Causes, symptoms, stages and treatment cervical cancer

• squamous cell, consisting of epithelium keratinized cells of the surface epithelium;
• squamous, composed of small cells.

Classification is not simple, contains a number of specific terms. The ordinary person is not required to know the intricacies of the forms of pathology that occur at the microscopic level. More important is to understand how these forms of the disease may manifest clinically. Our task is to simplify the understanding of the pathogenesis of squamous cell carcinoma, this is a bit of a distraction from the main topic.

The neck (cervix) of the uterus – anatomical education fusiform, 4-5 cm in length, connects the outer part of the vagina (outer locked throat) and the inner – uterine part (locked inner throat), between them is the cervical canal.

Stratified squamous epithelium (endocervix) lines the wall of the cervix closer to the outside – the vaginal part. There is a clear transition zone separating the flat and cylindrical (glandular) epithelium of the wall.

The squamous epithelium consists of four layers of cells, of different ages, who, under the influence of female hormones transferred from younger generations to older:

• surface old cells;
• intermediate – Mature cells;
• parabasal young cells;
• basal nascent stem cells.

The process of updating the layers of cells continuous throughout life. All of these layers of cells are stratified squamous epithelium of the cervix. The main function of squamous epithelium – protective. Also under the action of estrogen in their cells participate in the hormonal changes of the female body.

The earliest signs pointing to a lesion of the squamous epithelium may occur clinically at the macro and micro level.

1. Clinical symptoms of damage to the squamous epithelium which is impaired in estrogen levels, keratin and glycogen appear:

   • pain is the result of the roughening or thinning of the skin (changes in the level of keratin – dyskeratosis);
   • unnatural discharge from the vagina (hormonal imbalance);
   • violation of the pH of the medium is influenced by changes in the level of glycogen in the cells and correspondingly resistant genital dysbacteriosis – very bad.

2. Microscopic changes are manifested by the detection of cells that are not typical for:

   • a certain period of the month;
   • the body of a healthy woman of childbearing age or in the age of menopause.

   For example, the presence in the cervical smear:

   • basal cells – relative norm for the elderly, the violation of young women;
   • parabasal cells – the norm in postmenopausal women isolated during menstruation;
   • intermediate cells – the norm only in the second stage of the month;
   • superficial cells – rate in the first stage of ovulation, the ovulation period, then found in the form sloenogo (dead) epithelium;
   • changes in the shape, structure, number of nuclei in a cage – always a pathology.

Knowledge of the physiological, cytological, histological patterns helps doctors conducting gynecological physical, instrumental, laboratory investigations to detect violations.

In this part of the text is appropriate to say that not all proliferative processes, on the walls of the cervix are malignant. However, they are taken into account in cytological studies.

Shorthand benign growths in the area of multi-layered squamous epithelium is:

• hyperkeratosis;
• parakeets;
• dyskeratosis;
• squamous metaplasia;
• metaplasia with atypia.

Invasive cervical cancer

The term "invasion" is used extensively in Parasitologists to refer to diseases caused by multicellular organisms.

In Oncology, the same marking indicates the clinical stage of the disease that can spread throughout the body through metastasis.

So, invasive cervical cancer is the stage of the disease emerging possibility of distribution of metastasis in other parts of the body. The cancer has spread lymphogenous and hematogenous route. Through the lymph affects the regional lymph nodes, urogenital, and then distant organs. With the development of carcinogenesis may spread through the circulatory system, and affects distant organs.

There are two stages of the disease:

• Microinvasive. The first signs found on the border of epithelium and connective tissue, penetration of metastasis in the stroma to a depth of no more than 3mm from the lower, basal layer of cells, the absence of blockage of lymphatic vessels by conglomerates of malignant cells.
• Invasive. There are four stages in accordance with a common classification according to the size of the tumor, the spread of involvement of regional lymph nodes, presence of distant metastasis. Are all invasive stages of cervical cancer, when the tumor invasion in the stroma more than 3 mm,there are clusters of cells composed of degenerated cells, the plugging of lymphatic and blood vessels, found involvement of regional lymph nodes and distant metastases.

Numerous studies have established that metastasis in cancer of the cervix has a certain regularity.

In descending order of metastases find the following organs and tissues:

• paratransit lymph nodes, the probability distribution is 31%;
• pelvic organs – 30%;
• lung tissue – 16%;
• bone tissue – 13%;
• other bodies – 10%.

Endometrial cancer of the uterus

The endometrium is the inner membrane of the uterus. A long time cancer of the female genital organs did not differ. In medical statistics the disease were taken into account in an integrated manner, all types of cancer female genital organs United in a single disease. Currently, endometrial cancer is a separate disease.

The main causes of endometrial cancer, are associated with disorders of hormonal metabolism in a woman's body under the action of external or internal factors.

The first clinical signs of this form of the disease resemble gynecological inflammation, followed by:

• vaginal discharge of varying intensity;
• violations of cycles in fertile stage;
• the secretions of the type of lochia, perhaps with the putrid odor in the postmenopausal stage.

To exclude suspicion for cervical disease use the method of elimination. In the absence of cervical change pass to the examination of the body of the uterus.

Studies include a variety of clinical methods, in particular the diagnosis of endometrial cancer is put on the basis of:

• cytological examination of uterine fluid, obtained by means of the aspirator;
• Ultrasound diagnosis (the study of the median uterine echo, combined with aspiration biopsy);
• MRI diagnostics of soft tissues of the uterus are much higher than obtained using ultrasound.

Other methods used for clarification of diagnosis are endoscopy, histology of bioprobe the uterine wall.

Uterine cancer on the basis of microscopic changes klassificeret:

• squamous cell carcinoma of the uterine body;
• adenocarcinoma of uterine body;
• mixed (glandular-squamous);
• undifferentiated.

There are also clear cell, serality, mucinous.

To spread the growth of endometrial cancer is divided into tumors tending to growth:

• in the cavity of the body, the exophytic type;
• inside wall – endophytic type;
• mixed type of growth.

The type of onkokletok divided into low, medium and highly differentiated forms of cancer cells.

Neorogovevayuschy cancer of the cervix

One form of low-differentiated squamous cervical cancer. Characterized by aggressiveness, low content of keratin in cancer cells.

The histological form of the disease is determined on the basis of cytological studies.

Clinically, the patient manifested:

• abundant bleeding with minimal trauma to the vessel wall of the cervical canal;
• resistant the dairy maids;
• chronic anaemia, on the background of the decrease of the ESR;
• asthenia in chronic weakness;

• a low-grade fever at 37⁰C.

Effects after cervical cancer

Cervical cancer, particularly causing disease in young women, characterized by aggressiveness. Individual prediction of disease outcome can be considered reliable only on the basis of a thorough examination and consultation from a qualified oncologist.

Meanwhile, statistics show, about the different variants of the forecast:

• High probability of recovery in the early stages of the illness – carcinoma in situ stage I cancer. There are cases of successful pregnancy and delivery in patients at these stages of the disease without health consequences and progression of pathogenesis (obligatory consultation of the oncologist).

• A dubious forecast. Young women in the presence of a cancer provoking factors, herpes viruses, genital infections, low social level of life of the patient, genetic predisposition (the presence of such diseases in the blood of their ancestors in the female line), low immune status, including HIV.

• Poor prognosis. In older women, the presence of comorbidities at diagnosis of the disease in III, IV stage of carcinogenesis.

There are data on the occurrence of relapses some time after applicationtherapeutic procedures (surgical, chemotherapy or radiotherapy) for cancer of the cervix:

• In 10-40% of cases, a second cancer developed in nearby organs (okolomatocnah area);
• In 35% of cases of recurrent carcinogenesis developed in distant organs (urinary, regional lymph nodes and organs lung, bone).

Diagnosis of cervical cancer

The most valuable information is obtained by an extended colposcopy. With its help it is possible to detect signs of cervical cancer, as well as to make a differential diagnosis from:

• dysplasia – the stage preceding cancer occurring under the action of the papillomavirus;
• erosive conditions of the integumentary epithelium – conditions like sore the form of ectopia, leukoplakia, often they are not considered pathologies.

Attention! Diagnosis is a complicated process. Negative effects on the arches of the cervix identified by colposcopy, do not have signs of severe disease, consultation of oncologist. However, their presence should alert the patient about the potential consequences, identifying early signs of cervical cancer at a late – III, IV stages are not important.

The first signs indicating the presence of distant signs of precancerous conditions determine the result of extended colposcopy on the walls of the surface epithelium:

• The mosaic walls of the mucous membrane.
• Plots of the mucous membranes white in color after treatment of the walls with a weak solution of acetic acid, indicates subclinical lesions of the surface epithelium with human papillomavirus. To clarify, is biopsy and undergo a cytological smear in the laboratory under considerable magnification;
• Plots of the mucous membranes, do not stain with Lugol's solution (a weak solution of iodine in glycerin). Not, bright areas in the background epithelium of brown color indicates dysplasia. To clarify the stage of precancer, a biopsy.
• Detection of atypical superficial blood vessels on the walls of the cervix – evidence of early stages of cancer.
• Cornification of the surface epithelium of mucous membranes leukoplakia, a condition not typical for normal skin.

• Genital warts (condylomas) on the walls of the cervix are the result of pathological influence of viral agent on the cells.

Diagnostic events are divided by the basic and auxiliary with different research tasks:

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1. Medical history to clarify the risk.

2. Extended colposcopy with the aim of a condition survey of the walls of the vaginal vault and cervix. Manipulation has limitations, including the period of the monthly cycle, the time elapsed after the sexual contact, the presence of pregnancy.

   If necessary, during the colposcopy, additionally performed:

   • collection of material from the surface of the mucous membranes for further microscopic (cytologic) examination of the material after special staining
   • biopsy – obtaining a piece of tissue of the uterus for microscopic (histological) examination.

3. The typing of the virus based on their cancer aggression. The most dangerous types of HPV-16, HPV-18, related 16 types – HPV-33. In some cases, it may be recommended vaccination with the aim of creating a protective (protective) immunity to the virus.

4. Cytological, histological study is carried out to determine the type and stage of the pathogenesis, pre-cancer, microinvasive and invasive cancer.

5. Ultrasound, MRI, CT scan, sometimes they can be modified to detect damage to the cervix.

II. Helper methods include studies of neighbouring authorities:

1. The exact nature of the involvement in carcinogenesis. Usually examine the respiratory system, urogenital, bone and the rectum, using the methods of ultrasound, MRI, CT.

2. Laboratory tests (General and biochemical blood analysis, it is possible to identify some infections, the other are shown before the treatment methods).

Vaccination against cervical cancer

HPV is the only threat to humans the agent is able to provoke carcinogenesis. On the territory of the Russian Federation was the two vaccines, which correspond to the main requirements of biological safety, possessing high protective (protective) activity.

• The vaccine Gardasil (USA). Tetravalent drug, capable of producing immunity against HPV-16, HPV-18, HPV-11, HPV - 6. Gardasil contains adjuvant – amplifier immunity.
• The Vaccine Cervarix (UK). Bivalent drug that inhibits the activity of viruses HPV-16, HPV-18, also contains an adjuvant.

Despite the fact that both vaccines contain antigens for serotypes ecoactivism proven effectiveness against threat phylogenetically closely related serotypes HPV – 31, 33, 45, other.

Vaccination can be combined with the vaccine against hepatitis B. Safety is an important condition for the use of biologics in medical practice.

Possible local and General reactions to both vaccines in the form:

• swelling, pain at the injection site.

• the increased body temperature.

• headache.

• short-term disorders of the gastrointestinal tract.

Proven that these symptoms are a normal reaction to the introduction of foreign protein and adjuvant (chemical pharmaceutical) that do not have long-term consequences for health.

Deterrent to the use of vaccines, are the defects of cooperative humoral and cellular immunity in patients with cancer who are not amenable to correction by pharmaceutical adjuvants.

Impaired immunity is one of the factors in the emergence of cervical cancer, when a person's immune system is not able to eliminate a foreign agent – the human papillomavirus.

Treatment of cervical cancer

For treatment using surgical removal of the tumor, chemotherapy and radiation therapy. Usually use a combination of these methods of treatment.

Radiotherapy for cancer of the uterus

Uterine cancer in the second stage of carcinogenesis is combined with the transition of the tumor to the cervix. Therefore, radiation therapy will consider from the standpoint of the combined effects on the entire reproductive organ.

The most promising impact on well-differentiated onkokletki in the initial stages of the disease.

Thus it is possible to achieve five-year survival rate of patients in different stages of cancer, including:

• the first stage is 85-95%;
• the second stage is 65-70%;
• the third stage – 30%

The prospects for prolonged survival after combination therapy for stage IV small. Indications for radiotherapy are:

• the inability to perform surgical intervention on the background of weakness of the body and the presence of distant metastasis;
• poorly-differentiated tumor a large extent;

There are two main methods of radiation therapy.

• Intracavitary radiationimpact;
• Remote radiation exposure.

Intracavitary radiation therapy

The modern principle is based on adequate exposure to a gamma radiation source directly into the region of the primary tumor. The technique allows to achieve 85% survival rate within five years, patients with stage III uterine cancer.

Remote radiation exposure

Used alone or in combination with other methods. Irradiation may be moving or static. The method has limitations and side effects, however, are widely used in view of versatility and affordability.

Surgery to remove uterine cancer

The neck is the initial part of the uterus, so usually the question of the removal of the entire organ. Surgical removal is indicated if the metastases are localized in tissues or the immediate vicinity.

Surgery is contraindicated in:

• metastases in the organs located at a great distance;
• concomitant diseases, significantly reduces the vitality of the patient (diabetes, cardiovascular disease)
• old age patient.

Distinguish relative and absolute contraindications. The decision on whether the transaction takes the attending physician taking into account the views of the patient. The operation may be associated with the total removal or partial excision.

In the first case, the operation leads to infertility, in the second, it is possible to preserve fertility.

Removal of the uterus – a hysterectomy does not apply to complex operations can be conducted in the form of a cavity or laparotomies operations:

• Abdominal interventions. Associated with the opening of the abdominal wall, is held on with a large excision of the tissues is an absolute indication, or a small excision is a relative indication. The choice of method is associated with the patient or the technical capabilities of the surgical clinic.
• Laparotomies intervention. Opening of the abdominal wall through a small puncture, is performed in a small volume of extracted pathological body.

Both methods have contraindications, such as after laparotomy there is a high possibility of adhesions, and the total removal, one of the complications may develop cystic masses in the abdominal cavity.

In some cases, a hysterectomy involves the performance of plastics urogenital openings, what the patient must inform prior to the surgery. Plastic urogenital openings can severely complicate the postoperative period.

Early postoperativecomplications:

• bleeding capillary, vascular;
• post anesthetic state (hallucinations, agitation, confusion);
• weakness.

Late postoperative complications:

• suppuration of the wound;
• joints;
• postoperative adhesions.

Preparation for surgery and postoperative care is performed in a clinic, the joints in primary tension (no suppuration) are removed 7-10 days after surgery.

See also: Other effective treatments

Treatment of uterine cancer folk remedies

No doubt our descendants come upon the secrets of cancer and terrified the methods of treatment of cancer. About as well as we are surprised by the methods of medieval surgeons.

Modern methods of treatment based on extremely hard (physical, chemical) effects on cancer cells, which, in fact, are part of the human body. The result of developing numerous side effects, mistrust in the ability of scientific medicine to cope with cancer.

Meanwhile, the most successful country with perfect medical logistics (Germany, Israel, Switzerland, other).

Less visible results, for example, in China, where traditional medicine, has a history of millennia, recognized along with European medicine. Moreover, it is taught in higher medical schools. The effectiveness of acupuncture effects on the body natural substances in the treatment of many diseases in addition to cancer therapy, no doubt.

Topic: Rare recipes of traditional medicine

Prevention of cervical cancer

Preventive measures against cancer includes:

• for a large-scale education, with the aim of improving cancer alertness;
• the introduction of routine screening, starting with 21-25 years to detect dysplasia of the walls of the genital organs;
• conducting systematic vaccination against human papillomavirus in relation to cervical cancer, the establishment of a safety control system of vaccination;
• improvement of lifestyle, the most realistic recommendation for careful attention to the normalization of protein,carbohydrate metabolism

On topic: What foods boost immunity?

ykov, Yevgeny Pavlovich, doctor-oncologist