Uterus neck cancer
Uterus neck cancer – the tumoral defeat of the lower department of a uterus which is characterized by malignant transformation of an integumentary epithelium (ekto-or an endotserviksa). Specific displays of cancer of neck of a uterus are preceded by an asymptomatic current; further there are contact and intermenstrual bloody allocations, belly-aches and a sacrum, hypostases of the lower extremities, violations of an urination and defecation. Diagnostics at cancer of a neck of a uterus includes carrying out survey in mirrors, an expanded kolposkopiya, a research of cytologic scrape, a biopsy with the histologic conclusion, an endotservikalny curettage. Cancer therapy of a neck of a uterus is carried out taking into account a histologic form and prevalence by means of surgical intervention, radiation therapy, chemotherapy or their combination.
Uterus neck cancer
Uterus neck cancer (tservikalny cancer) makes about 15% among all malignant defeats of female reproductive system, taking the third place after a breast cancer and endometrial cancer. In spite of the fact that cancer of a neck of a uterus belongs to diseases of "visual localization", this pathology is diagnosed for 40% of women at a late (III-IV) stage. In Russia about 12000 cases of tservikalny cancer annually come to light. As the main category serve patients at the age of 40-50 years though in recent years growth of cancer cases of a neck of a uterus among women is noted 40 years are younger.
To the background diseases contributing to development of cancer of neck of a uterus, the gynecology carries a leukoplakia (an intraepitelialny neoplasia, CIN), an eritroplakiya, condylomas, polyps, a true erosion and a pseudo-erosion of a neck of a uterus, a tservitsita.
Classification of RShM
On histologic type, according to two types of the epithelium covering a uterus neck distinguish planocellular tservikalny cancer with localization in an ektotserviksa (85-95%) and the adenocarcinoma developing from an endotserviks (5-15%). Planocellular cancer of a neck of a uterus, depending on differentiation degree, can be orogovevayushchy, neorogovevayushchy and low-differentiated. Treat rare gistotipa of cancer of neck of a uterus light-cellular, melkokletochny, mukoepidermoidny, etc. forms. Taking into account type of growth distinguish ekzofitny forms of cancer of neck of a uterus and endofitny, meeting less often and having the worst forecast.
For prevalence assessment in clinical gynecology classifications of cancer of neck of a uterus by two systems are used: FIGO accepted by the International federation of obstetricians and gynecologists, and TNM (where T – prevalence of a tumor; N – involvement of regionarny lymph nodes; M – existence of the remote metastasises).
The stage 0 (FIGO) or Tis (TNM) is regarded as preinvazivny or vnutriepitelialny cancer of a neck of a uterus (in situ).
The stage of I (FIGO) or T1 (TNM) - a tumoral invasion is limited to a uterus neck, without transition to her body.
- I A1 (T1 A1) – microscopically defined uterus neck cancer with depth of invasion up to 3 mm with horizontal distribution to 7 mm;
- I A2 (T1 A2) – germination of a tumor in a uterus neck on depth from 3 to 5 mm with horizontal distribution to 7 mm.
- I B1 (T1 B1) – macroscopically defined tservikalny cancer limited to a uterus neck or microscopically revealed defeats exceeding IA2 (T1A) which is not exceeding 4 cm in the maximum measurement;
- I B2 (T1 B2) - macroscopically defined defeat exceeding 4 cm in the maximum measurement.
The stage of II (FIGO) or T2 (TNM) is characterized by spread of cancer out of uterus neck limits; lower third of a vagina and wall of a basin of an intaktna.
- II A (T2 A) – a tumor the parametriya infiltrirut the top and average third of a vagina or a body of a uterus without germination;
- II B (T2 B) – a tumor infiltrirut parametriya, but does not reach basin walls.
The stage of III (FIGO) or T3 (TNM) is characterized by spread of cancer out of uterus neck limits with germination a parametriya to walls of a basin either involvement of the lower third of a vagina, or development of a gidronefroz.
- III A (T3 A) – a tumor takes the lower third of a vagina, but does not sprout in basin walls;
- III B (T3 B) – a tumor passes to walls of a basin or causes , or secondary damage of a kidney.
The stage of the IV A (FIGO) or T4 (TNM) is characterized by spread of cancer of neck of a uterus to adjacent bodies or distribution out of basin limits. The stage of IV B (T4 M1) demonstrates existence of the remote metastasises.
Uterus neck cancer reasons
The key part in carcinogenesis is assigned to the human papillomavirus infection possessing a tropnost to a uterus neck epithelium. Serotypes of VPCh of high onkogenny risk (16, 18) are found in 95% of cases of cancer of neck of a uterus: at planocellular tservikalny cancer type VPCh 16 comes to light more often; at an adenocarcinoma and the low-differentiated form - type VPCh 18. Serotypes of VPCh of "low" onkogenny risk (6, 11, 44) and average risk (31, 33, 35) mainly cause formation of flat and peaked condylomas, a dysplasia and is rare – uterus neck cancer.
Distinguish genital herpes, a Cytomegaloviral infection, clamidiosis, HIV from other STD increasing risks of development of cancer of neck of a uterus. Follows from all aforesaid that the probability of development of cancer of neck of a uterus is more at the women who are often changing sexual partners and neglecting barrier methods of contraception. Besides, at the early beginning of sexual life (at the age of 14-18 years) the unripe epithelium of a neck of a uterus possesses a special susceptibility to influence of the damaging agents.
On development of cancer of neck of a uterus refer weakening of function of immune system to risk factors, smoking, age is more senior than 40 years, diets with the small maintenance of fruit and vegetables, obesity, a lack of vitamins A and S. Takzhe is proved that the probability of development of cancer of neck of a uterus increases at long (over 5 years) reception of oral contraceptives, numerous childbirth, frequent abortions. One of factors of late detection of cancer of neck of a uterus is the low medical culture, irregular passing by women of routine inspections with dab research from the tservikalny channel on an onkotsitologiya.
Uterus neck cancer symptoms
Clinical manifestations at a carcinoma of in situ and microinvasive cancer of a neck of a uterus are absent. Emergence of complaints and symptomatology demonstrates progressing of a tumoral invasion. As the most characteristic display of cancer of neck of a uterus serve bloody allocations and bleedings: intermenstrual, post-menopausal, contact (after sexual intercourse, survey by the gynecologist, syringing etc.), menorragiya. Patients note emergence is more white - liquid, watery, than yellowish or transparent color of the vaginal allocations caused limforey. At disintegration of a cancer tumor of allocation accept putreform character, sometimes have color of "meat slops" and a fetid smell.
At germination of a tumor in walls of a basin or nervous textures belly-aches, under a bosom, in a sacrum at rest develop or during sexual intercourse. In case of uterus neck cancer metastasis in pelvic lymph nodes and squeezings of venous vessels hypostases of legs and external genitals can be observed.
If tumoral infiltration affects intestines or a bladder, violations of defecation and an urination develop; there is a gematuriya or impurity of blood in Calais; sometimes arise vaginal and intestinal and vaginal fistulas. The mechanical compression metastatic lymph nodes of mochetochnik leads to an urine delay, formation of a gidronefroz with the subsequent development of an anury and uraemia. The general weakness, increased fatigue, fever, weight loss belong to the general symptoms of cancer of neck of a uterus.
Basis of early detection of microinvasive tservikalny cancer regular onkoprofilaktichesky surveys with cytologic make a research of scrape of a neck of a uterus. Fathers tests (dab across Papanikolau) allows to reveal precancer processes, cancer cells with a preinvazivny growth of a tumor. Visual gynecologic survey allows to find or suspect uterus neck cancer of an early stage on external to signs: to ulcerations, change of coloring of a neck of a uterus.
In an invasive stage at ekzofitny type of growth of cancer fibrinozny imposings, opukholevidny growths of reddish, whitish, pinkish-gray color which easily bleed at a touch are defined on the surfaces of a neck of a uterus. In case of the endofitny growth of tservikalny cancer the neck of a uterus becomes increased, gets a barrel-shaped form, an uneven hilly surface, uneven pink and marble coloring. At a rekto-vaginal research in a parametriya and a small basin infiltrates can be defined.
By means of a kolposkopiya at increase in the image by 7,5 - 40 times it is possible to study in more detail a uterus neck, to find background processes (a dysplasia, a leukoplakia) and initial displays of cancer of neck of a uterus. For a research of a zone of transformation of an epithelium use conducting test with acetic acid and Schiller test (iodic test). Atipiya at cancer of a neck of a uterus comes to light on a characteristic izvitost of vessels, less intensive coloring of the pathological iodnegative centers. At suspicion of cancer of a neck of a uterus the research of an opukholeassotsiirovanny anti-gene of planocellular carcinomas – an onkomarker of SCC is shown (normal does not exceed 1,5 ng/ml).
The expanded kolposkopiya gives the chance to reveal the site of transformation and to make an aim biopsy of a neck of a uterus for a histologic research of the taken-away fabrics. The knife biopsy of a neck of a uterus with a scraping of the tservikalny channel is obligatory at suspicion of tservikalny cancer. The uterus neck konization – cone-shaped excision of a piece of fabrics is made for definition of degree of an invasion of cancer. A decisive and final method in diagnosis of cancer of neck of a uterus is morphological interpretation of results of a biopsy.
In addition at cancer of a neck of a uterus the ultrasonography of a small pelvis allowing to stadirovat tumoral process and to plan intervention volume is carried out. For an exception of germination of a tumor in adjacent bodies and the remote metastasis tsistoskopiya, intravenous urography, ultrasonography of an abdominal cavity, a X-ray analysis of lungs, an irrigoskopiya, a rektoskopiya resort to performance of ultrasonography of a bladder and kidneys. In need of the patient with the revealed cancer of a neck of a uterus have to be consulted by the urologist, the pulmonologist, the proctologist.
Cancer therapy of a neck of a uterus
At preinvazivny cancer at the young women planning a child-bearing the sparing interventions with removal nachalno of the changed sites of a neck of a uterus within healthy fabrics are carried out. Refer cone-shaped amputation (konization) of a neck of a uterus, an electrosurgical loopback ekstsiziya, high amputation of a neck of a uterus to organ-preserving operations. Economical resections at cancer of a neck of a uterus allow to observe oncological radicalism and to keep reproductive function.
At more expressed changes and prevalence of tumoral process removal of a uterus with a transposition of ovaries (their removal out of basin limits) or with an ovariektomiya is shown. At uterus neck cancer in a stage the I B1 standard surgical volume is the pan-hysterectomy – a uterus extirpation with an adneksektomiy and pelvic limfodissektion. Upon transition of a tumor to a vagina carrying out a radical hysterectomy with removal of a part of a vagina, ovaries, uterine tubes, the changed lymph nodes, paratservikalny cellulose is shown.
The surgical stage of cancer therapy of a neck of a uterus can be combined with beam or chemotherapy, or with their combination. Himio-and radiotheraphy can be carried out at a presurgical stage for reduction of the sizes of a tumor (neoadjyuvantny therapy) or after operation for destruction of perhaps remained tumoral fabrics (adjyuvantny therapy). At the started forms of cancer of neck of a uterus palliative operations – removal of a tsistostoma, kolostoma, formation of roundabout intestinal anastomoz are carried out.
The forecast at RShM
The cancer therapy of a neck of a uterus begun at the I stage provides 5-year survival at 80-90% of patients; at the II Art. survival in five years makes 60-75%; at the III Art. - 30-40%; at the IV Art. – less than 10%. At implementation of organosberegayushchy operations for uterus neck cancer chances of a child-bearing remain. In case of carrying out radical interventions, neoadjyuvantny or adjyuvantny therapy fertility is completely lost.
At detection of cancer of neck of a uterus at pregnancy, tactics depends on terms of a gestation and prevalence of tumoral process. If the term of a gestation corresponds to the II-III trimester, it is possible to keep pregnancy. Conducting pregnancy at cancer of a neck of a uterus is carried out under the increased medical observation. As a rodorazresheniye method in this case usually serves Cesarean section with simultaneous removal of a uterus. At gestation term less than 3 months abortion with an immediate initiation of treatment of cancer of neck of a uterus is made.
The main preventive measure of cancer is mass oncological screening by means of a cytologic research of scrapes from a neck of a uterus and from the tservikalny channel. Inspection is recommended to be begun after the beginning of sex life, but no later than age of 21 years. Within the first two years dab is given annually; then, at negative results – 1 time in 2-3 years.
Prevention of cancer of neck of a uterus demands early detection and treatment of background diseases and sexually transmitted infections, restriction of number of sexual partners, use of barrier contraception at casual sexual communications. It is necessary for patients of risk groups passings of survey of the gynecologist at least 1 time in half a year with carrying out an expanded kolposkopiya and cytologic dab. Performing preventive vaccination against VPCh and cancer of a neck of a uterus by medicines of Tservariks or Gardasil is shown to girls and young women aged from 9 up to 26 years.