- Cervical cancer: the main culprit is HPV
- Cervical cancer: other risk factors
- Cervical cancer: symptoms
- Cervical cancer: diagnostic tests
- Cervical cancer: stages
- Cervical cancer: treatment
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Cervical cancer is the second most common female cancer in the world. In Poland, every year over three thousand women of all ages find out that they have cervical cancer, most of them, unfortunately, too late to have a chance to survive. What are the causes and symptoms of cervical cancer? What increases the chances of successful treatment?
Cervical cancer(Latincarcinoma cervicis uteri , cervical cancer) isprimary cervical cancer uterus . Cervical cancer is the second most common female cancer in the world and the most common cancer of the reproductive organ in women.
Out of 10 women diagnosed in Poland every daycervical cancer , 5 die - this is one of the highest mortality rates from this disease in Europe.
The most common histological type ofcervical canceris squamous cell carcinoma (around 80 percent), with adenocarcinoma much less common (around 10 percent). Very rare histological types are small cell carcinoma, primary lymphoma, and cervical sarcoma.
Cervical canceris most often found in women aged 40-55, but there is also a large group of women who develop cancer after the age of 25. Certain types of human papillomavirus are responsible for the formation of cancer -Human Papiloma Virus(HPV), sexually transmitted.
The basis for early detection and effective fight against this cancer is regular cytology. It is the cytology that can detect cervical intraepithelial neoplasia (another term is cervical dysplasia or pre-invasive cancer) that precedes invasivecervical cancer .
Such low-grade dysplastic (precancerous) changes (CIN-1) are most often treated pharmacologically ( although sometimes they regress on their own).
Early changes detected in cervical cells can be completely healed.
Cervical cancer: the main culprit is HPV
Long-term HPV infection is considered an essential and most important pathogen incervical cancer .
In almost all women withcervical cancerorwith precancerous lesions, the presence of the human papillomavirus - HPV ( Human Papilloma Virus ) was detected, or more precisely - its carcinogenic types: HPV 16 and 18 (responsible for over 70 percent of cases of the disease) and HPV 31, 33, 45.
If the virus has oncogenic features, early sexual intercourse and smoking increase the risk of developing the disease twice, and having at least three children, sexually transmitted diseases or long-term use of contraceptive pills - even four times.
Recent research shows that condoms do not protect against HPV unless they contain virucides. Relative security is provided by the so-called barrier contraception, i.e. vaginal inserts and rings. An important element of prevention is staying in monogamous relationships and being faithful by both partners.
Cervical cancer: other risk factors
Although in the case ofcervical cancerHPV infection is considered essential and the most important pathogen (this cancer is not detected without HPV infection), the presence of the virus alone is not enough, Other, less studied factors are essential for cancer to progress. These include:
- early onset of intercourse (before age 16)
- frequent changes of sexual partners
- partner's infidelity
- several deliveries in quick succession
- smoking (also passive) cigarettes
- untreated inflammation and any changes to the cervix
- age -cervical cancerrarely attacks before the age of 20, more often after the age of 30; the incidence reaches its peak at the age of 45-55, but a twenty-year-old who has not given birth and has not had intercourse may also fall ill; in women under 30, HPV infections are usually temporary, in women over 30 years of age, chronic HPV infection increases the risk of cervical cancer
Apart from that, there are other factors that are probably considered to be contributing to the disease:
- long-term oral hormonal contraception
- diet low in antioxidants
- HIV infection
- frequent vaginitis caused by gonorrhea andChlamydia trachomatis
Cervical cancer: symptoms
Cervical cancer is dangerous mainly because the precancerous condition produces no symptoms. Often the first sign a woman will notice that something is wrong is vaginal bleeding after intercourse or spotting between menstruation. The symptoms of the cervix are nonspecific, they include, among others :
- heavy discharge
- pain during intercourse
- pain in the lower abdomen
- bleeding after intercourse or gynecological examination
- longer and heavier than usual periods
- bleeding between regular monthly bleeds
- unusual vaginal bleeding
- postmenopausal bleeding
Cervical cancer: diagnostic tests
The basic test that allows to detectcervical cancerin the initial stage is cytology, which consists in microscopic evaluation of cells taken from the cervix with a special brush. The epithelial cells from the cervix are classified into normal, atypical, precancerous and cancerous. The presence of atypical cells requires replication of cytology after anti-inflammatory treatment.
If precancerous changes are suspected, colposcopy or endoscopy of the cervix is ordered. Colposcopy and HPV DNA testing, that is, the oncological examination of the virus, is also performed to verify unclear results.
The next stage of diagnostics is determining the clinical stage of advancement and planning the treatment. For this purpose:
- complete medical examination (history and physical examination), with particular emphasis on examining the available lymph nodes
- gynecological examination (per vaginam and per rectum)
- chest X-ray examination
- basic blood and urine tests (complete blood count, urinalysis, urea, creatinine, liver enzymes)
Complementary additional examinations include transvaginal ultrasound and ultrasound of the abdominal cavity.
Surgical conization (biopsy performed under general anesthesia) is required in the early stages of tumor development, which enables confirmation that the lesion is not greater than IA1.
At higher stages, in order to plan treatment, it is advisable to perform imaging tests (CT, MR, PET-CT) and fine needle aspiration (FNAB) biopsy of the lymph nodes and / or the paratyphoid (selected cases).
If an infiltration of the urinary bladder and rectum is suspected, cystoscopy, rectoscopy and microscopic examination of the material collected from suspected lesions in the urinary bladder and rectum should be performed. Laparoscopy may be performed in selected cases.
The clinical classification developed by FIGO (International Federation of Obstetricians and Gynecologists) is used to assess the stage of advancement, which accepts the following tests as part of additional tests:
- Chest X-ray
- Bone X-ray
- X-ray of the large intestine with contrast
- cystoscopy
- urography
- examination of materials from changes in the rectum and bladder
Cervical cancer: stages
Stage classificationcervical canceraccording to FIGO (2009)
| Grade | Characteristics |
| I | Cancer strictly confined to the cervix |
| IA | Microinvasive cancer diagnosed only microscopically on the basis of material covering the entire neoplastic lesion |
| IA1 | Stromal infiltration depth ≤ 3 mm from the basement membrane, lesion diameter ≥ 7 mm |
| IA2 |
Stromal infiltration depth ≤ 5 mm from the basement membrane, lesion diameter ≥ 7 mm |
| IB | All lesions greater than Grade IA2, whether clinically apparent or not |
| IB1 | Clinically apparent lesion ≤ 4 cm |
| IB2 | Clinically apparent lesion>4 cm |
| II | The cancer passes beyond the cervix without reaching the pelvic wall, but only invades the vagina in the upper 2/3 of its length |
| IIA | The infiltration passes to the vault and / or the vagina, but does not exceed 2/3 of the upper part and does not infiltrate the parasympathetic |
| IIA1 | Clinically apparent lesion ≤ 4 cm |
| IIA2 | Clinically apparent lesion>4 cm |
| IIB | Parachuteal infiltrates not reaching the pelvic bones (without or with vaginal infiltration) |
| III | The cancer reaches the pelvic walls (in the rectal examination there is no free space between the infiltration and the pelvic bone), the vaginal infiltration covers the lower 1/3 of the length, all cases of hydronephrosis or inactive kidney (regardless of the extent of the neoplastic process, found in the compiled study) is also classified as stage III cancer |
| IIIA | Cancer infiltrates 1/3 of the lower vagina, no bone infiltrates in the parasites |
| IIIB | Infiltrates in the invertebrates to the bones, presence of hydronephrosis or inactive kidney |
| IV | Movement of cancer beyond the pelvic area or involvement of the bladder or rectal mucosa |
| IVA | Invasion of adjacent organs |
| IVB | Distant metastases |
Cervical cancer: treatment
Treatmentcervical cancerdepends on its stage and the general condition of the patient.It is also taken into account whether the patient wants to preserve her fertility.
As the cancer progresses, the prognosis is worse and the five-year survival rate - lower and lower.
Low-grade dysplastic (precancerous) changes (CIN-1) are most often treated pharmacologically ( although sometimes they regress on their own). After treatment, it is necessary to check with a doctor.
In advanced dysplastic lesions (CIN-2, CIN-3) and in earlycervical cancer(stages IA-IB1 and IIA1) surgery is the method of treatment (common a feature in this group of patients is the size of the lesion not exceeding 4 cm and the lack of involvement of the parametrium) - the diseased fragment of the cervix is removed.
Sparing methods in the treatment of cervical cancerinclude :
- electrocautery (burning tissue using electrocautery)
- cryosurgery (destruction of tissue by means of freezing)
- laser surgery (laser therapy)
- LEEP method (LEEP-LOOP) - cut with an electric loop
- conization - conical excision of tissue around the cervical canal
If there is a risk of cancer recurrence, radiochemotherapy is recommended after surgery. In the case of invasive cervical cancer, extensive surgery is required - most often it is radical hysterectomy with removal of pelvic lymph nodes, which can be performed laparoscopically or transvaginally, but usually performed by opening the abdomen (the choice of method depends on how advanced and located the tumor is and on the skills of the surgeon).
- Hysterectomy - course and convalescence
Radiation therapy is a complementary treatment. If metastases to other organs have occurred, chemotherapy is also used. In Poland, when cervical cancer is usually diagnosed in the advanced stage, radiotherapy and radiochemotherapy play a significant role in its treatment.
Radiation therapy in the treatment of cervical cancer is used in two forms:
- tumor irradiation through the skin and he althy tissue surrounding the tumor
- irradiating the tumor by placing a radioactive element in the cervical canal, which saves he althy tissue
Chemotherapy forcervical canceris usually used in conjunction with radiotherapy, because cytostatics increase the effectiveness of radiation therapy. Chemotherapy alone is administered to terminally ill patients when other methods cannot be used.