Cervical Cancer - Causes, Symptoms and Treatment .MF .
Cervical Cancer - a malignant tumor that develops from the mucous lining of the cervix in the transition zone of the cervical epithelium of vaginal.Cervical cancer is one of the most common malignancies in women, it ranks second in frequency of occurrence after breast cancer.Every year revealed more than 500 thousand new cases of cancer.A significant portion of patients the tumor is detected at a late stage, it is due to lack of diagnostic coverage of the female population, as well as a very fast rate of tumor growth.
Causes Cervical Cancer
combination of factors usually occurs.The most common tumor found in women aged 40 to 55 years old from low-income social strata, living in rural areas and have more than 6 children.
The development of cervical cancer depends on the following factors:
- earlier onset of sexual activity - from 14 to 18 years of age, in this age of cervical epithelium of immature and are particularly exposed to damaging factors.
- frequent change of sexual partners (equal to or
- Smoking more than 5 cigarettes a day;
- hormonal contraceptives and as a result, non-barrier contraception (condoms and caps), with a risk of infection with sexually transmitted diseases;
- failure to comply with sexual health;sexual partners are circumcised do not (because cervical cancer can provoke smegma);
- immunodeficiency deficiency in the diet of vitamins A and C;
- virus infection of genital herpes and cytomegalovirus;
- infection by human papilloma virus (HPV).
Currently, through international research proved a direct carcinogenic role of HPV in cervical cancer development.It was revealed that 80 to 100% of cervical cancer cells contain the human papilloma virus.Once in the cell the virus is embedded in the DNA of the cell nucleus chain, causing it to "work for themselves" by creating new virus particles, which, coming out of the cell through its destruction, introduced in the new cells.HPV infections are sexually transmitted.The virus can have a productive (the formation of genital genital warts, papillomas) and transformaruyuschee effect on cells (causing degeneration and cancer).
There are several forms of existence in the body of HPV infection:
- asymptomatic - despite the fact that the virus is in full life cycle of the patient's cells, on examination it is practically not detected and, in a few months, provided a good immunity, can be displayedspontaneously from the body;
- subclinical form - when viewed with the naked eye, cervical pathology is not determined, but colposcopy revealed multiple small warts cervical epithelium;
- symptomatic form of the infection: genital warts are defined clearly in the vulva, anus, sometimes on the cervix.
There are more than 80 types (species) of the virus, about 20 of them can attack the mucous membranes of the genitals.They all have different effects on the development of cervical cancer, "high-risk" viruses: 16, 18, 31, 33, 35,39, 45, 50, 51, 52, 56, 58, 59, 64, 68, 70 types;Viruses "low-risk": 3, 6, 11, 13, 32, 42, 43, 44, 72, 73 types.
established that the 16 and 18 types most commonly found in cervical cancer, 6 and 11 - in benign tumors, and only occasionally in cancer.This type occurs in 16 squamous cervical cancer, and type 18 with adenocarcinoma and poorly differentiated cancer.
precancers (dangerous because of frequent transformation into cancer) cervical dysplasia (changes in the structure of the epithelium, which does not exist in the norm), cervical erosion, leukoplakia.Require mandatory treatment, most commonly, laser ablation lesion.
1- polyp of the cervical canal;2 cervical erosion.
Symptoms of cervical cancer
symptoms of cervical cancer are divided into general and specific.
Common symptoms: weakness, weight loss, loss of appetite, sweating, unreasonable rises in body temperature, dizziness, pallor and dry skin.
Specific symptoms of cervical cancer may include the following:
1. bleeding from the genital tract, are not associated with menstruation, may be small, spreadable, or abundant bleeding is observed in rare cases.Often spotting occur after sexual intercourse - "contact isolation".There are manifestations in the form of precipitates or acyclic background menopause.In the later stages of the selection may acquire an unpleasant odor associated with the destruction of the tumor.
2. Pain in the lower abdomen: may be accompanied by bleeding, or occur with advanced forms of cancer as a result of an infection or tumor invasion of joining other pelvic organs or structures (nerve plexus, pelvic wall).
3. Swelling of the extremities, external genitalia occur with the progression of the disease in advanced and advanced cases, are the result of metastasis to nearby pelvic lymph nodes and blocking of large vessels, diverting blood from the lower extremities.
4. Violation of bowel and bladder function occurs during germination tumor of these bodies - the formation of fistulae (holes between the authorities do not exist in the standard).
5. Retention of urine associated with mechanical compression of metastatic lymph nodes, followed by ureteral bud off from work, the formation of hydronephrosis, a consequence of something or poisoning of the body of waste products (uremia) in the absence of urine - anuria.
also described changes lead to the penetration of purulent infection on the urinary tract and the deaths of patients from serious infectious complications.Can hematuria (blood in the urine).
6. Swelling of the lower limbs on one side - can occur in the later stages, in the presence of metastases in the lymph nodes of the pelvis and compression of large vessels of the limbs.
survey with suspected cervical cancer include:
1. inspection in the mirror and bimanual (manual) study - the standard examination by a gynecologist, a visual inspection reveals or suspected tumor pathology appearance cervical mucosa (swelling, ulceration);
In view mirrors cervical
2. Lugol stain solution (iodine) and acetic acid: reveals indirect signs as the entry way and develop cervical cancer - vascular tortuosity, staining lesions less intense than normal sites andother;
plot altered epithelium (dark area, shown by an arrow)
3. Colposcopy - cervical examination at a magnification of 40 times 7,5- allows the cervix to examine in more detail the processes to identify precancerous (dysplasia, leukoplakia)and the initial form of cancer;
cervical leukoplakia with colposcopy
4. smears for cytological study of cervical and cervical canal - must be carried out each year for every woman to identify microscopic, early forms of cancer;
5. cervical biopsy and endocervical curettage - take on microscopic examination of the cervix piece, is required in cases of suspected cancer, can be performed with a scalpel or electrocautery.
6. ultrasound of the pelvic organs - allows you to estimate the prevalence of tumor in the pelvis (stage), you need to plan the operation volume;
7. CT of small pelvis - in case of doubt, a suspected tumor in-growth adjacent organs;
8. intravenous urography - performed to determine kidney function, since cervical cancer is common compression ureteral tumor, followed by impaired renal function and shutdown of its work;
9. cystoscopy and rectoscopy (or barium enema - radiopaque intestinal research) - a study of the bladder and the rectum in order to identify their tumor invasion;
10. chest X-ray and ultrasound of the abdominal cavity - is performed to exclude distant metastases.
stages of cervical cancer:
Stage 0 - the initial stage - "carcinoma in situ", the survival rate of patients after treatment is 98-100%;
Stage 1 (A, A1, A2-1V, B1, B2) - divided into subgroups, grows into the tissue of the cervix stage A tumor is not more than 5 mm in stadiya- tumors up to 4 cm;
Step 2 (A and B) - the tumor spreads to the uterus, but without engaging the pelvic wall or upper third of the vagina;
Stage 3 tumor invades the upper third of the vagina, pelvic wall or causes hydronephrosis with an ode to the side (overrides the ureter, shut down the work of the kidney);
Stage 4- germination of the bladder, rectum or pelvis (sacrum), as well as the presence of distant metastases.
Metastases - a screenings of the main tumor, with its structure and capable of growing, disrupting the function of those organs where they develop.metastases appearance is connected with the natural growth of the tumor: tissue grows fast food enough not to all its elements, part of the cell loses contact with the rest, breaks away from the tumor and into the blood vessels, spreads throughout the body and into the bodies of a small and well-developed vasculature (liver, lungs, brains, bone), they are deposited from the bloodstream, and begin to grow, forming kolonii- metastases.In some cases, metastases can reach huge sizes (10 cm) and lead to the death of patients by poisoning the tumor waste products, and disruption of the body.Cervical cancer most often spreads to the nearby lymph nodes - pelvic fat, in the course of large vascular bundles (iliac);from distant organs: lungs and pleura (lining of the lung a coating) in the liver and other organs.If metastases are rare possible to remove them - it gives a better chance for a cure.If they are numerous - only maintenance chemotherapy.Big problems delivering pleurisy patients - metastases lining of the lungs, which leads to a violation of its permeability, and fluid accumulation in the thoracic cavity, resulting in compression of organs - lungs, heart, and cause shortness of breath, chest tightness and exhaustion patients.
favorable forecast is possible only if adequate treatment (surgery or radiotherapy or a combination thereof) at an initial 1-2 stages.Unfortunately, the survival rate of stage 3 to 4 is very low, less than 40%.
Treatment of cervical cancer
most good results obtained in the treatment of early cervical cancer ( "carcinoma in situ"), does not grow into the surrounding tissue.In young patients of childbearing age who plan childbearing, there are several options for organ-preserving treatment: excision of the lesion with a scalpel within healthy tissue or laser vaporization, cryotherapy (liquid nitrogen), ultrasound of the cervix removal.
When microinvasive cancer - a tumor ingrowth into the tissue to be no more than 3 mm, as well as in all other stages of the tumor required surgery - hysterectomy without appendages in women of childbearing age and the removal of appendages in women postmenapauzalnom period.At this stage, since 1b adds nearby lymph nodes removal treatment.
In addition, the operation can be supplemented by radiotherapy (radiation).
At stages 1-2 can be independent radiotherapy without surgery: intracavitary (through the vagina) and remote (from outside).
Choice of treatment depends on the age, general health, the patient's desire.
When tumor ingrowth into surrounding organs can be combined surgery (removal of the uterus with a portion thereof).
For large inoperable tumor treatment option is radiation therapy, provided the reduction in size of the tumor, the next stage of operation is possible.
At higher tumor stage possible palliative operation (relief of symptoms): elimination of colostomy on the stomach, forming a bypass anastomosis.
treatment options may appear chemotherapy - surgery or chemo-radiation therapy without surgery.
In the presence of metastases in distant organs - only chemotherapy.
Full recovery of the patient is possible through the use of surgical or combined effects.
After treatment necessarily dynamic observation: the turnout to the gynecologist to perform a colposcopy and taking smears every 3 months.
In no case should not self-medicate, as the favorable period for treatment is during this time will be lost.
Complications of cervical cancer:
compression of the ureters, urinary retention, hydronephrosis, urinary tract purulent infection, bleeding from the genital tract tumors and up to profuse (deaths), fistulas (messages between the bladder or intestines and the vagina).
Doctor's consultation on cervical cancer:
Question: how often women suffer from cervical cancer?
Answer: This tumor occurs quite often, takes place at a frequency of 2 after breast cancer in Europe.At 6 Russia- place among malignant tumors and 3 among the reproductive system.Sick women of all ages, but mostly 50- 55 years.
Question: Is it possible to children born after treatment of cervical cancer?
Answer: Yes, it is possible, provided the early stages of cancer and perform organ operations.
Question: What is the alternative to surgical treatment of cervical cancer exist?
Answer: The treatment options can be a lot, it all depends on the willingness of patients and health facilities: excision with a scalpel (knife amputation) within healthy tissue or laser vaporization, cryotherapy (liquid nitrogen), ultrasonic removal of the cervix and others.
oncologist Barinov Natalia