Cervical cancer - causes, symptoms, diagnosis, treatment methods and prognosis

Experts from the World Health Organization claim that cervical cancer is one of the leading cancers among women. This is due not only to external factors, but also to the attitude of the woman herself towards her health. The benefits of modern medicine make it possible not only to successfully fight the disease, but also to prevent its occurrence. Successful anti-cancer treatment is a combination of ultra-modern diagnostic and therapeutic equipment and the work of high-level professionals: oncologists, gynecologists, surgeons, chemo- and radiotherapists.

What is cervical cancer?

Cervical cancer is quite common, ranking second among all gynecological cancers after uterine cancer.

At the bottom of the uterus is the cervix, which connects it to the vagina (birth canal). The first changes in this part of the uterus, which can later develop into cancer, often occur at the age of 20–30 years. This type of cancer is considered to be slowly progressive. 45-50 years is the average age of women diagnosed with cervical cancer. Treatment started on time can prevent the development of the disease.

9 out of 10 cases of cervical cancer are squamous cell

.
It develops from squamous cells in the part of the cervix closest to the vagina. Another type of cervical cancer is adenocarcinoma
, which develops in the glandular cells of the part closest to the uterus.

You should know that cervical cancer is preceded by benign and precancerous processes.

Benign changes include:

• simple ectopia;
• endocervicosis;
• leukoplakia;
• endometriosis;
• cicatricial deformation of the cervix, etc.

Precancerous - cervical dysplasia of varying severity.

Treatment of dysplasia CIN 1-2

In this situation, surgical removal of the altered tissues is indicated, followed by histological examination, which makes it possible to reliably assess the degree and depth of damage to the cervix and determine management tactics.

The first stage is the procedure of electrosurgical loop excision (LEEP) of the lesion of the outer part of the cervix with a one-time pass with a visually determined transformation zone and subsequent curettage of the mucous membrane of the cervical canal.

When the transformation zone is located deep in the cervical canal, it is necessary to perform a circular (cone-shaped) biopsy, since changes in the mucosa in the form of dysplasia in most cases are determined precisely in the zone of transition of squamous epithelium to cylindrical; then the cervical canal mucosa is also scraped. Circular (cone-shaped) biopsy differs from conization in the volume of tissue removed - in the first case, the minimum necessary part of the neck is removed, which is necessary to confirm the diagnosis. A more sophisticated approach is justified by the fact that although dysplasia is classified as a precancerous condition, it is still a benign condition. The second stage is therapy aimed at improving tissue regeneration and eliminating the virus.

Statistics

According to statistical data, the incidence of this type of cancer is decreasing from year to year.

In the European list of common female cancers, cervical cancer is in 7th place, in Russia it is in 5th place. In the world, this disease ranks fourth among female cancers. In 2021, experts estimate that 570,000 new cases will account for 6.6% of all cancer cases among women. Approximately 90% of deaths from cervical cancer occurred in low- and middle-income countries.

In countries with developed economies, due to early screening and vaccination against human papillomavirus, the incidence rate is lower - approximately 3.8%. In the US, it has decreased by 45% since 1980. In Eastern European countries, incidence rates are higher. At the beginning of the 21st century, there was a slight increase in the percentage of patients who were diagnosed with stage IV malignant lesions of the cervix - from 37.1 to 47.3.

At the age of 30–35 years, the disease is quite rare. The risk group is women from 35 to 55 years old. Only in 20% of cases, women over 65 are diagnosed with cervical cancer. Treatment and survival prognosis depend on timely visits to the doctor and early detection of the disease.

If cancer is detected early, 92% of patients live 5 years or more.

Prevention measures

There are two effective ways to prevent cervical cancer. One of them is preventive examinations with a gynecologist at least 2 times a year. As part of screening, a cytological examination of a cervical smear according to Papanicolaou is performed. Source: Origoni M, Prendiville W, Paraskevaidis E Cervical Cancer Prevention: New Frontiers of Diagnostic Strategies // Biomed Res Int. 2015;2015:250917. doi: 10.1155/2015/250917. Epub 2015 Jun 10 .

If the analysis results reveal abnormalities, the patient is indicated for further diagnosis, observation or treatment. In addition, to prevent infection with HPV 16 and 18, vaccination of teenage girls and women aged 9 to 45 years is indicated.

Sources:

• M.R. Kairbaev, R.O. Bolatbekova. Human papillomavirus and cervical cancer // Bulletin of KazNMU, 2021, No. 4, pp. 105-108.
• V.A. Krutova, D.V. Burtsev. Cervical cancer: modern diagnostics // Chief Doctor of the South of Russia, 2013, No. 5(36).
• Dizon DS, Mackay HJ, Thomas GM, Werner TL, Kohn EC, Hess D, Rose PG, Covens AL. State of the science in cervical cancer: where we are today and where we need to go // Cancer. 2014 Aug 1;120(15):2282-8. doi: 10.1002/cncr.28722. Epub 2014 Apr 15.
• Origoni M, Prendiville W, Paraskevaidis E. Cervical Cancer Prevention: New Frontiers of Diagnostic Strategies // Biomed Res Int .2015;2015:250917. doi: 10.1155/2015/250917. Epub 2015 Jun 10.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Risk factors

Most cases of cervical cancer are caused by long-term infection with one of the human papillomaviruses (HPV). HPV infection is very common, and most people with HPV infection do not develop cancer. There are more than 100 types of HPV, and only certain types are associated with cancer.

The following factors play a role in the occurrence of cervical cancer:

• smoking
• having multiple sexual partners
• weakened immune system (patient after organ transplant, HIV-positive, etc.)
• past or current chlamydial infection, as well as if there were/are other sexually transmitted infections (STIs)
• overweight
• three or more full-term pregnancies
• long-term use (five or more years) of oral contraceptives (birth control pills)
• Presence of first full-term pregnancy before age 17
• early sexual life
• low social status
• family predisposition to cancer and, in particular, cervical cancer

Symptoms

At an early stage, cervical cancer may not cause any noticeable changes in a person’s condition. Signs of the disease usually appear when cancer cells begin to grow through the top layer of the cervix into the nearby tissue underneath.

It is necessary to consult a doctor if a woman begins to be bothered more often by:

• abnormal bleeding
• longer or heavier periods than usual
• painful urination
• bleeding after menopause
• pain during intercourse
• bleeding after sex
• pain in the pelvis
• vaginal discomfort
• bleeding or spotting between periods
• other abnormal vaginal discharge that is unusual in amount, color, consistency, or odor

The disease may be accompanied by rapid weight loss, fatigue, frequency of urination, a feeling of hard-to-determine discomfort, weakness, anemia, loss of appetite, a slight long-term temperature within 37.0 - 37.5 ° C, an increase in ESR in the blood, swelling of one or both legs .

It is important to note that all of the above symptoms for cervical cancer are not specific. They can be caused by various conditions.

Distribution in the body

As cervical cancer grows, it spreads to neighboring organs. First of all, regional lymph nodes and surrounding tissue (parametrium) are affected.

The upper third of the vagina is often affected, which is not surprising, since it is in direct contact with the cervix. The spread of cancer cells occurs directly when a tumor grows into the vagina, lymphogenously (through lymphatic vessels), by contact implantation - where the vaginal wall comes into contact with the tumor. The body of the uterus is also involved.

The spread of tumor cells into the rectum, bladder and ureters, as a rule, occurs by contact.

Distant metastases most often occur in the retroperitoneal lymph nodes, lungs, bones, and liver. In less than 1% of cases, metastasis occurs in the spleen, kidneys, and brain.

Diagnosis of cervical cancer

One of the most important methods for early detection of any female disease is regular gynecological examination. Since the clinical manifestations of precancerous and background diseases are not clearly expressed, differential diagnosis of cervical cancer will help to detect changes, including:

• cytological screening
• visual examination of the genitals
• colposcopy
• bacterioscopic/bacteriological examination
• targeted biopsy of the cervix
• biopsy of tissue from suspicious areas of the cervix
• curettage (scraping) of the cervical canal
• screening for sexually transmitted infections

Cytological screening

- This is a study of smears that helps to identify the beginning of the pathological process.

Colposcopy

– the main diagnostic method. If necessary, it is supplemented with manipulations (biopsy, cytology of smears, treatment of the cervix with acetic acid to detect flat condylomas, curettage of the cervical (cervical) canal, etc.).

Precancerous lesions in the cervix can be treated with cryosurgery, cauterization, or laser surgery. If oncology is suspected, a biopsy is performed during the above procedures to determine the extent of organ damage and the stage of cancer.

Cervical biopsy

is a surgical procedure in which a small amount of epithelium is removed from the cervix. This tissue sampling method is usually used after a gynecologist has discovered an abnormality during a routine examination. A biopsy may show the presence of human papillomavirus (HPV) or precancerous cells or cervical cancer.

When monitoring the cervical epithelium, diagnostic methods such as:

• optical coherence tomography
• Ultrasound
• fluorescence spectroscopy
• irrigoscopy
• X-ray of the lungs
• rectoscopy
• MRI
• urography
• cystoscopy
• PET CT
• use of SCC tumor marker
• CT

Indications for referral to colposcopy

• High degree of abnormalities detected by cytology.
• Persistent low grade or unsatisfactory cytology results.
• Cytology showed the presence of AGUS (atypical glandulocytes of undetermined significance).
• Suspicious appearance of the cervix during visual examination.

Basic instruments for colposcopy

• Colposcope with 6-16 times magnification
• Bright lighting with adjustable position
• Focal length 250mm for instruments
• Solutions:
• saline solution, 3-5% acetic acid, Lugol's solution

Colposcopic picture

Cervical cancer treatment

Treatment depends on many factors, including the stage of the malignancy. Common treatment methods are surgery, radiation therapy, chemotherapy, targeted therapy. Various specialists may be involved in their participation, including:

• gynecologist-oncologist - a doctor who specializes in the treatment of cancer of the female genital organs, including surgery to remove it
• radiation oncologist – a doctor who uses radiation to treat various types of cancer
• medical oncologist – a specialist in the use of chemotherapy and other medical treatments

How does the quality of drugs affect the cure for stage 3-4 uterine cancer?

Patients with stages 3-4 endometrial cancer are usually prescribed chemotherapy. Research shows that this type of treatment is more effective than radiation therapy, but under one condition: the drugs must be of high quality and, of course, protected from counterfeiting. You can buy such medicines in Israel.

1. Counterfeiting of medicines is prohibited in Israel. According to the laws of this country, a pharmacist who sells a drug of inadequate quality bears criminal liability for this. The Israeli Ministry of Health regularly conducts test purchases and quality checks of drugs in all pharmacies.
2. In Israel, one does not have to wait long for innovative medicines to be licensed. In this country, all effective drugs appearing in the world are quickly introduced into clinical practice.
3. The Israeli company TEVA is a leader in the global pharmaceutical industry. Medicines developed and produced by this company are taken by 200 million people in 60 countries.

Free Oncotest of the Ikhilov Oncology Center

Begin

Cervical cancer: stages and treatment

The stage reflects the extent to which the disease has spread.

• At stage zero, there are precancerous cells on the surface of the cervix
• In the first case, the tumor is in the cervix, but can grow into the uterus and nearby lymph nodes
• In the second stage, the cancer has spread beyond the cervix to the upper part of the vagina.
• In the third case, the tumor has affected the lower vagina, the walls of the pelvis, and can block the ureters
• In stage four, the cancer has reached the rectum or bladder, or distant organs.

At the zero stage

In oncology, surgery is usually used as the only and independent therapeutic approach. Precancerous cells are removed under local anesthesia.

Treatment of stage 2 cervical cancer (and sometimes stage 1)

It is carried out in combination: irradiation with surgical intervention. Radiation therapy is used after surgery if the doctor thinks there may be cancer cells in the body. Radiation may also reduce the risk of the tumor returning.

When cancer has spread beyond the cervix, surgery is usually not used. Treatment of stage 3 cervical cancer

requires more extensive treatment, which usually includes radiation therapy or a combination of it and chemotherapy.

At stage 4

Radiation and palliative therapy are used for cancer.

Surgery

A common method of treating cervical cancer when malignant cells are located within this organ.

There are three main types of surgical intervention for this type of oncology:

• Removal of the cervix, surrounding tissue and the upper part of the vagina. But the uterus remains.
• Removal of the cervix along with the uterus. Depending on the stage of the disease, removal of the ovaries and fallopian tubes may be required.
• Surgical treatment of cervical cancer. During the intervention, the cervix, ovaries, vagina, bladder, uterus, fallopian tubes, and rectum can be removed.
• Relapse of the disease. Surgery is only suggested when the cancer has returned.

Removal of cervical cancer may be accompanied by radiation therapy.

Chemotherapy

A treatment that uses special medications to reduce or destroy cancer. Medicines can be pills or drugs injected into veins, or sometimes a combination of both.

The method of treating cervical tumors with chemotherapy is less studied. Most often, this method is used for malignant organ damage, either in case of relapse of the disease, or in case of a tumor with metastases that have penetrated to distant areas of the body.

Chemotherapy for cervical cancer is aimed at alleviating the disease or slowing its progression. Although it can be given orally, most often all drugs used for treatment are given intravenously—either directly into a vein or through a thin tube called a catheter that is temporarily inserted into a large vein to facilitate injection.

Patients with cervical cancer are often given chemotherapy in combination with radiation.

Radiation therapy

High-energy rays (similar to X-rays) are used to kill cancer.

At an early stage of cancer, radiation therapy can be used either alone or in combination with surgery.

In the later stages of the disease, treatment is combined - radiation is combined with chemotherapy.

Treatment of cervical cancer with radiation therapy is performed using three methods:

1. Remotely. A high-energy external beam is directed from the outside at the neoplasm in the pelvis. External irradiation using external beam radiation therapy is carried out daily for one to one and a half months. The duration and therapeutic technique depend on the tumor site, stage of cancer, area of ​​metastasis, etc.
2. Location near the malignant tumor (brachytherapy). This is contact internal radiation therapy, in which a radioactive implant is inserted through the vagina into the cavity of the cervix closer to the tumor and remains there for a certain time.
3. Intensity modulated radiotherapy. This chemoradiotherapy combination (radiation + low-dose chemotherapy) is used for enlarged lymph nodes or a certain form of neoplasm in the treatment of locally advanced oncology. The treatment method is also used to prevent tumor recurrence.

On what basis is the stage of the disease determined?

The stage of uterine cancer is determined by examining tissue removed during surgery. This process is called surgical staging. The need for such diagnostics is driven by the fact that doctors often cannot accurately determine the stage of cancer until they receive tissue samples.

Before surgery, your doctor may order imaging tests:

1. Ultrasound;
2. MRI;
3. CT;

This is done in order to determine signs of the spread of pathology. Although the accuracy of these methods is inferior to that of surgical staging, the information obtained can be useful in planning surgery and other procedures.

If diagnostic images indicate that the cancer may have spread beyond the uterus, you will be referred to a gynecological oncologist (if you have not already seen one).

Disease prognosis

Early diagnosis, a vaccine to prevent HPV infection, screening tests, and treatment for cervical cancer in women are critical to reducing mortality rates. If the tumor is detected in the zero and first stages, then the cure rate ranges from 80 to 100%.

Five-year survival rates by stage of cervical cancer:

• I – 80–93%
• II – 58–63%
• III – 32–35%
• IV – 15–16%

Survival rates are based on studies of large groups of patients. Other factors, such as general health, how the cancer responds to treatment, etc., may affect the prognosis for an individual patient.

Where can I buy Israeli-made medicines?

1. In Israel - after a face-to-face consultation with a doctor. If you undergo diagnostics at the Ichilov Cancer Center, you will receive prescriptions during the consultation. You can purchase medications using them at any Israeli pharmacy.
2. In the locality where the patient lives. The Ichilov Cancer Center has a telemedicine program. As part of this program, you will be able to receive a video consultation with an Israeli oncologist without leaving your home. The doctor will prescribe medications for you, which you can order at home in any country in the world.

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Clinical groups on cytology and treatment tactics:

Cytology without any features - routine examination, treatment and monitoring as indicated

Inflammatory type of smear

– anti-inflammatory treatment, cytological and bacterial control

Inflammation, mild dysplasia

– anti-inflammatory treatment, then cytological, bacterial, colposcopic control:

- if there are no changes: cytological examination and extended colposcopy every 3 months for 1 year, then annually;

- if changes persist - examination for HPV, cervical biopsy.

Moderate dysplasia

– HPV testing, cervical biopsy. Treatment (based on biopsy results), cytological and colposcopic control after 3 months for 1 year, then annually.

Severe dysplasia

– HPV testing, cervical biopsy. Treatment (based on biopsy results), cytological and colposcopic control after 3 months for 1 year, then annually.

Suspicion of cancer

– in-depth examination and treatment in a hospital.

Cancer

– referral to a hospital for special treatment.

LEEP biopsy

Cone knife biopsy

Conization of the cervix