One of the leading positions among the variety of oncological pathologies in the modern world is cervical carcinoma in women. The source of its formation are hormonal cells that line the surface of the body. Like any other malignant formation, the disease develops as a result of a pathological condition of the cellular genetic material, and this happens under the influence of adverse external factors.
Annually, cervical carcinoma is diagnosed in almost 600,000 women during examinations. The insidiousness of this disease is that there are no signs and manifestations.
Reason for development
The main part of oncological diseases occurs under the influence of certain factors, among which are the elderly female age and prolonged exposure to harmful chemicals and radiation.
Clinical studies have confirmed that there is some relationship between cervical cancer and papillomavirus. Those patients who were diagnosed with carcinoma on the cervix were later found to have this virus.
In addition, there are a number of reasons that can cause the development of this pathology:
- early onset of sexual activity;
- abortion;
- early first pregnancy;
- many sexual partners;
- inflammatory diseases of the reproductive organs;
- immunity weakening;
- long-term use of hormonal medications;
- smoking;
- cervical injury during labor.
Cervical dysplasia is considered a precancerous condition, and this phenomenon can gradually transform into carcinoma. A characteristic feature of this disease is the rapid growth of pathological cells.
Classification
International classification of cervical carcinoma includes several forms of this disease:
- Intraepithelial squamous neoplasia is known as dysplasia.
- Cervical carcinoma in situ (cancer in situ).
- Squamous cell carcinoma with minimal invasion into the underlying layers of the epithelium.
- Squamous cell carcinoma of the cervix, which also has its own varieties. The most common types are keratinizing cancer, basaloid.
- Nonkeratinized carcinoma of the cervix can also be identified.
The following types are less common:
- papillary;
- warty;
- squamous-transitional;
- lymphoepithelioma-like.
Carcinomas from the secreting epithelial layer are classified as follows.
- Adenocarcinoma in situ (cervical carcinoma in situ).
- Adenocarcinoma with minimal invasive features. It is also called microinvasive cervical carcinoma.
Mixed epithelioid neoplasms include:
- glandular squamous cell carcinoma;
- adenoid basal carcinoma;
- adenoid cystic carcinoma.
Adenocarcinoma happens:
- endometrioid;
- mucinous (intestinal, endocervical, glandular-villous, cricoid);
- serous;
- clear cell;
- mesonephric.
In addition, there are these types of neuroendocrine carcinomas:
- neuroendocrine large cell carcinoma;
- carcinoid;
- small cell cancer;
- sarcoma;
- undifferentiated carcinoma.
The predominant number of malignant pathologies of the cervix is histologically squamous (more than 80%). Approximately 17% of cases of cervical carcinoma develop adenocarcinoma and its combination with squamous cell carcinoma. In other cases, other histological varieties of this oncological tumor are noted.
Carcinoma affects not onlycervical canal, but also the body of the uterus. According to this principle, it is customary to divide it into two types: cancer of the body of the uterus and cancer of the cervix. Cervical carcinoma develops several times more often than a cancerous neoplasm of the uterine body.
Features of manifestation
The shape of cervical carcinoma can also differ in certain ways:
- papillary form, which is characterized by the formation of small papillae, a bit like cauliflower;
- a crater-like shape that appears in the form of an ulcer covered with a gray coating.
Cervical cancer is dangerous because in the first stages there are almost no negative symptoms, which leads to the rapid spread of the pathological process to other organs.
Stages
Due to the spread of a malignant tumor, the following stages of cervical carcinoma are observed:
- 1 stage - occurrence of pathological tumor cells;
- 2 stage - penetration of cancer cells into the cervix;
- 3 stage - growth of the neoplasm in the periuterine tissues, the development of the first metastases;
- 4 stage - damage to nearby organs, in which a large number of metastases are observed.
Distribution
Metastases from cervical carcinoma can spread in the following ways:
- lymphogenic;
- hematogenous;
- implantation.
The most common type is considered to be hematogenous, since the lesion is most often observedlymph node metastases. The number of metastases depends on the location of the primary tumor, as well as on the level of its invasion and differentiation.
In the case when the pathological formation passes to the cervical canal, the probability of the formation of metastases increases several times. In such a situation, the lymph nodes located in the pelvis are affected. For the hematogenous pathway, damage to the liver, bone tissue and lungs becomes characteristic.
The implantation path is characterized by the penetration of tumor cells into the abdominal cavity. Subsequently, the fallopian tubes and ovaries are affected.
Symptoms
In the early stages, the presence of squamous cell carcinoma of the cervix may not manifest itself in any way. Later, the oncological process manifests itself in the form of three main symptoms:
- The occurrence of sudden uterine bleeding, which is not due to the course of the menstrual cycle. Blood can be released from the genital tract once or several times. In advanced stages, bleeding may occur after sexual contact, examination by a gynecologist, or physical exertion. If blood is released from the uterus during menopause, then this is considered an almost unambiguous symptom of the development of carcinoma.
- Specific discharge, leucorrhoea, which may be transparent or have a reddish tint. Most often, such a discharge is accompanied by blood impurities.
- Painful sensations. The occurrence of pain indicates that the oncological tumor has grown significantly. This means that metastases have begun to affect the lymph nodes, and they put pressure on the nerve endings. This may cause pain in the lower abdomen. Pain can be contraction-like, intermittent or constant. This symptom of cervical carcinoma in most cases is the reason for an urgent visit to a specialist.
Unfortunately, it often happens that women go to the doctors too late, after the development of severe pain, which characterizes the last stages of cervical carcinoma, which are extremely difficult to treat.
Diagnosis
The diagnostic stage is considered the most important in the treatment of cervical cancer (carcinoma), since it is at this time that the specialist selects the most appropriate therapeutic measures. This process is influenced by the age of the patient, the stage of development of the pathology, the localization of the malignant neoplasm, its structure and type.
An oncological tumor in the tissues of the cervix can be detected by a gynecologist during examination. Often this happens during colposcopy, when the monitor can clearly see the changes that occur on the mucous membrane.
The diagnostic process, as a rule, begins with a visual examination of a woman by a gynecologist, who then directs the patient to instrumental, laboratory and hardware diagnostic procedures. Among them it should be noted:
- screening;
- colposcopy;
- biopsy;
- hysteroscopy;
- ultrasound;
- cystoscopy and rectoscopy;
- HPV testing;
- study for the presence of tumor markers;
- CT or MRI.
For a definitive diagnosis, a biopsy is considered mandatory. This procedure involves puncturing a small piece of the affected tissue. After that, a histological or cytological analysis is carried out, which helps to determine the type of carcinoma and the stage of the oncological process.
Cervical carcinoma treatment
Early diagnosis is important for effective therapy. To do this, it is necessary for preventive purposes to perform an ultrasound examination of the patient from time to time and conduct laboratory blood tests, which will help determine oncology at a time when the carcinoma is asymptomatic.
The main goals of treatment are:
- removal of a malignant neoplasm;
- Prevention of metastasis and tumor recurrence.
Complex Therapy
Cervical carcinoma is usually treated through complex therapy, which includes medical, surgical and radiation methods. The scope of their use is determined only by the stage of the cancer process and the peculiarities of the course of the pathology.
Methods of treatment are prescribed for each patient individually, taking into account the intensity of the development of carcinoma. Hospitalization of the patient becomes mandatory for the organization of proper therapy. During treatment in recent yearsit has been proven that the use of complex surgical and medical treatment is much more effective than radiation therapy.
Surgical treatment is often used to get rid of invasive cervical carcinoma. It becomes the basis for combination therapy.
Laparotomy
In addition, laparotomy is used in the treatment of this type of cancer. Its volume largely depends on the main indicators of carcinoma and the age of the patient. If the disease is at the initial stage, then the woman simply removes the uterus with appendages. In later stages, the lymph nodes are also removed.
Radiation therapy is used for combination therapy with advanced oncological process. For this, ionizing rays are used, to which the cervical epithelium is very sensitive. This technique is used after laparotomy. The vagina, the pelvic area, as well as the area of metastasis growth are processed.
Radiation therapy is prescribed based on the individual characteristics of the patient, as well as prognosis for recovery.
Medicated treatment
Drug treatment of cervical carcinoma also includes the use of hormone therapy and chemotherapy, but such methods are highly prescribed on their own. Much more often they are used in complex treatment after the removal of the reproductive organs.
However, unlike chemotherapy, hormonal medications can in some cases be used on their own.therapy. Treatment should be carried out in two stages. At the initial stage, oncology treatment should end. At the second stage, the woman's menstrual cycle is restored. To do this, in the first few months, the cycle is created artificially, for which hormonal drugs are prescribed to the patient.
Forecast
After surgery for carcinoma, the five-year survival rate is approximately 45-87%.
Prognosis for uterine carcinoma is most favorable in cases where the pathology is detected at an early stage of development (about 80%). Only 5% of patients with the fourth stage survive.
If the pathology is aggravated by relapse, then only a quarter of patients survive after surgical treatment.
