of the vaginal portion of the cervix in brown color. Not colored areas affected by the tumor, and the epithelium with the processes of keratinization. From suspicious sites aiming to take tissue for histological examination.
For cytological examination of smears from suspected areas of the vaginal portion of cervix, cervical canal, and the posterior vaginal fornix. Swabs are taken with a cotton canonical affixed to a glass slide, dried and stained according to a certain method (Papanicolaou or hematoxylin-eosin). Examination of smears under the microscope allows to identify atypical cancer cells.
For the diagnosis of cervical cancer is also used (along with biopsy of the cervix) scraping the mucosa of the cervical canal with histological examination of scrapings.
At diagnosis of cervical cancer for the choice of treatment necessary is to determine the extent of the process. In this regard, great importance is a comprehensive examination that includes, along with clinical, instrumental and morphological techniques such as x-ray and indirect radioisotope outflow, perosseous venography, arteriography, etc.
One of the methods of intravital diagnosis of metastases of cervical cancer is a direct contrast to the outflow.
Contrast venography is an indirect method of diagnosis of lymphatic spread of cervical cancer, arteriography provides an opportunity to clarify the degree of damage of the pelvic tissue and to assess, therefore, the stage of the tumor process.
Additionally is made radiopaque urological research setting the state of the urinary system (the possibility of compression of the ureter by the growing tumor).
Cervical tumors usually are of two types - squamous and glandular (adenocarcinoma). In 80-90 cases of tumor of uterine cervix squamous cell carcinoma presents. Each of these forms can be highly-, moderately - and poorly-differentiated.
The larger the size of the tumor and lower the degree of differentiation of its cells, the worse the prognosis of the disease. The factors influencing the prognosis of the disease and the effectiveness of his treatment, include the state of the regional (pelvic) lymph nodes. Prior to treatment, to detect their metastases can an ultrasound or CT scan, and histological examination of the removed during surgery lymph nodes.
Guidelines for the early detection of cervical cancer:
- All women should undergo screening (desempeno survey) for cervical cancer 3 years after first sexual intercourse, but no later than 21 years. Screening should be performed annually with the examination of smears from the cervix.
- Starting from the age of 30, women who have had three consecutive negative result in the study of smears from the cervix, may be screened every 2-3 years. Women with HPV or a weakened immune system as a result of transplantation, chemotherapy, or prolonged use of steroid hormones should continue annual screening.
Women 70 years and older with three or more normal results of smears from the cervix for the last 10 years may not participate in screening. Women who have had cervical cancer with HPV or weakened immune system should continue screening until health permits them.
Women who underwent removal of the uterus and cervix, may not participate in the screening, if the operation has not been performed for cancer or precancerous conditions of the cervix. Women who made the removal of the uterus without removing the cervix should continue screening.
Some women believe that they should not be examined due to the fact that you no longer wish to have children. This dot sight is wrong.
Examination of the pelvis is part of a survey of women. In this study, the doctor evaluates the condition of the reproductive organs, including the uterus and ovaries, and can also identify diseases, sexually transmitted. However, in this study it is impossible to diagnose cervical cancer at an early stage or to detect altered cells of the cervix.
Smears from the cervix are performed prior to the examination of the pelvis, the surgeon uses a special tool receives a certain number of cells from the cervix, which are then examined under a microscope.
Other malignant tumors: Melanoma, sarcoma and lymphoma can also occur in the cervix, but these tumors are very rare.
Colposcopy: If, according to the survey of suspected cervical cancer, it is recommended to perform colposcopy. In this procedure, the doctor examines the cervix with a colposcope (a device with a magnifying lens). When this is studied in detail the surface of the cervix. If a suspicious area is the biopsy (removal of a small piece of tissue for examination). The biopsy allows us to judge whether the woman is a precancerous condition, a true cancer or anything else.
In the case of the woman suspicious changes in the cells of the cervix can be offered cryosurgery (using liquid nitrogen) or laser surgery.
These two methods almost always possible to cure the precancerous disease and prevent the development of cancer.

Thanks to a successfully operating in Western European countries and the U.S. the screening system of the female population cervical cancer can be easily detected in its earliest stages and completely cured in most cases. Statistics of the European Association of cervical cancer (ESA) show that if detected early cervical cancer can be cured in 98 cases.
The choice of treatment depends on the stage of the disease, the patient's age, presence of comorbidities and other factors, including the preferences of the patient (if the situation allows).
Surgeonalgebraic method
The volume of surgical treatment depends on the stage of the disease. In the initial stages (microinvasive cancer), stage TA, usually in young patients it is possible to conduct organ-preserving treatment, which is consistent with the principles of oncological radicalism. Depending on the localization of the tumor process possible cervical conization, hysterectomy with ovarian preservation, trachelectomy (removal of cervix with preservation of the uterus and ovaries, allowing you to maintain menstrual and reproductive functions of women), if necessary supplemented with pelvic lymphadenectomy.
Stage TV and TV, in some cases, stage To require radical hysterectomy (Wertheim's operation), which consists of removing the uterus with a neck, of the uterus (tubes and ovaries), paracervical tissue, the upper third of the vagina and pelvic lymph nodes (iliac, paracervical, sacrococcyx). In women under 40 to 43 years, this surgery can be performed with preservation of the ovaries in order to prevent the development of post-castration syndrome.
Radiotherapy
Radiation therapy is an effective alternative treatment of cervical cancer stages TV – T2A, and only possible when stage T2B, TA and TV. Radiotherapy as an independent method is used in the later stages because these stages observed involvement of the surrounding cervix tissues. According to international standards, the irradiation of patients with cervical cancer is performed on linear accelerators using three-dimensional planning system that allows you to bring the most effective tumor dose while simultaneously "cover" healthy bodies, falling within the zone of irradiation, special multilaboratory. It should be noted that a high percentage of cure with a minimum number of side effects is also achieved with the use of computer planning at all stages of the radiotherapy.
Radiation treatment is carried out according to international protocols of treatment adopted in all developed countries, with the simultaneous use of radiomodificators (anticancer agents in small doses, which increase the damaging effect of radiation therapy on the tumor).
Radiation therapy may also be used as an additional (adjuvant) method after radical surgical treatment. Assigned to adjuvant radiation therapy in the case of tumor invasion into the underlying tissues more than 50 of their thickness, in case of detection of metastases in distant regional lymph nodes, in the case of the location of the tumor in the cervical canal and other adverse factors. Adjuvant radiation therapy is administered to prevent a local (i.e. in place of the removed tumor) recurrence of the disease.
Chemotherapy
Chemotherapy as a stand-alone method of treatment is seldom used. This is mainly due to the fact that cervical cancer is considered to be relatively insensitive to this type of therapy. Basically, chemotherapy is applied in the case of palliative if it is impossible for radiation therapy.
The combination of chemotherapy and radiation therapy has shown good results in the extensive local spread of cervical cancer. Also proven is effective in treating drugs based on platinum squamous cell cervical cancer.
Is it always necessary to treat the infection caused by HPV
No, treatment is necessary only in case of detection by a physician of the pathological changes on the cervix Cytology smears and/or colposcopy and, if the viral infection is determined after one year after its first detection. In many women the infection goes away on its own without treatment due to the immune mechanisms of the body.
Forecast
Once widespread screening test, developed in 1950 by George Papanicolaou, based on taking a smear from the cervix and are known as PAP test, the number of deaths from cervical cancer in countries that have applied this benchmark, are down about 10 times. Today, in developed countries there is a trend of annual declines in mortality from cervical cancer by detecting the disease at early stages.

Since most tumors cervical cancer develops from precancerous diseases, there are two ways to prevent their occurrence. The first way consists in the prevention of precancerous States and the second is the detection and treatment of precancerous diseases before they turned into cancer.
You should avoid risk factors
You can avoid most of precancerous cervical disease, if to prevent the occurrence of risk factors, for example, infections caused by human papilloma virus (HPV). The exclusion of sexual relations at a very young age, limiting the number of sexual partners and sexual contacts with people who have many sexual partners reduces the risk of HPV. This virus does not always cause papillomas or other symptoms, so a person can be infected, carry the infection and not know it.
Remember that condoms do not protect against HPV, as this infection can be transmitted by contact through the skin. The infection can exist for many years without giving symptoms.
Detection of precancerous conditions
A second means of preventing invasive cervical cancer is HPV and precancerous conditions. Treatment of these conditions can stop the development of cancer. Most invasive cervical tumors diagnosed in women who have not received special examination (examination of smears from the cervix).

Oncologist
Gynecologist