Endometrial cancer (the inner layer of the uterus) is one of the most common cancers among Russian women. It accounts for 7.7% of all malignant tumors. The higher the economic level of a country, the more common this disease is.
The only exceptions are eastern countries (Japan), where food traditions are somewhat different from the West. Average age The age at which this type of cancer is detected is 65 years, and detection of a tumor before 50 years is very rare.
What is endometrial cancer?
Tumors of the inner layer of the uterus are called endometrial tumors. This layer is surrounded by muscles that form the body of the uterus (myometrium), and all this is covered with a thin serous membrane. Cervical cancer is not an endometrial tumor; it is separate disease with completely different reasons and forecasts.
Risk factors for endometrial cancer
All of the above factors are not the direct causes of uterine cancer; they only increase the risk of cancer.
Polycystic ovary syndrome
Polycystic ovaries is a syndrome in which each ovary simultaneously contains 12 or more follicles. The reason for this phenomenon is considered to be a disrupted exchange of sex hormones: male and female. Girls and women with this syndrome usually have an irregular menstrual cycle, infertility and “masculine” signs: excess hair growth, fat layer on the stomach, rough voice. The risk of uterine cancer increases due to metabolic failure. In addition, obesity may be an additional risk factor.
Obesity and excess dietary fat intake
Excess weight increases the risk of uterine cancer by 2-3 times. This applies to women with a body mass index of more than 25. This increase in risks is associated with an excess of estrogens synthesized by adipose tissue. The same mechanism also operates when eating large amounts of animal fat. It has been proven that in countries where the diet is dominated by fats and there are few vegetables, the risk of developing endometrial tumors is much higher.
Hormone replacement therapy
It is believed that in women over 55 years of age, long-term replacement therapy increases the risk of uterine cancer by 2-3 times. It should be taken into account that the risk when taking outdated drugs (containing only estrogens in large quantities) was sevenfold. Modern means, including, have a right to exist. Therefore, the main rule replacement therapy– timely prescription according to strict indications, using the latest medicines.
Immunohistochemical study
When a tumor is detected, it is necessary to find out whether it is sensitive to hormonal treatment. To do this, the number of receptors for estrogen and progesterone is determined by immunochemical analysis.
Forecast
It is very important to establish all prognostic factors in order to select adequate and appropriate treatment options. The worse these factors are, the more aggressive the therapy should be.
Treatment of endometrial cancer
Most cases of uterine tumors are treated comprehensively, using three main methods: surgery, radiation and chemotherapy. This combination significantly increases 5-year disease-free survival.
Surgical method
The main operation for endometrial cancer is. It is often necessary to remove nearby lymph nodes and tissue affected by the tumor.
Radiation therapy
Irradiation of the uterine area and adjacent tissues is carried out for advanced cancer that is sensitive to rays. This method is also used in patients for whom surgery is contraindicated. These are older women who often suffer from liver, heart and kidney diseases.
Chemotherapy
Chemotherapy drugs (doxorubicin, cisplatin) for uterine cancer do not give as impressive results as for other tumors. They are used for advanced processes, as well as for contraindications to surgery.
Hormone therapy
One more step combination treatment Endometrial cancer can be treated with hormonal drugs (progestogen derivatives), since some tumors are sensitive to these substances. The drug regimen is designed for 2-3 years. Given the frequent side effects, tumor sensitivity and differentiation are examined before starting therapy.
Observation after therapy
After surgery and completion of treatment, the woman should be regularly monitored by a doctor. In the first year it is necessary to be examined every 4 months, in the second year - once every 6 months, then - once a year. IN last years There were recommendations to be monitored every 4 months for the first three years. If signs and symptoms of uterine cancer appear that are suspicious of relapse, then you need to make an unscheduled visit to the doctor.
Endometrial cancer survival
Due to early diagnosis and improved therapy, uterine cancer can be treated quite successfully. Thus, the 5-year survival rate of patients with stage I is up to 98%, with stage II – about 70%, with Stage III– 32%, stage IV – about 5%.
Prevention
- Having at least one pregnancy
- Long-term breastfeeding
- Physical activity
How do they manifest themselves? characteristic symptoms and signs of uterine cancer? Very often, oncological diseases early stages are asymptomatic: the neoplasm makes itself felt only when the process has already gone far. However, this does not apply to malignant endometrial tumors. With uterine cancer, the first symptoms appear almost immediately, which in the vast majority of cases provides the possibility of a radical solution to the problem and a favorable prognosis.
That is why, if any suspicious signs appear, you should contact a gynecologist. There is no need to put off visiting the doctor “for later”: if the cancer spreads to other parts of your body, its treatment will be more complicated and the prognosis will worsen.
The first symptoms of uterine cancer
A cancerous tumor that develops in the endometrium manifests itself as abnormal vaginal bleeding. In patients with uterine cancer, these symptoms are almost always present, but may vary depending on functional state female reproductive system.
Due to the fact that the disease is directly related to an imbalance of female sex hormones, it usually occurs during the period of hormonal changes, that is, during menopause. Moreover, the nature and intensity of symptoms for uterine cancer depend on the phase of decline of sexual function:
- If a woman has not yet reached menopause, the occurrence of malignant neoplasm may indicate bleeding between menstruation, as well as regular hypermenorrhea - heavy and prolonged periods (more than 7 days).
- After menopause (duration of absence of menstruation for 1 year or more), any vaginal bleeding is abnormal and should be a signal for immediate consultation with a doctor. Sometimes the first symptoms of uterine cancer and pronounced signs become watery discharge mixed with blood. As the tumor grows uterine bleeding intensify and become permanent.
It should be added that only in 1 out of 10 cases the above-described disorders are a consequence of the development of cancer. The same manifestations are characteristic of endometriosis, fibroids ( benign neoplasm), polyposis of the mucous membrane, etc. Therefore, their appearance is a reason for examination, and not for panic.
Particular attention to your women's health should be shown to overweight patients. Moreover, the likelihood of developing endometrial cancer is highest in women with accumulation of fat deposits in the waist area. This is where the most “dangerous” fat is deposited, which is rich in excess substances that contribute to the start of neoplasia in the inner mucous membrane of the uterine wall.
Interventional cardiologist, one of the regular presenters of the television program “Live Healthy”, Israeli doctor Herman Gandelman advises overweight women at the age of 45 or more, regularly carry out a very simple and equally informative test: measure your waist circumference. If it is less than 88 cm, the likelihood of developing the disease in the near foreseeable future is low. If more than 120 cm, the risk of a tumor is very high, you must immediately visit a gynecologist and have an ultrasound of the pelvic organs.
Important point. Even if the examination does not reveal problems, fat in the waist area must be combated by everyone possible ways, including medicinal adjustment of hormonal levels and metabolism, low-calorie nutrition, dosed physical activity.
Other signs and symptoms of uterine cancer:
- Pain in the pelvic area. Pelvic pain occurs constantly, varies in duration and intensity, and intensifies during menstruation and during sexual intercourse. If the cause of their appearance is a cancerous focus in the endometrium, this indicates the prevalence of the process.
- Anemia. If left untreated, constant blood loss contributes to the development of anemia. A woman's hemoglobin decreases, which is accompanied by weakness, dizziness and shortness of breath even with minor physical exertion.
- Cancer intoxication. Any cancer over time leads to general deterioration well-being caused by the toxic effects of waste products of malignant cells. This occurs in patients with advanced stages of uterine cancer increased irritability, loss of appetite, nausea, fatigue.
As the disease progresses, the above-described signs are joined by symptoms such as pain in the back, legs, pelvic region and other disorders associated with the growth of the tumor into neighboring organs and tissues, and the appearance of distant metastases.
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Expert opinion
Uterine cancer is one of the most common cancers of the female reproductive system, occurring in the form of a malignant tumor. The early stages of uterine cancer provoke the appearance of a number of symptoms and signs that are very similar to simple inflammation, therefore, if any abnormalities are detected, it is advisable to seek help from a gynecologist as soon as possible. Cancer of the uterus, very dangerous disease, as it is the cause of death for many women, especially without the necessary treatment.
Causes
Oncologists have not yet established the reliable reasons for the development of a malignant neoplasm in the body of the uterus, but taking into account long-term statistics, they were able to identify some factors that can provoke the appearance of this disease in women. These include:
- Endometrial hyperplasia is a pathology that manifests itself in the form of thickening of the endometrium due to constant cell division. In the early stages, it is not a malignant process, but if treatment is not started, it can easily develop into one.
- Obesity - as practice shows, to the group increased risk occurrence of uterine cancer include women with increased body weight.
- Women whose periods started before 13 summer age or lasts up to 55 years, and those who do not yet have children are more susceptible to developing uterine cancer.
- Quite a long period of use oral contraceptives estrogen-based, especially if they are not balanced with progesterone.
- A history of radiation therapy aimed at treating cancer in the pelvic area.
- Heredity - if there are women in the family with uterine cancer, the risk increases by 2 times.
- HPV is the human papillomavirus, one of the most important causes of cancer.
The above factors do not mean that their presence will be 100% the cause of cancer development. But women who have them should monitor their health more closely, and if any warning signs, seek advice from a gynecologist so that the specialist can timely detect cancer at an early stage.
Stages and symptoms
- First stage– the neoplasm is localized in the endometrial region, or slightly extends deep into the muscle layer. This stage is very difficult to recognize, since there are practically no symptoms, but it is best treated, after which it is possible to preserve reproductive function.
- Second stage– the tumor has grown over the entire area of the uterus, but has not yet affected neighboring tissues and organs. The second stage has an average survival rate of 60%.
- Third stage– the neoplasm affects the vagina and lymph nodes. At this stage, the mortality rate is almost on par with the survival rate, but after treatment, reproductive capacity is permanently lost.
- Fourth stage– the tumor produces many distant metastases, invasion of the bladder or rectum occurs. Women with the last stage of cancer live very rarely and for a short time, only a few can cope with it.
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First signs
The first symptoms that may indicate uterine cancer: abnormal bleeding from the vagina, leucorrhoea, painful sensations in the pelvis and lower abdomen, discharge of blood after sexual intercourse. There is also an increase in the duration and intensity of menstruation in young girls, and vaginal bleeding during menopause. When the tumor continues to grow and affects neighboring tissues, a mass joins secondary symptoms, such as: lower back pain, leg pain, swelling, urinary dysfunction.
According to statistics, the most early symptoms and signs of uterine cancer begin to appear in the form bloody discharge from the uterus itself. If blood appears during or after sexual intercourse, a woman should think about the possible presence of a malignant process in her cervix or in the uterus itself, and seek advice from a gynecologist. In addition, it is necessary to pay attention to bleeding from the genitals in the absence of menstruation for more than six months. In the postmenopausal period, bleeding should be the first sign of a serious abnormality, which requires immediate consultation with a doctor and examination for uterine cancer. IN at a young age, the first symptoms of oncology may be atypical discharge of bloody masses that appear spontaneously, without any temporal order, as well as disruption of the normal menstrual cycle.
In addition to bleeding, abnormal white discharge may be a sign of cancer. At the very beginning of the malignant process, they may have the appearance of a colorless liquid, in very scanty quantities, without affecting the frequency of menstruation. Over time, as the disease progresses, bloody impurities begin to join such secretions, which is why they take on the appearance of ichor and are characterized by a sharp and unpleasant smell. The presence of discharge of this nature indicates that the neoplasm has entered the stage of decay and uterine cancer is developing with particular activity.
The third and final symptom of uterine cancer is considered pain syndrome. When a woman began to be bothered severe pain, this means that the tumor has reached the stage of inoperability, and it must be removed using surgical intervention It won't work anymore. The cancer has already left the uterine body and has affected the pelvic and abdominal organs.
As with any other type of cancer, during uterine cancer a woman may experience typical signs of this disease. She notices a rapid weight loss that happened without any reason, chronic fatigue and weakness in the body, poor appetite.
Diagnostics
After collecting an anamnesis and verbally questioning the woman about the presence of certain signs and obvious symptoms, the doctor begins an examination. First, he studies the size and position of the uterus. If the gynecologist was able to detect cancer in the early stages, he sends the woman for an ultrasound, which should detect the tumor and determine its location in the body of the uterus.
For a more accurate and detailed diagnosis of the uterine body, gynecologists perform hysteroscopy. The essence of the procedure is to insert a thin tube into the uterine cavity, which is equipped with a camera and lighting at the end. The image captured by the camera is transmitted to the doctor’s screen, and he can visually examine the condition of the uterine body and the tumor itself. In parallel with hysteroscopy, materials are often taken for biopsy. A biopsy allows you to determine the histological type of cells and the degree of malignancy of the process, which affects further treatment patients.
Treatment
Treatment for maca cancer is carried out using three standard methods:
- Surgical intervention;
- Chemotherapy;
- Irradiation.
They can be used either singly or in combination. Statistics show that the use of surgery in combination with antitumor drugs and radiation significantly reduces mortality rates among cancer patients.
Forecasts
Each patient, or her relatives, repeatedly asked questions to the attending physician, such as what the patient’s chances for successful treatment and survival rate, and how long will she live after treatment?
It is almost impossible to give an unambiguous answer to how long the patient has left, or how her treatment will progress; both general statistics and the personal characteristics of each woman are taken into account, which become the basis of any forecast.
How long do people live with stage 1 uterine cancer? at this stage, the tumor is best treated, since the tumor is localized within the endometrium, and there are no metastases yet. According to statistics, the average five-year survival rate is about 90%, which means that every 9 out of 10 women live another 5 years or more.
How long do people live with stage 2 uterine cancer? at this stage, the disease is already beginning to grow, which affects the success of the prognosis. Full recovery can be achieved by extirpation of the uterus and appendages. Survival predictions are approximately 70-75%.
How long do people live with stage 3 uterine cancer?- the disease begins to spread in abdominal cavity and release metastases into The lymph nodes, vagina and appendages, which significantly complicates treatment. Prognosis for survival and mortality are practically balanced (45% and 50%), respectively, so much will depend on the patient herself.
How long do people live with stage 4 uterine cancer?– the most advanced form of cancer, or terminal stage, the cause of death for many women. The disease begins to spread throughout the body, metastasizing even to the most distant organs. Treatment is only palliative, aimed at improving well-being. Projections for five-year survival are extremely low, at most 10%. Only one in 10 patients lives within a few years of treatment.
Video on the topic
11.02.2017
Uterine cancer (or endometrial cancer of the uterus) is a malignant tumor formed from the tissues of the uterus, which can spread throughout the body.
This common disease ranks 4th after breast cancer, skin cancer and cancer gastrointestinal tract. They form in women over 45 years of age, and the type of oncology depends on its location, because the uterus is a multilayered organ. Think about it: hundreds of thousands of women face this diagnosis every year.
Causes of oncology
The causes of uterine cancer are not precisely determined; there are factors that aggravate the risk of the occurrence and development of the disease. Research results show that the disease is caused by:
- diabetes;
- hypertonic disease;
- HIV infection;
- smoking;
- human infection with papilloma virus;
- disruption of the menstrual cycle;
- late menopause;
- infertility;
- active sex life with multiple partners, its early onset;
- venereal diseases;
- oral contraceptives;
- early birth.
Obesity remains a significant influencing factor. If a woman's weight is 15 kilograms more than normal, the risk of the disease increases. And if more than 30 kilograms, then 10 times.
Causes such as precancerous conditions that affect the formation of oncology can intensify the occurrence of uterine cancer. Among them are scars, ulcers, erosions after childbirth, leukoplakia, polyps, condylomas and chronic inflammatory processes, such as endometritis and endocervicitis.
How does uterine cancer develop?
The nature of the epithelium determines the division into squamous cell carcinoma and glandular carcinoma (adenocarcinoma) in the uterine cavity. Glandular cancer is the most common and accounts for about 70%. There is a rare tumor that affects the uterine canal - this is a sarcoma.
There are three tumor differentiations: well-differentiated tumors, moderately differentiated tumors and undifferentiated tumors.
Stages of development of uterine cancer:
- In the first stage, the tumor is located in the body of the uterus.
- The second cancer process produces further damage to the cervix.
- The third stage is characterized by the transition of the tumor to tissue, and metastases occur in the vagina.
- The fourth degree is characterized by the spread of the tumor beyond the pelvic area, and its further germination to the rectum or neighboring organs.
Symptoms of the disease
With uterine cancer, the symptoms of this disease develop. The first signs of uterine cancer are a woman complaining of bleeding, pain and discomfort, and the appearance of leucorrhoea.
Symptoms and signs appear as the tumor disintegrates, which means that uterine cancer may not manifest itself for a long time.
In the early stages, purulent mucous masses may appear, which cause irritation and itching. The first symptoms appear after physical activity, defecation or shaking.
Then there is the manifestation of bloody discharge, it doesn’t even matter what nature. A similar process occurs periodically (constantly) and the discharge can be abundant or scanty.
Menstrual irregularities indicate that pathology is developing. The duration of menstruation can be reduced or increased, pain is characteristic when urinating, indicating that the tumor is growing in bladder.
What are the main symptoms of uterine cancer? Oncologists say that 80% have uterine bleeding; such symptoms of uterine cancer do not relate to menstruation.
In later stages, uterine cancer has signs and symptoms:
- IN lumbar region, abdomen and in the perineal area, a pulling pain develops.
- There is pain during and after sexual intercourse.
- Disturbances in the process of bowel movement - diarrhea or constipation.
- Unreasonable weight loss.
- Loss of appetite.
- Nausea and vomiting.
- Decreased performance, rapid fatigue.
- Hyperthermia (increased body temperature, heat accumulation).
Cancer of the uterus before menopause has the following symptoms:
- No characteristic decrease in the amount of bleeding.
- Bloody discharge appears frequently.
- There is an abundance of discharge (instead of proper weakening and impoverishment).
During the postmenopausal period, there are no periods, so vaginal discharge should at least alert a woman. It does not matter what the intensity, duration and frequency of bleeding is. Symptoms of uterine cancer should be suspected in women who are concerned about their health.
If found the slightest symptoms uterine cancer - consult a doctor immediately! After all, uterine cancer can have terrible consequences. A timely visit to the doctor will allow you not to worsen the situation and cope with oncology in a timely manner.
Diagnostic methods
Diagnosis is an important stage; treatment of uterine cancer depends on it. First, the patient’s complaints are examined and determined. Suspicious cases of the disease occur during observation by a gynecologist; without examining patients, it is impossible to cure the disease.
Diagnosis is made by vaginal examination, rectal examination and examination using speculum.
A vaginal examination of endometrial cancer of the uterus helps to determine changes in a pronounced process of tumor development. The study is characterized by bleeding due to damage to the tumor with a finger. If uterine cancer is widespread, then additional research rectum to identify a tumor on the walls of the pelvis, in the area between the uterus and sacrum.
To detect cervical cancer on initial stage- vaginal examination will not be enough. An inspection method using mirrors is used. A biopsy or cytological examination helps determine the initial stage of cervical cancer, after which a smear sample is taken from the surface. If doctors suspect cancer of the cervical canal, or cavity, then the canal is curetted for diagnosis and histology.
The manipulations are carried out in a clinic by a doctor with the necessary equipment. By exact method a biopsy remains; here cases of errors are rare. In half of the cases diagnosed during vaginal examination, cervical cancer is not detected. Diagnosis using mirrors leaves about ten percent of cancer cases unrecognized.
Treatment of uterine cancer
Can uterine cancer be cured? It all depends on general condition patient, age, form and stage of tumor development. The main treatment is surgical, which involves extirpation (removal) of the uterus, and in some cases the lymph nodes of the pelvic area have to be removed.
At a late stage, a combined treatment method is used, in which surgery is performed, followed by remote irradiation of the vagina (radiotherapy, radiation therapy) and the use of drugs (chemotherapy).
Combined treatment of uterine cancer involves intracavitary therapy. If development cancerous tumor has reached the third stage, then before the operation radiation therapy. As a stand-alone method, radiation therapy is effective when the tumor is localized, as well as when there are contraindications for surgery. At the third and fourth stages of development, antitumor drugs are effective.
After treatment for uterine cancer, you need to visit a gynecologist for examination and additional tests. Do procedures intravenous pyelography, chest x-rays, ultrasound. During the first year after treatment, the doctor must be visited four times, and over the next five years - once every six months, but then the control does not stop - the patient visits the doctor annually. When relapses occur, pelvic exenteration is performed (partial or complete removal of the pelvic organs).
Five-year survival rates range from 80 to 40% after surgery.
Metastases in uterine cancer
Distant metastases are curable with chemotherapy. Metastases occur in the pelvic lymph nodes, less often in the inguinal nodes. With distant metastases, the prognosis is not favorable; they most often occur in the lungs, kidneys or liver. A quarter of patients are saved from relapse by radiation therapy. With recurrent metastases, a cure for cancer is unlikely, and the effect obtained from treatment is short-lived.
Prevention methods
For preventive purposes, all women over 30 years of age are recommended to undergo examinations by a doctor, systematically twice a year.
Regular examinations, which should begin with the onset of sexual activity, will help identify possible precancerous diseases, the signs of which do not manifest themselves. Cytological examination and ultrasound tomography should be added to such examination methods.
General signs are the presence of symptoms, their chronic and long-term type, and the lack of results from anti-inflammatory treatment.
Diseases in the cervix need to be treated radically using electrocoagulation, electroexcision or complete removal cervix.
Diagnosis carried out on time and the treatment process give a positive prognosis for survival. If a malignant tumor of the uterus is detected at an early stage, then the chances of favorable outcome more. Monitor your health and visit your doctor promptly.
Cervical cancer– a malignant tumor that develops in the cervix. This form of cancer ranks among the first oncological diseases of the genital organs. Cervical cancer most often occurs between the ages of 35 and 55 years. It is much less common in young women.
Every year, about half a million women fall ill around the world. Moreover, the risk of developing the disease largely depends on race. For example, Latin women get sick 2 times more often than European women.
This cancer of the female genital organs can be successfully treated in the early stages. It is often preceded by precancerous conditions (erosion, dysplasia), by getting rid of which it is possible to prevent the appearance of cancer.
It is important to know that a diagnosis of cervical cancer is not a death sentence. If a woman starts treatment on time, she has an excellent chance of recovery. More than 90% of early-stage tumors are curable. Modern methods allow you to save the uterus and ovaries. Thus, patients who have successfully coped with the disease retain their sexuality and can successfully become pregnant.
The human papillomavirus (HPV) from the Papovaviridae family plays a major role in the development of cervical cancer. Moreover, the virus is transmitted from partner to partner, even if the couple used a condom. Due to the small size of the pathogen, it easily penetrates the pores in latex. In addition, the virus can be transmitted from any infected part of the body (lips, skin).
This virus introduces its genes into the DNA of epithelial cells. Over time, this leads to cell degeneration. They stop maturing, lose the ability to perform their functions and can only actively divide. This leads to the appearance of a cancerous tumor in the place of one mutated cell. Gradually it grows into the nearest organs and metastasizes to distant parts of the body, which leads to severe consequences for the body.
In addition to the virus, there are a number of factors that can cause the appearance of a malignant neoplasm in the cervix.
- Early onset of sexual activity in girls.
- Having a large number of sexual partners.
- Smoking.
- Sexually transmitted infections.
- Excessive passion diets.
Anatomy of the uterus
Uterus- This is the muscular organ in which the fetus is born during pregnancy. The uterus is mainly composed of smooth muscle. It is located in the pelvis. The upper part includes the fallopian tubes, through which the egg enters the uterus from the ovaries. In front of the uterus is the bladder, and behind it is the rectum. The uterus is protected from displacement by elastic ligaments. They are attached to the walls of the pelvis or woven into the fiber.
The uterus resembles a triangle. Its base faces upward, and the lower narrowed part, the cervix, opens into the vagina. On average, the uterus is 7-8 cm long, 3-4 cm wide and 2-3 cm thick, the uterine cavity is 4-5 cm. In women before pregnancy, the uterus weighs 40 g, and in women who give birth, 80 g.
The uterus has three layers:
- Parametrium or periuterine tissue. This is a serous membrane that covers the outside of the organ.
- Myometrium or average muscle layer, consisting of intertwined bundles of smooth muscle. It has three layers: outer and inner - longitudinal and middle - circular, which contain blood vessels. The purpose of the myometrium is to protect the fetus during pregnancy and contract the uterus during childbirth.
- Endometrium or mucosal layer. This is the inner mucous membrane, which is densely permeated blood capillaries. Its main function is to ensure the attachment of the embryo. Consists of integumentary and glandular epithelium, as well as groups of ciliated cylindrical cells. The ducts of simple tubular glands open onto the surface of this layer. The endometrium consists of two layers: the superficial functional layer exfoliates during menstruation, the deep basal layer is responsible for restoring the superficial one.
Parts of the uterus
- Fundus of the uterus- upper convex part.
- Body of the uterus- the middle part has the shape of a cone.
- Cervix- the lower, narrowest part.
The lower narrowed part of the uterus looks like a cylinder through which the cervical canal passes. The cervix consists mainly of dense elastic tissue rich in collagen and a small number of smooth muscle fibers. The cervix is conventionally divided into two sections.
- Supravaginal part located above the vagina
- Vaginal part enters the vaginal cavity. Has thick edges (lips) that define the outer opening cervical canal. It leads from the vagina to the uterine cavity.
The cervix in the lower vaginal part is covered with flat non-keratinizing epithelium. Its cells also enter the cervical canal. Above, the canal is lined with columnar epithelium. This picture is observed in women after 21-22 years. In young girls, the columnar epithelium descends lower and covers the vaginal part of the cervix.
We offer you answers to questions regarding cervical cancer that concern women most.
What are the stages of cervical cancer?
Stages of cervical cancer
Stage 0Cancer cells are found only on the surface of the cervical canal, do not form a tumor and do not penetrate deep into the tissue. This condition is called cervical intraepithelial neoplasia.
Stage I
Cancer cells grow and form a tumor that penetrates deep into the tissue of the cervix. The neoplasm does not extend beyond the organ and does not spread to the lymph nodes.
Substage IA. The diameter of the neoplasm is 3-5 mm, depth up to 7 mm.
Substage IB. The tumor can be seen with the naked eye. Penetrates connective tissues cervix by 5 mm. The diameter ranges from 7 mm to 4 cm.
It is diagnosed only by microscopic examination of a cytological smear from the cervical canal. If this oncocytology test reveals atypical (irregular) squamous epithelial cells, it is recommended to conduct an examination using a colcoscope. This is a device that allows you to conduct a detailed inspection with an image displayed on the screen. And also carefully examine the cervix and do tests for the presence of cancer.
Stage II
The tumor grows into the body of the uterus and extends beyond it. It does not apply to the walls of the pelvis and lower parts of the vagina.
Substage IIA. The tumor is about 4-6 cm in diameter and is visible during examination. The neoplasm affects the cervix and upper parts of the vagina. Does not spread to lymph nodes, does not form metastases in distant organs.
Substage IIB. The neoplasm spreads to the periuterine space, but does not affect surrounding organs and lymph nodes.
For diagnosis, a study using a colcoscope and ultrasound of the pelvic organs is prescribed. A biopsy may also be required. This is taking a tissue sample from the cervix. This procedure is carried out during colcoscopy or independently. Using a curette, part of the epithelium is scraped from the cervical canal. Another method is wedge biopsy.
Performed using an electric surgical loop or scalpel. Allows you to take tissue from deep layers for analysis.
Stage III
The malignant tumor has spread to the walls of the pelvis and the lower part of the vagina. It can affect nearby lymph nodes and interfere with the flow of urine. Does not affect distant organs. The tumor can reach large sizes.
Substage IIIA
The tumor has grown into the lower third of the vagina, but the walls of the small pelvis are not affected.
Substage IIIB. The tumor causes blockage of the ureters and can affect the lymph nodes in the pelvis and be found on its walls.
Colposcopy, biopsy, and computed tomography are used for diagnosis. The last method is based on X-ray irradiation. With their help, the scanner takes many pictures, which are compared in the computer and give a holistic picture of the changes. Magnetic resonance imaging is also informative. The operation of the tomograph is based on the action of radio waves, which varying degrees absorb and release different types fabrics.
Stage IV
The tumor has reached a significant size and has spread widely around the cervix. Near and distant organs and lymph nodes are affected.
Substage IVA. Metastases have spread to the rectum and bladder. Lymph nodes and distant organs are not affected.
Substage IVB. Distant organs and lymph nodes are affected.
For diagnosis, visual examination, intestinal endoscopy, computed tomography or magnetic resonance imaging to determine the size of the tumor. In order to identify distant metastases, positron emission tomography is prescribed. Glucose containing a radioactive atom is introduced into the body. It concentrates in cancer cells of the tumor and metastases. Such clusters are then identified using a special camera.
What are the signs of cervical cancer?
In the early stages of cervical cancer specific symptoms does not arise. The woman does not notice any changes or discomfort. The first signs appear when the tumor reaches a significant size and affects neighboring organs. Therefore, it is so important to undergo annual preventive examination see a gynecologist to detect cancer at an early stage, when it can be overcome.Symptoms of cervical cancer
- Bleeding from the vagina.
- After the onset of menopause
- Between periods
- After gynecological examination
- After intercourse
- After douching
- Changes in the nature of menstruation.
- Prolongation of bleeding period
- Changing the nature of discharge
- Change in vaginal discharge.
- With traces of blood
- Increase in leucorrhoea
- On late stages disintegration of the tumor, the discharge becomes foul-smelling and looks like meat slop
- Pain during intercourse.
- Pain in the back and lower abdomen.
- Swelling of the legs
- Impaired urination and bowel movements.
- Decreased performance, weakness.
Consultation with an oncologist for the treatment of cervical cancer
Diagnosis of cervical cancer
What to expect at your doctor's appointment?
Anamnesis collection. The doctor collects data about health complaints, menstruation, etc. Visual inspection. Examination of the vagina and lower cervix using gynecological speculum. At this stage, the doctor takes smears of the vaginal contents for microflora and the presence cancer cells(oncocytology).
If there is a need to conduct a more thorough examination, colposcopy is prescribed. It is carried out using an instrument equipped with magnifying lenses and a lighting element. The procedure is painless and allows you to perform special tests to detect cancer cells and take a tissue sample for analysis. During the examination, the doctor may notice an area of mucous membrane that is different in color from the surrounding tissues or rises above them.
If the tumor develops in the thickness of the walls of the uterus (endophytic), then the organ increases in size and has a barrel-shaped shape. In the case when the growth of the tumor is directed outward (exophytic), then upon examination the doctor sees growths similar to cauliflower. These are round formations of gray-pink color that begin to bleed when touched. The tumor may also look like a mushroom on a stalk or look like an ulcer.
What test is there for cervical cancer?
Today, the internationally recognized analysis for early diagnosis Cervical cancer is a Pap test or test Pappanikolaou.The analysis is taken with a spatula or Wallach brush from the mucous membrane of the cervix. Then the material in a special container is sent to the laboratory. There, the sample is applied to a glass slide and a study of the cell characteristics (cytological) is carried out. The result will be ready in 7 days.
The analysis is taken no earlier than the fifth day from the start of the cycle and no later than 5 days before the start of menstruation. The day before visiting the gynecologist, you should refrain from sexual intercourse and douching.
There are several other tests to diagnose cervical cancer.
- Cytology for atypical cells. This is taking a sample of the contents of the cervical canal. Under a microscope, the presence of cancer cells is determined.
- Thin Prep method or liquid cytology. It involves the preparation of special thin-layer cytological preparations.
- HPV double gene trap test. It allows you to diagnose not the tumor itself, but the degree of infection with the human papillomavirus and the degree of risk of developing cancer.
In conclusion, we once again emphasize how important it is to visit a gynecologist in a timely manner. Preventative visit Seeing a doctor once every six months will reliably protect you from the development of cancer and help maintain your health.
What is squamous cell carcinoma of the cervix?
The cervix is covered by two types of epithelium. Depending on which cells become the basis of the tumor, there are 2 types of cancer:
Squamous cell carcinoma of the cervix is a malignant tumor that develops from the squamous epithelial cells that cover the vaginal part of the cervical canal. It accounts for 80-90% of all cases. This type of disease is much more common than the glandular form of cancer (adenocarcinoma). This form of cancer is caused by a mutation in squamous epithelial cells. Infection with human papillomavirus, the presence of polyps and erosions of the cervix can lead to the transformation of normal cells into cancer cells. Inflammatory processes and the IUD, which is used as a means of contraception, may also be the cause.
The action of these factors leads to trauma and inflammation of squamous epithelial cells. This causes a malfunction in the DNA structure, which is responsible for transmitting genetic information to daughter cells. As a result, during division, not a typical squamous epithelial cell is formed, which can perform its functions, but an immature cancerous one. She is only capable of dividing and producing others like herself.
Squamous cell carcinoma has three stages:
- poorly differentiated squamous cell carcinoma– immature form, the tumor is soft, fleshy, actively growing.
- nonkeratinizing squamous cell carcinoma– an intermediate form, characterized by a wide variety of manifestations.
- keratinizing squamous cell carcinoma– mature form with a hard, dense consistency, the beginning of tumor formation.
If cancer can be detected in the early stages, it is highly treatable. An operation is performed to remove the tumor and a course of chemotherapy is performed to prevent the formation of new foci of the disease. In this case, it is possible to preserve the uterus and in the future the woman can carry and give birth to a child.
If the moment is missed and the tumor has grown into the uterine tissue, it will need to be removed and, possibly, the appendages. To consolidate the results of treatment, chemotherapy and radiation therapy are prescribed. A serious danger to life and health arises in patients with the fourth stage of cancer, when secondary foci of cancer have appeared in nearby and distant organs.
What is the prevention of cervical cancer?
Prevention of cervical cancer is largely based on a woman’s conscious attitude towards her health. Important regular visits to the gynecologist.
- You need to visit a doctor twice a year. The gynecologist will take smears of vaginal flora.
- It is advisable to undergo a colposcopy once a year to thoroughly examine the condition of the cervix.
- Once every 3-4 years, a cytological examination is performed for atypical cells. This PAP test allows you to determine the precancerous condition of the mucous membrane or the presence of cancer cells
- If necessary, the doctor will prescribe a biopsy. Taking a small piece of mucous membrane for a thorough examination.
Main risk factors:
- Early onset of sexual activity and early pregnancy. Those who frequently had sexual intercourse before the age of 16 are at risk. This is due to the fact that at a young age the cervical epithelium contains immature cells that easily degenerate.
- A large number of sexual partners throughout life. American studies have shown that a woman who has had more than 10 partners in her life has a 2-fold increased risk of developing a tumor.
- Sexually transmitted diseases, especially human papillomavirus. Viral and bacterial sexually transmitted diseases cause cell mutations.
- Long-term use of oral contraceptives causes hormonal disbalance in organism. And imbalance has a bad effect on the condition of the genital organs.
- Smoking. Tobacco smoke contains carcinogens - substances that contribute to the transformation of healthy cells into cancerous ones.
- Long-term diets and poor nutrition. Lack of antioxidants and vitamins in food increases the likelihood of mutation. In this case, the cells suffer from free radical attacks, which are considered one of the causes of cancer.
Prevention methods
- Having a regular sexual partner and regular sex life significantly reduces the likelihood of tumors and other genital diseases.
- Also very important point- use of condoms to prevent infection with the human papillomavirus (HPV). Although these remedies do not provide an absolute guarantee, they reduce the risk of infection by 70%. In addition, using a condom protects against sexually transmitted diseases. According to statistics, after suffering venereal disease, mutations in the cells of the genital organs occur much more often.
- If sexual intercourse unprotected with a condom occurs, it is recommended to use Epigen-intim for the hygiene of the internal and external genital organs. It has an antiviral effect and can prevent infection.
- Compliance with personal hygiene rules plays an important role. To save normal microflora genitals and maintaining local immunity, it is advisable to use intimate gels with lactic acid. This is important for girls after puberty. Choose products that contain a minimum amount of fragrance.
- Quitting smoking is an important part of prevention. Smoking causes vasoconstriction and impairs blood circulation in the genitals. In addition, tobacco smoke contains carcinogens - substances that contribute to the transformation of healthy cells into cancerous ones.
- Refusal of oral contraceptives. Long-term use contraceptives drugs can cause hormonal imbalances in women. Therefore, it is unacceptable to independently determine which pills to take to prevent pregnancy. This should be done by the doctor after the examination. Hormonal imbalances caused by other factors can also cause tumors. Therefore, you need to consult a doctor if you notice a disruption in the menstrual cycle, increased hair growth, acne appears after 30, or you begin to gain weight.
- Some studies have found a link between cervical cancer and injuries resulting from gynecological procedures. This includes abortion, trauma during childbirth, and placement of a spiral. Sometimes, as a result of such injuries, a scar can form, and its tissue is prone to degeneration and can cause a tumor. Therefore, it is important to trust your health only to qualified specialists, and not to private doctors whose reputation you doubt.
- Treatment of precancerous conditions, such as dysplasia and cervical erosion, can prevent tumor development.
- Proper nutrition. You need to consume enough fresh vegetables and fruits, more cereals containing complex carbohydrates. It is recommended to avoid foods that contain large amounts of food additives (E).
Is the cervical cancer vaccine effective?
The vaccine against cervical cancer is given with the drug Gardasil. This is a four-component vaccine against the most dangerous types of human papillomavirus (HPV), which is the main cause of cervical cancer. In Russia it was registered in 2006. The drug contains virus-like particles (proteins) that trigger the production of antibodies in the human body. The vaccine contains no viruses that could multiply and cause disease. The drug is not used to treat cervical cancer or genital papillomas and should not be administered to infected women.
Gardasil is designed to protect the body from the human papillomavirus. It has been scientifically proven that its varieties 6, 11,16,18 cause the appearance of papillomas (warts) on the genitals, as well as cervical and vaginal cancer.
Vaccination against cervical cancer guarantees immunity for three years. It is recommended for girls aged 9-17 years. This is due to the fact that, according to statistics, women who were diagnosed with cancer after the age of 35 became infected with HPV at the age of 15-20 years. And from 15 to 35 years, the virus was in the body, gradually causing the transformation of healthy cells into cancerous ones.
The vaccination is done in three stages:
- On the appointed day
- 2 months after the first dose
- 6 months after first administration
The drug is produced by the oldest German pharmaceutical corporation Merck KGaA . And to date, more than 50 million doses have already been used. In 20 countries this vaccine is included in national calendar vaccinations, which indicates its recognition in the world.
There is still debate about the safety of this drug and the advisability of its administration to adolescents. Severe cases have been described side effects(anaphylactic shock, thromboembolism) and even deaths. The ratio is one death per million vaccinations administered. At a time when more than 100,000 women die from cervical cancer every year. Based on this, those who have not been vaccinated are at much greater risk.
Manufacturers conducted an investigation, during which it was proven that the percentage of complications with vaccination against cervical cancer is no higher than the corresponding rate in other vaccines. The developers say that many deaths were not caused by the drug itself, but occurred after its administration and were associated with other factors.
Opponents of cervical cancer vaccination argue that there is no point in vaccinating girls at this age. early age. It is difficult to disagree with this argument. At the age of 9-13, girls usually do not have an active sexual life, and immunity lasts only 3 years. Therefore, it makes sense to postpone vaccination to a later date.
Evidence that Gardasil has a negative effect on reproductive system and is “part of a conspiracy theory for the sterilization of the Slavs” - an invention of sensation lovers. This has been shown by many years of experience using the drug in the USA, the Netherlands and Australia. Women who were vaccinated with Gardasil had problems with fertilization no more often than their peers.
The significant cost of the vaccine (about $450 per course) greatly limits the number of women who will be able to get vaccinated at their own expense. It's hard to argue that the manufacturing corporation makes huge profits. But a drug that can really protect against the development of cancer is worth the money.
To summarize, we note that Gardasil is effective means prevention of cervical cancer. And the percentage of complications is no greater than that of vaccines against influenza or diphtheria. Based on this, it can be recommended to vaccinate those young women who are at risk. This should be done at the age of 16-25, when the likelihood of HPV infection increases. Vaccination can be carried out after careful medical examination, if no serious illnesses were detected during it.
