Cervical Cancer

Causes

A key role in carcinogenesis is assigned to papillomavirus infection, which has a tropism for the epithelium of the cervix. HPV serotypes of high oncogenic risk (16, 18) are found in 95% of cases of cervical cancer: in squamous cervical cancer, HPV type 16 is more often detected; with adenocarcinoma and low-grade form - HPV type 18. HPV serotypes of “low” oncogenic risk (6, 11, 44) and medium risk (31, 33, 35) predominantly cause the formation of flat and genital warts, dysplasia, and rarely cervical cancer.

Other STIs that increase the risk of developing cervical cancer include genital herpes , cytomegalovirus infection, chlamydia , and HIV . From the foregoing, it follows that the likelihood of developing cervical cancer is greater in women who often change sexual partners and neglect barrier methods of contraception .

 In addition, with an early onset of sexual life (at the age of 14-18 years), the immature epithelium of the cervix is particularly susceptible to the effects of damaging agents.

Risk factors

•    Weakened immune system,
•    Age over 40
•    Early onset of sexual activity;
•    Indiscriminate change of sexual partners;
•    Rejection of barrier contraceptives;
•    Long-term use of hormonal contraception;
•    Immunosuppressive therapy for autoimmune diseases and the treatment of oncological diseases of other localizations;
•    Sexually transmitted infections: genital herpes, HIV, chlamydia;
•    Long-term dependence on smoking.
•    Lack of sufficient fruits and vegetables in the diet.

The highest percentage of infection and accordingly, the incidence of cervical cancer is observed among young women, most likely due to their greater sexual activity.
Background diseases predisposing to the development of cervical cancer in gynecology include leukoplakia (intraepithelial neoplasia, CIN), erythroplakia, warts , polyps , true erosion and pseudo-erosion of the cervix , cervicitis .
 

Treatment

Surgery

All operations for cervical cancer are divided into organ-preserving and radical. The choice of tactics depends on the woman's age, reproductive plans, and the prevalence of the oncological process. In oncogynecology,  it is used:

•    Organ-preserving tactics . In case of pre-invasive cancer in young women planning childbearing, sparing interventions are performed with the removal of initially altered areas of the cervix within healthy tissues. Such operations include cone-shaped amputation (conization) of the cervix, electrosurgical loop excision, high amputation of the cervix. Economical resections for cervical cancer make it possible to maintain oncological radicality and preserve reproductive function.

•    radical tactics . With more pronounced changes and the prevalence of the tumor process, removal of the uterus with transposition of the ovaries (bringing them outside the pelvis) or with oophorectomy is indicated . For cervical cancer in stage I B1, the standard surgical procedure is panhysterectomy - extirpation of the uterus with adnexectomy and pelvic lymph node dissection. When the tumor moves to the vagina, a radical hysterectomy is indicated with the removal of part of the vagina, ovaries, fallopian tubes, altered lymph nodes, and paracervical tissue.

Anticancer treatment

The surgical stage of cervical cancer treatment can be combined with radiation or chemotherapy , or a combination of both. Chemotherapy and radiotherapy may be given preoperatively to shrink the tumor (neoadjuvant therapy) or after surgery to destroy any remaining tumor tissue (adjuvant therapy). With advanced forms of cervical cancer, palliative operations are performed - removal of cystostomy , colostomy , formation of bypass intestinal anastomoses.
 

Tests Required for Diagnosis

The basis for the early detection of microinvasive cervical cancer is regular onco-prophylactic examinations with a cytological examination of cervical scrapings. Pap test (Pap smear) allows you to detect precancerous processes, cancer cells with preinvasive tumor growth. The survey scheme includes:

•    Examination of the cervix in the mirrors . Visual gynecological examination at an early stage allows you to detect or suspect cervical cancer by external signs: ulceration, discoloration of the cervix. In the invasive stage, with an exophytic type of cancer growth, fibrinous deposits are determined on the surface of the cervix, tumor-like growths of a reddish, whitish, pinkish-gray color that bleed easily when touched. In the case of endophytic growth of cervical cancer, the neck becomes enlarged, acquires a barrel-shaped shape, an uneven bumpy surface, and an uneven pink-marble color. When recto-vaginal examination in the parameters and small pelvis can be determined infiltrates.
•    Colposcopy . With the help of colposcopy with an image magnification of 7.5-40 times, it is possible to study the cervix in more detail, detect background processes (dysplasia, leukoplakia) and the initial manifestations of cervical cancer. To study the transformation zone of the epithelium, a test with acetic acid and a Schiller test (iodine test)are usedAtypia in cervical cancer is detected by the characteristic tortuosity of the vessels, less intense staining of pathological iodine-negative foci. If cervical cancer is suspected, a study of the tumor-associated antigen of squamous cell carcinomas, the tumor marker SCC, is indicated (normally does not exceed 1.5 ng / ml).

•    Biopsy of the cervix . Colposcopy makes it possible to identify the site of transformation and make a targeted biopsy of the cervix for histological examination of the collected tissues. Knife biopsy of the cervix with curettage of the cervical canal is required if cervical cancer is suspected. To determine the degree of cancer invasion, cervical conization is performed - a cone-shaped excision of a piece of tissue. The decisive and final method in the diagnosis of cervical cancer is the morphological interpretation of the biopsy results.

Additionally, for cervical cancer, pelvic ultrasound is performed, which allows staging the tumor process and planning the scope of the intervention. To exclude the germination of the tumor in adjacent organs and distant metastasis, they resort to performing ultrasound of the bladder and kidneys, cystoscopy , intravenous urography , ultrasound of the abdominal cavity , radiography of the lungs, barium enema , rectoscopy. 

 

Useful info

Treatment of cervical cancer, started at stage I, provides a 5-year survival rate in 80-90% of patients; at II stage - Survival after five years is 60-75%; under III stage- 30-40%; at IV stage- less than 10%. When performing organ-preserving operations for cervical cancer, the chances of childbearing are preserved. In the case of radical interventions, neoadjuvant or adjuvant therapy, fertility is completely lost.

When cervical cancer is detected during pregnancy , tactics depend on the timing of gestation and the prevalence of the tumor process. If the gestational age corresponds to the II-III trimester, the pregnancy can be saved. Pregnancy management for cervical cancer is carried out under increased medical supervision. The method of delivery in this case is usually a caesarean section with simultaneous removal of the uterus. With a gestational age of less than 3 months, an artificial termination of pregnancy is performed with the immediate start of treatment for cervical cancer.