Update: October 2018
Cervical cancer is one of the most common malignant
neoplasms in women, it accounts for more than 5% of all tumors and
takes 5 place. AT последние десятилетия болезнь помолодела,
therefore, it is often found in women aged 20-30. AT отличие
from other tumors of the reproductive system, cervical cancer is most common in
developing countries in Africa and Latin America.
The cervix is the lower part of the uterus. AT ее центре проходит канал,
called cervical. Its one end opens into the uterus, and
the other is in the vagina. Only a third of the entire neck is visible when viewed in
gynecological chair. Most of it is hidden from view. On
throughout the life of a woman’s neck is constantly changing. AT ней
there is a special zone at the junction of two types of epithelium, which with
time shifts into the cervical canal. This zone
transformation – the most vulnerable to all adverse factors.
It is from it that most of all precancerous and cancerous
Cervical erosion and cancer
Often you can hear the diagnosis of cervical erosion. it
inaccurate term. Most often it means ectopia –
a condition that is the norm for 25% of young women. With this
features a cylindrical epithelium lining the cervical
the channel comes to the place of multilayer. Transformation zone in
the result is shifting outward. AT большинстве случаев эктопия не
requires treatment, has no symptoms and is certainly not
precancerous condition. The only recommendation is regular
observation at the gynecologist.
Risk factors for cervical cancer
- Early sexual debut
- Frequent change of sexual partners
- Use of oral contraceptives (waiver
- Numerous pregnancies and childbirth
- Инфицирование ATПЧ высокой степени онкогенности, особенно –
together with another genital infection (genital herpes,
Рак и носительство ATПЧ
Cervical cancer is one of the diseases that is easier to prevent than
cure. A great achievement in science was the discovery of viral
the nature of this oncoprocess. It is believed that it is a virus infection.
human papilloma causes precancerous changes in the end
leading to malignant tumors.
AT настоящее время выявлено более 100 видов ATПЧ, способных жить в
human body. But not all of them are a risk factor.
по развитию crayfishа cervix. ATсе вирусы условно делят на группы
high, medium and low oncogenic potential:
- Низкий риск: 6, 11, 42, 43, 44 типы ATПЧ (вызывают остроконечные
condylomas do not increase the incidence of cancer)
- Intermediate risk: 31, 33, 35, 51 and 52 types (often cause
dysplasia, much less – cancer)
- ATысокий риск: 16, 18, 39, 45, 50, 53, 55, 56, 58, 59, 64, 68
types (found in 99% of cases of cervical cancer)
AT большинстве случаев ATПЧ исчезает самостоятельно в течение 1-2
years without significant changes. And only occasionally he causes
chronic, long-term current infection leading to dysplasias and
являющуюся причиной crayfishа cervix. Believed that the younger
the woman, the faster self-healing occurs. Therefore, girls
definition of the virus by PCR is considered inappropriate. Usually
анализ на определение ATПЧ проводят при изменениях (лейкоплакия,
dysplasia), detected with a smear and colposcopy, and
симптомах crayfishа cervix.
Факты о ATПЧ
- Human papilloma virus infection causing cancer
occurs sexually, more often in young men and women.
- It is estimated that 50% of all sexually active people at least once
life faced with this infection.
- AT большинстве случаев вирус, в том числе и онкогенной группы,
self leaves the body within 1-2 years.
- There are no drugs that effectively help
get rid of the virus.
- Единственный способ защититься от ATПЧ высокой онкогенности и от
crayfishа шейки матки – vaccination.
- Обследование женщин до 30 лет на ATПЧ нецелесообразно (так как
the disease passes on its own).
Early symptoms of cervical cancer:
- Appearance of discharge
They usually have a watery character, have the color “meat
slop “, have a specific smell. Such secretions arise
if the tumor grows to a large size and gradually
- Non-menstrual bleeding
- Contact bleeding (with intercourse), pain during sexual
- Postmenopausal bleeding
- Боли грызущего и тянущего харan actра, возникающие внизу живота,
in the lower back and sacrum, in the rectal area.
- Frequent urination
- Signs of tumor intoxication: a sharp weight loss, a decrease
appetite, persistent fever, fatigue, anemia
- Onрушение мочеиспускания и дефекации: кровь в моче, кровь в
- Dribbling of urine or feces from the vagina (during germination by a tumor
walls of the bladder and intestine with the formation of fistulas)
- Swelling of the legs, shortness of breath
Tumors of the cervix may consist of different tissues,
form in different parts of the body, have different
- Preinvasive cancer
- Squamous crayfish
- Железистый crayfish (аденокарцинома)
- Другие виды crayfishа (в том числе недифференцированный)
Preinvasive cancer (in situ, дисплазия 3 степени, CIN 3)
Cancer “on the spot”, or cancer in situ – different names for the same
same pathology. AT этом случае клетки, покрывающие шейку, имеют
signs of malignancy. But they do not germinate deep into the stroma.
Accordingly, there is no metastasis. Since this
стадии симптомов crayfishа шейки матки нет, то обнаружить его можно лишь
with regular checkup by a doctor. WITHо временем crayfish «на месте»
turns into a micro-invasive, and then into a metastatic
Often, experts distinguish a particular form of cervical tumors –
микроинвазивный crayfish, соответствующий Ia стадии. it уже не cancer
in situ, as the tumor cells invade the stroma. But this
invasion does not exceed 5 mm, and the size of the tumor itself is 1 cm and
less. AT таком случае crayfish обычно малоагрессивен, не дает метастазов
and pretty well treated.
Invasive cervical cancer
If a опухоль проникает вглубь тканей, то ее называют инвазивной.
Именно при ней возникают первые симптомы crayfishа cervix. Such
crayfish легче заметить при осмотре у гинеколога, к тому же он имеет
харan actрные особенности мазков и кольпоскопии. AT случаях далеко
bright cancer can appear
In their form, cervical tumors are divided into three groups:
- With exophytic growth
Such crayfish растет внутрь цервикального канала, как бы в просвет
cervix. Him можно обнаружить при осмотре на гинекологическом
chair: it often hangs out of the neck in the form of a polyp with a shape
cauliflower. Such tumors are considered less aggressive,
позже метастазируют и имеют лучший forecast.
- With endophytic growth
These tumors grow deep into the neck. Outside they look
small, but in the thickness of the tissues form ulcerations and disintegration. AT
таких случаях болезнь течет агрессивнее, forecast менее
AT статистику заболеваемости не входит преинвазивный crayfish (in
situ). Эту стадию crayfishа шейки часто объединяют с дисплазией 3
degree, since the treatment is absolutely identical. For tumors,
penetrated deeper, created a special classification. She allows
определить forecast и способ лечения diseases.
Stage I: The tumor does not extend beyond the uterus.
- IA – a tumor that penetrated less than 5 mm
- IB – a tumor that has penetrated deeper than 5 mm
Stage II – A tumor that has spread beyond the uterus (but not
struck the pelvic walls and the lower third of the vagina) III stage –
A tumor that has spread to the walls of the pelvis or lower third
stage IV vagina – a tumor that has penetrated beyond the pelvis or
sprouted bladder, rectum.
Diagnosis of cervical cancer
- Cytological examination (oncocytology smear)
A Pap smear is the global standard for screening for cervical cancer. WITH
using a spatula of a special form, cells are taken with
the surface of the cervix. After studying under a microscope, it is concluded that
their structure. AT мазке могут быть обнаружены воспалительные
changes, various atypia (including severe dysplasia),
crayfishовые элементы. При подозрительных на предcrayfish и crayfish результатах
prescribe additional research methods.
Kolposkop – a special device that allows to increase
image of the neck and study the structure of its cells and vessels.
Examination of the cervix with a colposcope is especially important when
начальных стадиях crayfishа, когда опухоль не видна при обычном осмотре.
Поздние стадии crayfishа шейки матки легко заметить без дополнительных
When suspicious areas are detected, a biopsy is performed with
subsequent examination of tissues under a microscope.
- ATыскабливание цервикального канала
If a результаты цитологического исследования показали
предcrayfishовые или crayfishовые изменения, а кольпоскопия – нормальную
picture, then you need to go through scraping the cervical canal.
ATелика вероятность, что атипичные клетки располагаются внутри,
therefore unavailable for visual inspection. Such a procedure
not everyone is prescribed, usually cytology is enough
colposcopy with biopsy.
Ultrasound diagnosis – simple, painless and inexpensive
survey method. Особенно эффективно Ultrasound трансвагинальным
sensor. Difficulties arise only with very common
processes, as well as the presence of adhesions in the abdominal cavity. For more
effective diagnostics use a three-dimensional image
allowing to see the tumor from all sides. If a дополнить Ultrasound
dopplerography (blood flow examination), it can be detected
small tumors due to excessive proliferation of blood
- CT and MRI
Additional advanced research methods allow to evaluate
the spread of cancer, the state of the neighboring
органов и выбрать treatment tactics. For this purpose is better suited
MRI Computed tomography has one important disadvantage:
the density of the pelvic organs when it is held is about the same.
Поэтому даже обширный crayfish можно не различить из-за сходства с
- Methods for the determination of distant metastases
X-ray of the chest, CT abdominal scintigraphy
skeletons allow you to detect metastasis of cervical cancer and select
treatment tactics. These methods are used after initial installation.
diagnosis of invasive cancer, as well as to monitor the treatment of metastasis
and when symptoms of cervical cancer develop after surgery.
Blood test for cervical cancer
The scientist identified a special squamous cell antigen – SCC,
which can be considered a marker of cervical cancer. Level of this
antigen depends on the stage of the disease, involvement of lymph nodes and
total tumor mass. SCC is used to monitor effectiveness
treatment and early diagnosis of disease recurrence. After about 4-8
weeks after therapy, the level of antigen is reduced. If a
after that the marker has risen, then it can be suspected
Using the level of SCC antigen as a primary method
diagnosis of cervical tumors is unacceptable. There is a high probability
false positive and false negative results. So, the marker
increases with skin diseases (psoriasis, eczema), liver disease and
kidney, endometrial cancer and vagina. In addition, not all types
Cervical cancer gives high levels of this antigen. So absolutely
There is no reliable test for cervical cancer.
Screening for cervical cancer
Unlike many other cancers, cervical tumors
develop a long period. This allows you to identify women from
risk groups and with the initial stages of the disease. For screening
There is a wonderful method – cytological Pap test.
The sensitivity of this method is about 90%. That is, 9 of
10 women with cancer, the usual smear “on cytology” allows you to identify
All women between 25 and 49 must be screened once
in three years. After 50 years it is enough to take a smear on cytology 1
once in 5 years.
Metastases of cervical cancer
Cervical cancer is a highly aggressive tumor. He early
metastasizes by spreading through lymph, blood or
germination in organs. Thus, approximately 30% of patients with stage II have already
there are tumor cells in the nearest lymph nodes. Among the remote
organs often affect the lungs, liver and bones.
Treatment of cervical tumors
Cervical cancer is not a sentence. Modern treatment methods allow
полностью излечить эту disease. In the early stages it is possible
preservation of organ and childbearing function. In the later stages
use an integrated approach. A woman loses as a result
opportunity to have children, but the quality and duration of her life
remain high. Before determining the tactics of treatment, the doctor
be sure to study the histological examination of the tumor and
determines its stage.
- Cervical conization (with non-invasive cancer)
Removing a part of the neck in the form of a cone – the most common
surgery for severe dysplasia and in situ cancer. Intervention
under anesthesia (general anesthesia or epidural
anesthesia). If a подозревается легкая или умеренная дисплазия, то
Doctors try to avoid this operation.
There is some risk for unborn women: clearance
cervical canal can narrow and overgrow, leading to
difficulties of conception and carrying. However, the benefits of complete removal
non-invasive cancer “on the spot” significantly exceeds all possible
risks. The deleted fragment is sent for histology to deliver
- Extended uterus extirpation
The most common treatment used for extensive surgery is to remove
the uterus, its surrounding tissues and parts of the vagina. Such volumes
interventions are due to the fact that most cancers are
running In rare cases of micro-invasive cancer in women
carry out only the removal of the neck (if pregnancy is planned).
Perhaps such a treatment for cervical cancer stage 1.
- Radiation therapy
Irradiation is the main treatment for cervical cancer. Him
used as an adjunct to surgery during the initial stages or as
the only way with far advanced processes. Often to radiation
therapies have resorted to alleviating the suffering of the patient in neglected
cases. After treatment with rays, complications in the form of lesions are possible.
skin, internal organs, which are most often non-dangerous.
Chemotherapy drugs (cisplatin) are used to
treatments are quite rare, and only as an addition to surgery and
|Papanicolaus Evaluation||Invasive Cancer Treatment|
Observation after treatment
All life after cancer a woman should be observed in
oncogynecologist. The first 2 years of the survey is carried out every three
month, then up to 5 years, you need to pass inspection every six months. AT
subsequent enough to be examined every year.
Cancer and pregnancy
Cervical tumor detection during pregnancy is quite
a rare thing. AT связи с изменениями иммунитета crayfish у женщин в
The position develops faster and flows more aggressively. Unfortunately, in
first trimester the only way to save the life of the patient
is an abortion with subsequent exposure and
operation. Only in the third trimester is it possible to postpone treatment until
maturation of the fetal lungs and caesarean section. Usually wait until 32
weeks of pregnancy. Simultaneously with a caesarean section, they perform and
cancer removal surgery cervix.
Prognosis for cervical tumors
- Five-year survival for stage 1 cancer is
- At stage 2, this figure is slightly lower, in the region of 65-75%
- Survival decreases sharply in 3 stages (up to 30%)
- Whereas in the started cases 4 stages a five-year boundary
survive only 10% of patients.
ATсе вышеуказанный цифры достоверны лишь при полноценном лечении
Prevention of cervical cancer
The main way to prevent cervical cancer is considered
vaccination. ATакцина Гардасил разработана против 4 видов вируса. Two
of these (16 and 18 type), cause about 70% of cancer cases, and 6 and 11 types
associated with most cases of genital warts. ATакцина
underwent extensive clinical studies for 15 years,
showing high performance and safety.
It is recommended to vaccinate girls aged 11 – 13 years.
ATозможна вакцинация и девушек до 26 лет, особенно если они не
started sex life and were not infected with the above types
viruses. For full protection requires three times the introduction
drug for 6 months. The duration of the vaccine
finally not determined, minimum – 5-8 years.
ATакцина Гардасил гарантированно защищает женщину от crayfishа,
caused by 2 types of virus. But 30% of cancers are caused by rarer
видами ATПЧ или имеет невирусное происхождение. Therefore, all
women who receive the vaccine still need regular checkup
gynecologist with a cytological smear.
- Treatment of precancerous diseases
ATсе изменения клеток шейки матки, способные превратиться в
Oncology, called precancerous conditions. These include
dysplasias, extensive leukoplakia and other pathologies. AT среднем на
The development of cancer from precancer takes 10-15 years. Therefore, in time
seen and cured dysplasia is a good way to avoid
malignant process. Therefore, it is important to pass
regular examination and consult a doctor at the first symptoms
- Condom use
Barrier contraceptive methods significantly reduce the risk of transmission
ATПЧ, хотя и не защищают от него полностью.
Is the appearance of genital warts a risk factor or
symptom of cervical cancer?
Genital warts (genital warts) are caused
non-oncogenic virus types. Although they may cause discomfort
and aesthetic inconvenience, for cervical cancer is not relevant.
A smear on oncocytology revealed mild dysplasia of CIN1 and
inflammatory process. Do I need to conizate the cervix?
Mild dysplasia in most cases goes away on its own and
requires only observation twice a year. In addition, inflammatory
the process (cervicitis) could affect the assessment of smear results.
Therefore, it is first necessary to find out the cause of inflammation, treat
her, and then repeat cytology.
How many people live at stage 2 of cervical cancer?
For the second stage is characterized by local spread of the tumor.
During radical surgery followed by radiotherapy
and regular observation, 75% of women are experiencing a five-year milestone. AT
Oncology patients who have lived for 5 years without a relapse are conditionally considered
What kind of initial treatment can be done if in the future
Have a desire to have children?
ATопрос о методе лечения решается в первую очередь лечащим
doctor: oncogynecologist. In addition to the stage, the type of tumor plays a role,
возраст женщины и сопутствующие diseases. With favorable
Circumstances can be performed: removal
только cervix. Pregnancy after this intervention
Three years have passed since surgery to remove a cervical tumor. how
Can you suspect cancer metastases? Is there enough tests for
gynecologist twice a year?
Metastases to distant organs make themselves felt quite often.
Sudden jaundice, pain in the bones, pathological
fractures, headaches and loss of consciousness. If a метастазы возникают
in the nearest lymph nodes, there may be no symptoms. ATсе
additional examinations prescribed by the doctor in the light of complaints and the outcome
past operation. Usually standard examination twice a year.