One of the leading positions among the variety of oncological pathologies in the modern world is occupied by cervical carcinoma in women. The source of its formation are hormonal cells that line the surface of the organ. Like any other malignant formation, the disease develops as a result of the pathological condition of the cellular genetic material, and this happens under the influence of adverse external factors.
Annually, during the examination, cervical carcinoma is diagnosed in almost 600 thousand women. The insidiousness of this disease lies in the fact that any signs and manifestations are absent.
Development reasons
The main part of oncological diseases arises under the influence of certain factors, among which are old female age and prolonged exposure to harmful chemical and radiation substances.
Clinical studies have confirmed that there is some relationship between cervical cancer and papilloma virus. In those patients who were diagnosed with carcinoma on the cervix, this virus was later detected.
In addition, a number of reasons can be identified, the presence of which can cause the development of this pathology:
- early onset of sexual activity;
- abortions
- early first pregnancy;
- many sexual partners;
- inflammatory diseases of the reproductive organs;
- weakened immunity;
- prolonged use of hormonal medications;
- smoking;
- neck injuries during labor.
Cervical dysplasia is considered a precancerous condition, and a similar phenomenon can gradually transform into carcinoma. A characteristic property of this disease is the rapid proliferation of pathological cells.
Classification
The international classification of cervical carcinoma includes several forms of this disease:
- Intraepithelial squamous neoplasia is known as dysplasia.
- Cervical carcinoma in situ (cancer in place).
- Squamous cell carcinoma with minimal germination in the underlying layers of the epithelium.
- Squamous cell carcinoma of the cervix, which also has its own varieties. The most common types are keratinized, basaloid cancer.
- Non-keratinized carcinomas of the cervix can also be distinguished.
Less common are these types:
- papillary;
- warty;
- squamous-transitional;
- lymphoepithelial-like.
Carcinomas from the secreting epithelial layer are divided as follows.
- Adenocarcinoma in situ (cervical carcinoma in situ).
- Adenocarcinoma with minimal invasive symptoms. It is also called microinvasive carcinoma of the cervix.
The category of mixed epithelioid neoplasms includes:
- glandular squamous cell carcinoma;
- adenoid-basal carcinoma;
- adenoid cystic carcinoma.
Adenocarcinoma happens:
- endometrioid;
- mucinous (intestinal, endocervical, glandular-villous, cricoid cell);
- serous;
- clear cell;
- mesonephral.
In addition, there are such varieties of neuroendocrine carcinomas:
- neuroendocrine large cell carcinoma;
- carcinoid;
- small cell cancer;
- sarcoma;
- undifferentiated carcinoma.
The predominant number of malignant pathologies of the cervix is accounted for by the histological squamous appearance (more than 80%). In approximately 17% of cases of cervical carcinoma, adenocarcinoma and its combination with squamous cell carcinoma are observed. In other cases, other histological varieties of this oncological tumor are noted.
Carcinoma affects not only the cervical canal, but also the body of the uterus. According to this principle, it is customary to divide it into two types: cancer of the uterus and cervical cancer. Cervical carcinoma develops several times more often than cancer of the uterus.
Features of manifestation
The form of cervical carcinoma can also differ in a certain way:
- papillary form, which is characterized by the formation of small papillae, a bit like cauliflower;
- crater-shaped, which appears in the form of an ulcer, covered with a gray coating.
Cervical cancer is dangerous because in the first stages almost no negative symptoms are noted, which leads to the rapid spread of the pathological process to other organs.
Stages
Due to the spread of the malignant tumor, the following stages of cervical carcinoma are observed:
- Stage 1 - the occurrence of pathological tumor cells;
- Stage 2 - the penetration of cancer cells into the cervix;
- Stage 3 - the growth of tumors in the perinatal tissues, the development of the first metastases;
- Stage 4 - damage to the nearest organs, in which there is a large number of metastases.
Spread
Metastases in cervical carcinoma can spread in the following ways:
- lymphogenous;
- hematogenous;
- implantation.
The most common type is considered hematogenous, since metastases of the lymph nodes are most often observed. The number of metastases depends on the site of localization 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 likelihood of metastasis increases several times. In a similar situation, the lymph nodes located in the pelvis can be affected. The hematogenous pathway is characterized by damage to the liver, bone tissue and lungs.
The implantation pathway is characterized by the penetration of tumor cells into the abdominal cavity. Subsequently, damage to the fallopian tubes and ovaries occurs.
Symptoms
In the early stages, the presence of squamous cell carcinoma of the cervix may not manifest itself. Later, the oncological process manifests itself in the form of three main symptoms:
- The occurrence of sudden uterine bleeding, which is not caused by the course of the menstrual cycle. Blood can be released from the genital tract once or several times. In the advanced stages, bleeding may occur after sexual intercourse, examination by a gynecologist or physical exertion. If blood from the uterus is excreted during menopause, then this is considered an almost unambiguous symptom of the development of carcinoma.
- Specific highlight, leucorrhoea, which may be transparent or have a reddish tint. Most often, such secretions accompany blood impurities.
- Painful sensations. The onset of pain indicates that the cancer tumor has grown significantly. This means that metastases began to affect the lymph nodes, and they put pressure on the nerve endings. This may hurt the lower abdomen. The pain can have the nature of contractions, occur periodically or constantly. This symptom of cervical carcinoma in most cases is the reason for an urgent appeal to a specialist.
Unfortunately, most often it happens that women turn to doctors too late, after the development of severe pain, which characterizes the last stages of neck carcinoma, which are extremely difficult to treat.
Diagnostics
The diagnostic stage is considered the most important in the treatment of cervical cancer (carcinoma), because it is at this time that the specialist selects the most suitable therapeutic measures. This process is affected by the age of the patient, the stage of development of the pathology, the localization of the malignant neoplasm, its structure and variety.
An oncological tumor in the tissues of the cervix can be detected by a gynecologist during examination. Often this happens during colposcopy, when on the monitor you 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
- cystoscopic and rectoscopic diagnostics;
- HPV test;
- research on the presence of tumor markers;
- CT or MRI.
For a final diagnosis, a biopsy is considered mandatory. This procedure involves the puncture of a small fragment of the affected tissue. After this, a histological or cytological analysis is performed, which helps to determine the type of carcinoma and the stage of the oncological process.
Treatment of cervical carcinoma
For effective therapy, early diagnosis is important. To do this, it is necessary for preventive purposes from time to time to perform an ultrasound examination of the patient 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;
- preventing the occurrence of metastases and tumor recurrence.
Complex therapy
Cervical carcinoma is usually treated with the help of complex therapy, which involves medical, surgical and radiation methods. The volumes of their use are determined only by the stage of the cancer process and the peculiarity of the pathology.
Methods of treatment are prescribed for each patient individually, taking into account the intensity of development of carcinoma. Hospitalization of the patient becomes mandatory for the organization of proper therapy. During the treatment in recent years, it has been proven that the use of complex surgical and drug treatment is much more effective than radiation therapy.
Surgical treatment is often used to get rid of invasive cervical carcinoma of the cervix. It becomes the basis for combination therapy.
Laparatomy
In addition, laparotomy is used to treat 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 an initial stage, then the woman simply removes the uterus with appendages. In the subsequent stages, lymph nodes are also removed.
For combination therapy with an advanced oncological process, radiation therapy is used. 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, and also the metastasis proliferation zone are processed.
Radiation therapy is prescribed based on the individual characteristics of the patient, as well as forecasts for recovery.
Drug treatment
Drug treatment of cervical carcinoma also includes the use of hormone therapy and chemotherapy, however, such methods are independently prescribed extremely. Much more often they are used in complex treatment after removal of the reproductive organs.
However, unlike chemotherapy, hormonal medications can in some cases be used as an independent 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. For this, in the first few months, the cycle is created artificially, for which purpose hormonal drugs are prescribed to the patient.
Forecast
After surgery for carcinoma, survival for five years is approximately 45-87%.
The prognosis for uterine carcinoma is most favorable in those cases when 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 exacerbated by relapse, then only one fourth of the patients survive after surgical treatment.