Contents of the article

Every year, about 400,000 new cases of cervical cancer (PLUM) and more than 200,000 deaths from this disease are registered worldwide. 81% of cases occur in developing countries. In Russia, cervical cancer ranks 2nd among oncogynecological pathologies (after uterine cancer). The standardized incidence rate for 2006 was 12.7, mortality rate - 5.1 per 100,000 women. In 2006, 13,268 new cases of cervical cancer were registered in Russia, and 6,047 patients died from disease progression.
The incidence, or more precisely the detection rate, of malignant tumors of the cervix in Russia as a whole is not increasing. However, there is a clear increase in the incidence of PLUM among women under the age of 40 years. The increase in incidence is especially noticeable in the group of women under 29 years of age (by 2.1% per year). Over the past 10 years, there has also been an increase in the incidence of adenocarcinoma of the cervical canal.
In addition, it should be noted that there has been a significant increase in neglect indicators. The proportion of patients with stage III-IV cervical cancer in 1982 was 24.8%; in 1990 it was 34.2%, in 1992 - 37.1%, in 1995 - 38.8%, and in 2003 - 39.7%. In some regions of Russia, these indicators were exceeded.

Etiology of cervical cancer

Of the etiological factors, the main role belongs to infectious agents, and primarily viruses. The leading role in the induction of tumor growth is played by HPV, especially types 16 and 18, as well as types 31 and 33, which are less common in cervical cancer. Highly oncogenic HPV types (16 and 18) were identified most often in CIN I-III and squamous cell carcinoma, with type 16 being more common in squamous cell carcinoma, and type 18 being more common in low-grade and adenocarcinoma.
Thus, the cause of cervical cancer in 90% of cases is HPV infection. Moreover, in 95% of cases, HPV is localized in the zone of transitional epithelium, where up to 90% of cervical dysplasias occur. It is precancerous diseases of the cervix, in which HPV types 16 and 18 are detected, that have the greatest risk of developing into invasive cancer.
The role of the Herpes simplex type II virus in the occurrence of cervical cancer should not be underestimated, especially in combination with cytomegalovirus and other infectious agents.
Risk factors:
early onset of sexual activity (under the age of 16 years, the risk of developing cervical cancer increases 16 times, 16-19 years - 3 times; during the 1st year of menstruation - 26 times, in the period from 1 to 5 years from the beginning of menarche - 7 times);
sexual activity, frequent change of sexual partners (> 4 partners - 3.6 times, and under the age of 20 years - 1st partner - 7 times);
poor sexual hygiene, sexually transmitted diseases, viral infections (especially HPV);
smoking tobacco, especially before the age of 20, increases the risk of developing cervical cancer by 4 times (smoking reduces immune defense, in addition, nicotine plays the role of a co-carcinogen);
lack of vitamins A and C in food, oral contraceptives may be used.

Pathological anatomy of cervical cancer

The pathological process can be localized on the vaginal part of the cervix or in the cervical canal. The following clinical and anatomical forms of cervical cancer growth are distinguished: exophytic (32%), endophytic (52%), mixed (16%) and ulcerative-infiltrative, which occurs in advanced stages of cervical cancer and is mainly a consequence of tumor disintegration and necrosis with the endophytic form.
Histological types of tumor:
squamous cell carcinoma - 68-75% (keratinizing: highly differentiated - 14%, moderately differentiated - 54.8%, non-keratinizing - poorly differentiated - 27.5%);
adenocarcinoma - 10-15%; glandular squamous cell - 8-10% and rare forms of tumor: endometrioid adenocarcinoma, clear cell adenocarcinoma and small cell tumors.

Metastasis of cervical cancer

Cervical cancer can spread throughout the body of the uterus, vagina and parametrium. More often it metastasizes lymphogenously, but hematogenous metastasis is possible. Regional lymph nodes are located near the cervix and body of the uterus, hypogastric (internal iliac, obturator), common and external iliac, presacral and lateral sacral. Characteristic is early metastatic damage to the lymph nodes; their frequency is: with IA1 - 0.5-0.7%; IA2 - 5-8%; IB1 - 10-13%; IB2 - 16-30%; ON - 24-30%; IIB - 20-33%; III - 35-58%; IV- 55-65%. Hematogenous metastasis is detected when the tumor spreads widely: to the lungs 8-10%; liver, bones - up to 4%, less often in other distant organs.
Based on the degree of development, cervical cancer can be divided into preclinical and clinically evident (invasive) forms. Preclinical ones include preinvasive cancer and microcarcinoma (with minimal invasion of up to 3 mm). This pathology should be considered as a compensated process in which clinical signs of cancer do not yet appear; This is an early oncological pathology, which is characterized by minimal tumor growth, low potential for metastasis, and preservation of tissue immune reactions. Further spread of complexes of cancer cells into the stroma (invasive growth) leads to the emergence of new qualities of the tumor process: aggressive growth, spread beyond the organ, high potential for metastasis, etc.
The beginning of tumor growth should be considered pre-invasive cancer (cancer in situ, intraepithelial cancer, stage 0). This is a microscopic form of cervical cancer and is characterized by complete replacement of the epithelial layer with anaplastic cells, loss of complexity and polarity of all layers. A so-called neoplastic membrane is formed, but the process of anaplasia occurs within the epithelium and does not extend beyond the basement membrane. Like invasive cancer, it can have varying degrees of differentiation - from the more differentiated to the anaplastic form. In intraepithelial cancer, the process is limited to the basement membrane, but anaplastic cells, spreading throughout the entire layer, can grow into erosive glands. The release of complexes of atypical cells into the stroma is accompanied by disruption of the basement membrane and signifies the beginning of invasive growth - microinvasive cancer. The development of microinvasive cancer, as a rule, occurs against the background of preinvasive cancer, as an exception - against the background of dysplasia. Microinvasive cancer includes cancer with invasion up to 3 mm (T1A1). The morphological signs characterizing this process include the protective reaction of subepithelial tissue in the form of pronounced lymphoid-plasmacytic infiltration, which practically disappears with invasion of more than 3 mm. In patients under the age of 40, the vaginal part of the cervix is ​​most often affected, after 40-45 years - the cervical canal. The average age of patients with initial forms of cancer is 40 years, with severe invasive forms - 49-55 years.

Cervical Cancer Clinic

Patients with initial forms of cervical cancer often do not notice mild symptoms of the disease, which can only be identified with a thorough examination. They usually complain of watery, cloudy leucorrhoea, menstrual irregularities, intermenstrual or contact bleeding. Such women have a history of long-existing pathological processes in the cervix, for which treatment was carried out. In a significant number of patients with early cancer, visual changes are detected that are not suspicious for cancer: pseudo-erosion, leukoplakia, polyps, ruptures and deformation of the cervix. An important clinical sign is vulnerability and increased bleeding of the mucous membrane of the cervix during a gynecological examination.
With clinically significant cervical cancer, one of the main symptoms is bleeding of varying intensity. During reproductive age, they have the character of acyclic bloody discharge - “daub” before and after menstruation. In the premenopausal period, erratic, prolonged bleeding may be observed, which is often interpreted as dysfunctional; in this case, the cervix and cervical canal are not examined, which leads to diagnostic errors. During the postmenopausal period, this symptom is observed in most patients and appears quite early, which is most likely due to the fragility of the cervical vessels and the more frequent development of anaplastic forms. Characteristic of cervical cancer is contact bleeding that occurs during sexual intercourse, defecation, physical activity and vaginal examination. Leucorrhoea occurs in 1/3 of patients with cervical cancer. They can be watery, mucopurulent, dirty, sanguineous and permanent. Pain in the lower back, sacrum, rectum, radiating to the lower extremities, is characteristic of advanced cervical cancer and occurs when parametric tissue is involved in the process, compression of the nerve trunks by infiltrates, damage to the lymph nodes, as well as the pelvic bones and spine.

Diagnosis of cervical cancer

With clinically significant cervical cancer, exophytic or mixed tumor growth, it is not difficult to establish a diagnosis. When examined in a speculum, the cervix is ​​hypertrophied and deformed due to the presence of a lumpy, bleeding tumor or a crater-shaped ulcer with purulent edges, often extending to the fornix. Vaginal examination should be performed carefully so as not to cause bleeding. When the tumor grows endophytically or is localized in the cervical canal, changes in the mucous membrane of the vaginal part of the cervix may be insignificant or even absent; only palpation and additional studies help clarify the diagnosis.
Bimanual and rectovaginal examination reveals compaction, deformation, hypertrophy and barrel-shaped shape of the cervix. An increase in the supravaginal part of the cervix indicates damage to the cervical canal, the transition of the tumor to the body of the uterus or an endophytic form of cancer. Determination of infiltrates in the parametrial tissue and compactions near the pelvic wall confirm the presence of a common process.
To identify the initial forms of cervical cancer, the following are required: extended colposcopy (highly atypical epithelium is detected), targeted taking of smears from the cervix and cervical canal for cytological examination, targeted biopsy of the most suspicious areas of the cervix and curettage of the cervical canal. In the initial forms of cervical cancer, only a knife biopsy should be performed (a conchotome can be used to take material only in cases of a widespread process and a pronounced exophytic component of the tumor). In cases where there are changes that involve the entire surface of the cervix, or colposcopic and cytological studies fail to obtain convincing evidence of malignant growth, conization of the cervix is ​​performed with curettage of the cervical canal. With intraepithelial cervical cancer and initial invasion, conization can be not only a diagnostic, but also a therapeutic procedure.
For clinically pronounced forms of cervical cancer, after morphological confirmation of the diagnosis, clarifying diagnostic methods are used to establish the extent of the tumor process and select the optimal method of treating the patient. For this purpose, ultrasound (if indicated - computer or magnetic resonance imaging) tomography of the pelvis, abdominal organs and retroperitoneal space, radiography of the lungs, excretory urography, and if indicated - cystoscopy and sigmoidoscopy are performed. In recent years, the tumor marker SCC (norm less than 1.5 ng/ml) has been used.

Cervical cancer treatment

The choice of treatment method depends on the patient’s age, stage of the disease, location of the tumor, its histological structure and concomitant diseases.
Currently, surgical, combined, combined radiation, antitumor drug and complex treatment of patients with cervical cancer are used.

Surgical treatment

Only the surgical method is used mainly in the early stages of cervical cancer and in women of reproductive age.
The increase in morbidity among young women acutely raises the issue of organ-preserving treatment, which makes it possible to preserve fertile function. Organ-preserving operations on the cervix include: cone-shaped excision, knife conization or amputation, laser or ultrasound cone-shaped excision or amputation, radiosurgical method (“Surgitron”).
At the same time, organ-preserving operations can be performed only under certain conditions: minimal invasion of the tumor into the stroma (up to 2-3 mm); absence of tumor emboli and vascular invasion; absence of tumor at the resection margin; squamous cell (well- or moderately differentiated cancer); location of the tumor in the ectocervix; age up to 40 years, presence of an experienced morphologist; possibility of dynamic observation. In addition, organ-saving operations can only be performed in a specialized clinic that has appropriate diagnostic and therapeutic equipment and the ability to objectively analyze the results of treatment, taking into account the absolute criteria of its effectiveness.
Indications for performing hysterectomy from the upper 1/3 of the vagina for intraepithelial cancer and microcarcinoma are:
age of patients over 45 years;
predominant localization of the tumor in the cervical canal;
common anaplastic variant with ingrowth into the glands;
the absence in the preparation after previously performed conization of areas free from pre-invasive cancer (especially intersection police);
technical impossibility of carrying out wide conization due to a conical (in nulliparous) or shortened cervix, with smoothed vaginal vaults, cicatricial changes in the upper 1/3 of the vagina, malformations of the external genitalia;
combination of pre-invasive cancer with uterine fibroids or adnexal tumors;
spread to the vaginal vaults;
relapses after previous treatment (cryo- or laser destruction).
For IA2 and 1B1 in women under the age of 45, it is advisable to begin treatment with surgery (extended hysterectomy leaving the ovaries), since this ensures a better quality of life for the woman. With a tumor size of up to 1 cm and a depth of invasion of up to 1 cm (in the absence of metastases in regional lymph nodes), treatment can be limited only to radical surgery without adjuvant therapy.
In addition, extended hysterectomy from the upper 1/3 of the vagina is indicated for prognostically unfavorable histological tumor types (poorly differentiated, glandular, clear cell cancer), even with slight tumor invasion into the stroma of the cervix.

Combined method

The combined method involves the use of two fundamentally different methods of treatment - surgical and radiation in different sequences. This method is used mainly in the treatment of patients in stages IB and PA. Depending on the size of the tumor, radiation therapy is carried out before or after surgery - extended hysterectomy (Wertheim type). The operation is indicated in the following situations:
young and middle-aged patients (up to 50 years);
combination with pregnancy;
combination with uterine fibroids and inflammatory processes or tumors of the appendages;
tumor resistance to radiation, revealed during radiation therapy, especially in cases of a swollen “barrel-shaped” neck due to infiltration;
the presence of metastases in regional lymph nodes.
For large exophytic tumors TIB2 and in all cases T2A
Preoperative external beam or intracavitary radiation therapy with a total dose of 30 Gy is preferred.
Postoperative external pelvic irradiation is indicated in the presence of metastases in distant lymph nodes and deep tumor invasion (> 1 cm). If preoperative radiation therapy was performed at the first stage of treatment, then when radiation therapy is performed in the postoperative period, the total dose is 30 Gy. When performed at the 1st stage of the operation, the total dose of postoperative radiation increases to 45-50 Gy.

Combined radiation therapy

Combined radiation therapy is used for all stages of cervical cancer, but most often for PA, B and especially stage III. If there are contraindications to surgery - for TIA2, TIB and TPA.
Contraindications to combined radiation treatment are: inflammatory processes in the pelvis in the form of encysted pyosalpinx, endometritis, parametritis; distant tumor metastases, invasion of the mucous membrane of adjacent organs; acute nephritis, pyelitis, chronic diseases of the bladder, rectum and colon with frequent exacerbations; abnormalities in the development of the reproductive system that do not allow intra-abdominal gamma therapy; ovarian tumors; uterine fibroids and pregnancy.
Combined radiation treatment consists of external pelvic irradiation and intracavitary administration of radioactive drugs. Remote irradiation is carried out on gamma-therapeutic installations or with photons on electron accelerators in a statistical or mobile mode with classical dose fractionation to the area of ​​the primary tumor and the zone of possible parametric and lymphogenous spread of the tumor, alternating it with sessions of intracavitary irradiation.
Intracavitary irradiation is carried out mainly on devices with automated introduction of sources into special metrocolpostats (AGAT-V, AGAT-VU, Selectron, Microselectron, ANET-V, etc.).

Chemotherapy

The increasing number of patients with advanced stages of the disease makes it necessary to study the possibility of introducing antitumor drugs into clinical practice and their combination with existing standard treatment methods.
A number of studies have shown that cytostatics increase radiation damage to tumor cells by disrupting the DNA repair mechanism and synchronizing the entry of tumor cells into phases of the cell cycle that are most sensitive to radiation exposure.
Large international randomized trials (GOG85I GOG 120, RTOG-9001 and SWOG-8797) have shown a significant advantage of chemoradiotherapy over monoradiotherapy in the treatment of locally advanced cervical cancer. The use of cisplatin alone or in combination with other cytostatics (fluorouracil, bleomycin, vincristine) made it possible to increase 5-year disease-free survival by 27%, 5-year overall survival by 15%, reduce the incidence of distant metastases by 20%, and the incidence of local recurrence - by 23% and by 39-46% to reduce the risk of death (Morris M., Rose R., Keys N. et al., 1999). Moreover, the results of treatment when using cisplatin in mono mode at 40 mg/m2 weekly for 6 weeks. against the background of combined radiation therapy were practically no different from the results of combination chemotherapy (cisplatin with other cytostatics), but treatment tolerability was better.
Neoadjuvant chemotherapy for locally advanced cervical cancer (T2ABN0-1M0) before surgery can increase the operability of patients in this category by up to 85%, reduce the rate of relapses by 18%, and also reduce the rate of detection of metastases in regional lymph nodes by 17%.
Neoadjuvant chemotherapy before a radical course of combined radiation therapy has not yet shown a significant improvement in treatment results, and in 2 of 11 large randomized studies, treatment results were significantly worse. However, during the treatment of patients in this category, a high level of toxicity was observed.
Adjuvant chemotherapy after combined or surgical treatment, it is indicated for unfavorable prognostic signs: metastases in the pelvic lymph nodes, low degree of tumor differentiation, tumor spread beyond the organ.
Carrying out adjuvant chemotherapy after a radical course of combined radiation therapy is not always advisable, since tissue fibrosis occurs after radiation treatment; irradiation reduces bone marrow reserves, which limits the possibility of using sufficient doses of cytostatics; Cross-resistance and renal dysfunction may occur.
Chemotherapy is used as an independent treatment option for stage IV disease, its relapses and metastases. 1. Cisplatin - 40 mg/m2 IV once a week (6 weeks) during radiation therapy.
2. Campto - 40 mg/m2 IV once a week (5 weeks) against the background of a standard course of combined radiation treatment.
3. Cisplatin - 70 mg/m2 IV on days 1, 21 and 42;
ifosfamide -1.5 mg/m2 on days 1-3, 21-23, 42-44 with mesna on
background of radiation therapy.
4. Fluorouracil - 500 mg/m2 IV from days 1 to 5. After 2 days - external irradiation according to the dynamic fractionation scheme. The first 3 days, 3.5-4 Gy with intravenous administration of cisplatin 30 mg, then continue irradiation in the classical mode. Treatment should be combined with the prescription of protectors.
5. Cisplatin - 75 mg/m2 IV on day 1;
fluorouracil - 4 g/m2 IV 5-day continuous infusion on days 1 and 22 during combined radiation therapy.
6. Cisplatin - 40 mg/m2 IV once a week during radiation therapy;
gemcitabine - 100-125 mg/m2 IV once a week during radiation therapy.
7. Gemcitabine - 350 mg/m2 30-minute infusion weekly (5 weeks) during combined radiation treatment.
Neoadjuvant preoperative chemotherapy.
Immunotherapy:
leukocyte or recombinant a-interferon in the form of ointment applications or injections into the cervix in doses of up to 15 million units per course (can lead to cure of pre- or microinvasive cervical cancer or tumor regression);
interferon inducers (neovir, cycloferon) - in the treatment of dysplasia and cancer in situ;
systemic administration of 13-cis-retinoic acid with local application of os-interferon in the form of applications.

Treatment planning for patients with cervical cancer

Pre-invasive and micro-invasive cancer (stages 0 and TlalNOMO):
women of reproductive age, in the absence of vascular invasion and other contraindications - organ-preserving operations;
for contraindications - hysterectomy with the upper 1/3 of the vagina and preservation of the ovaries;
for women over 45 years old - extirpation of the uterus with appendages and the upper 1/3 of the vagina;
in case of contraindications to surgery, intracavitary radiation therapy with a total dose of 40 Gy.
Stage Tla2NOMO (Ial):
women of reproductive age (up to 45 years) - extended hysterectomy from the upper 1/3 of the vagina, preservation of the ovaries and their exposure to the upper abdominal cavity;
women over 45 years old - extended extirpation of the uterus with appendages and the upper 1/3 of the vagina;
in case of contraindications to surgery - combined radiation treatment.
Stage (Tla2NlM0):
if metastases are detected in the lymph nodes after surgery - external pelvic irradiation up to a total dose of 44-46 Gy.
Stage TlblNOMO (Ib1):
if the tumor size on the cervix is ​​less than 1 cm and the depth of invasion is less than 1 cm - extended hysterectomy with the upper 1/3 of the vagina and preservation of the ovaries in women under 45 years of age, without adjuvant therapy;
if the tumor is large and the depth of invasion is more than 1 cm, external irradiation of the pelvis or vaginal stump is indicated after surgery;
Stage T1b1MMO:
if metastases are detected in the lymph nodes - postoperative pelvic irradiation ± adjuvant chemotherapy or chemoradiotherapy;
Stage Tlb2N0M0:
external or intracavitary irradiation; women of reproductive age may receive neoadjuvant chemotherapy; at the 2nd stage of treatment - extended extirpation of the uterus with appendages and the upper 1/3 of the vagina;
in case of deep invasion - postoperative irradiation of the vaginal stump;
in case of contraindications to surgery - combined radiation therapy in combination with cytostatics.
Stage Tlb2NlM0:
if metastases are detected in the lymph nodes - external pelvic irradiation + adjuvant chemotherapy or chemoradiotherapy.
Stage T2a N0MO (Pa):
if only the vaginal vaults are affected, for women under 50 years of age - intracavitary radiation therapy followed by surgery - extended extirpation of the uterus with appendages and the upper 1/3 of the vagina;
in case of significant damage to the vagina - neoadjuvant chemotherapy or chemoradiotherapy, followed by a decision on the possibility of extended extirpation of the uterus and appendages;
with deep invasion and low degree of tumor differentiation in the postoperative period - irradiation of the vaginal stump;
for contraindications to surgery and for women over 50 years of age - combined radiation treatment in combination with cytostatics.
Stage T2aNlM0:
when metastases are detected in the lymph nodes in the postoperative period - external irradiation in combination with cytostatics.
Stage T2bN0M0 (lib):
for women of reproductive age with small cervical infiltrates - preoperative external irradiation of the pelvis followed by extended extirpation of the uterus with appendages and the upper 1/3 of the vagina;
with pronounced infiltrates in the parametrium - neoadjuvant chemotherapy ± external pelvic irradiation or chemoradiotherapy; subsequently - extended extirpation of the uterus with appendages and the upper 1/3 of the vagina;
in case of deep invasion - irradiation of the vaginal stump in the postoperative period;
for contraindications to surgery and for women over 50 years of age - combined radiation treatment with simultaneous or sequential administration of cytostatics.
Stage T2bNlM0:
if metastases are detected in the lymph nodes - in the postoperative period, adjuvant chemotherapy or chemoradiotherapy.
Stage T3aN0M0 (IIIa):
for women of reproductive age - an attempt at neoadjuvant chemotherapy + radiation therapy or chemoradiotherapy with assessment of the effect and decision on the possibility of performing radical surgery. If possible, extended extirpation of the uterus with appendages and the middle or lower 1/3 of the vagina, followed by postoperative irradiation;
in the absence of effect, and for women over 50 years of age, combined radiation therapy in combination with cytostatics (chemoradiation treatment).
Stage T3aNlM0:
if metastases are detected in the lymph nodes during surgery - external irradiation + adjuvant chemotherapy in the postoperative period;
if metastases are detected after combined radiation treatment, an attempt at extrafascial lymphadenectomy is performed.
Stage T3bN0-lM0 (Illb):
chemoradiotherapy;
with detectable metastases in the lymph nodes, an attempt at extrafascial lymphadenectomy.
Stage T4aN0-lM0, T4bN0-lM0 (IVab):
radiation therapy in combination with cytostatics according to an individual plan.

Prognosis for cervical cancer

Unfavorable prognosis factors include:
high prevalence of the process: 5-year survival rate for stage I is 90-100%, for stage IV - 0-11%;
metastases to the lymph nodes, as well as their number, location and size: in the absence of metastases, the 5-year survival rate is 85-90%, in the presence - from 20 to 74%;
large tumor sizes: with a tumor less than 2 cm, 5-year survival rate is 90%, 2-4 cm - 60%, more than 4 cm - 40%;
tumor infiltration of the parametrium: in its absence, 95% are alive for 5 years, in the presence of infiltration - 69%;
deep invasion: 90% are alive for 5 years with invasion less than 1 cm, more than 1 cm - 63-78%.
In addition, the prognosis worsens in poorly differentiated, clear and small cell cervical cancer.
When carrying out combined radiation treatment, unfavorable factors are anemia and thrombocytopenia.
5 year survival rate: stage 1a - 98-100%, lb - 89-96%; II - 62-80%; III- 30-70%; IV-0-11%.

Recurrence of cervical cancer

Recurrences of cervical cancer are more often detected during the first 2 years after the end of treatment. After combined treatment they usually develop in the vaginal stump, after combined radiation - in the cervix and body of the uterus, in the parametrium. Surgical treatment is indicated when the relapse is localized in the uterus or the presence of isolated metastases in the pelvic lymph nodes. For single metastases and a stump or lower parts of the vagina, application or interstitial radiation therapy can be performed. Treatment should be combined with antitumor drug therapy. If surgical or radiation treatment is not possible, combination chemotherapy is indicated:

Cervical stump cancer

Cancer of the cervical stump occurs in 0.14-4.75% of patients previously operated on for supravaginal amputation of the uterus. Main clinical symptoms: pain, menometrorrhagia, dull aching pain in the lower abdomen and lower back. A gynecological examination reveals a “barrel-shaped” cervix with ulcerations and papillary growths. The examination is the same as for cervical cancer, but it must be remembered that with cancer of the cervical stump the path of tumor spread may change. Treatment uses surgical, combined or combined radiation methods. Surgical intervention is accompanied by high surgical traumatism due to disruption of the topographic-anatomical relationships of organs in the pelvis. For cervical stump cancer, it is advisable to carry out combined treatment (surgery and radiation therapy in different sequences). If surgery is not possible, combined radiation therapy is used. The question of the need to prescribe cytostatics is resolved, as in the case of cervical cancer.

Metastases occur in cervical cancer, already at later stages of the disease. This type of oncology was no exception. In some cases, individual metastases make themselves known faster than the main tumor.

Types of metastasis

Cervical cancer, metastasis has two widows, the most widespread is lymphogenous. In this case, the atypical cell enters the lymph and affects the lymph nodes.

Regional lymph nodes that are damaged in cervical cancer are six groups:

1. pericervical;
2. periuterine;
3. obturator;
4. internal iliacs;
5. external iliac;
6. common iliacs.

Metastasis to the peri-aortic and inguinal lymph nodes occurs much less frequently. The iliac lymph nodes are the first to be affected by metastases, and later all other types.

The second type of metastasis is hematogenous. It is characterized by the movement of a cancer cell through blood vessels along with blood. In this case, a secondary neoplasm can occur in distant organs; the liver, bones, lungs and kidneys are most often affected.

Disease in numbers

Despite the fact that the tumor is localized in such a way that it can be detected by visual examination by a gynecologist, in 40% of cases the pathology is diagnosed in an advanced stage. Mortality within the first year after detection of the disease occurs in 20% of patients, the main reason for this is the prevalence of the process throughout the body in the form of metastases, as well as relapse of the pathology.

The prognosis for patients with identified individual metastases is disappointing. According to statistics, only 10-15% of women survive to one year with a similar diagnosis. Treatment in most cases is palliative and ineffective.

According to studies of cervical cancer patients with different stages in the gynecology department of the Federal State Institution “RNIOI” of the Ministry of Health and Social Development of the Russian Federation, the following statistics were revealed:

• the average number of patients with metastases at different stages of pathology was 12.5%;
• Lymph nodes in cervical cancer were affected in 55%, lungs and pleura in 19%, and liver in 11.6%;
• the frequency of metastasis depends on the stage and depth of tumor invasion. Thus, at the first stage, secondary lesions were detected in no more than 2.8% of patients, at the second stage in 10.2%, and at the third degree of pathology in 15%. At the fourth stage, metastases occurred in more than 76% of patients;
• Depending on the depth of invasion, metastases were noted as follows: lesions up to 3 mm. - 5%, up to 5 mm. - 6.7%, up to one centimeter 34%. With invasion deeper than one centimeter, metastasis is more than 54%;
• most often metastases form in women aged 40 to 60 years, their percentage is 28.5%;
• interesting data were obtained regarding the timing of the occurrence of secondary lesions. In 38% of patients, metastases occurred in the first year of pathological progression. From one to three years, metastases were detected in 50% of women, in 8% secondary formations were identified with a period of disease progression from 3 to 5 years. Patients with a disease duration of more than five years experience metastases in 3.5% of cases.

Patients with cervical cancer with metastases have different mortality rates. Survival depends on the stage of the disease, tumor invasion, and treatment undertaken. So five-year survival rate:

Symptoms of the disease

The symptoms of cervical cancer in the early and later stages are different. The greater the progress of the pathology, the more pronounced the clinical picture. Metastases also manifest themselves, in some cases even more active than the main tumor. Thus, damage to the pelvic lymph nodes is necessarily accompanied by edema of the lower extremities.

Liver affected by metastases

With hematogenous metastasis, symptoms depend on which organ is affected. For example, localization of metastasis in the lungs is accompanied by persistent cough, hemoptysis, fever, shortness of breath, and difficulty breathing. If the liver was affected, the main signs of metastases are severe pain in the abdominal cavity, yellowness of the skin and mucous membranes, nausea and vomiting. Damage to the bones is accompanied by incredible pain, which cannot be completely removed even with the help of strong painkillers.

Primary cervical cancer is characterized by the following manifestations:

• leucorrhoea mixed with blood in the intervals between the menstrual cycle or after menopause. In later stages, bleeding may occur;
• contact bleeding during sexual intercourse;
• discharge of pus with a characteristic fetid odor, this sign indicates severe intoxication and tumor disintegration;
• pain in the pelvis, sacrum and lower back occurs when a tumor grows through the nerve endings.

Any manifestations uncharacteristic of everyday life must be examined without fail. Early diagnosis is half the success of treatment. If a tumor is detected, it should be carefully examined to understand the degree of its invasion into the walls of the cervix, its histological and morphological composition, the stage of pathological progress and other data. All this allows us to assess the criticality of the situation and predict the possible occurrence of metastases, thereby preventing the development of secondary foci of malignancy. If there are metastases in the anamnesis, the prognosis worsens significantly, thereby treatment in many cases takes on a symptomatic and palliative nature. Thus, allowing to prolong and improve the patient’s quality of life.

Video: treatment methods for cervical cancer

How useful was the article for you?

If you find an error, simply highlight it and press Shift + Enter or click here. Thank you very much!

There are no comments or reviews for “Metastases in cervical cancer”

Add a comment Cancel reply

Types of cancer

Folk remedies

Tumors

Thanks for your message. We will fix the error soon

Cervical metastases

The cervix represents the lower part of the uterus, one end of it opens into the uterine cavity, and the other ends into the vagina. Sperm rise from the vagina through the cervical canal and enter the uterine cavity. During childbirth, the cervix opens to allow the baby to be born. Among the diseases that occur in the cervix, cancer, a malignant tumor, occupies one of the first places.

This insidious disease can affect the cervix in older people, but recently it has also occurred in young women. Risk factors for cervical cancer include exposure to radiation, chemical components, viral infections, genital herpes and human papillomavirus. Most often, the tumor occurs in women who began sexual activity early, have had early pregnancy and early childbirth, are promiscuous, and have had several abortions.

Risk factors also include inflammatory diseases that have become chronic. Hormonal drugs taken for a long time can cause the development of cancer. Metastases occur in the early period of cancer development through the lymphogenous route, spreading to the lymph nodes of the pelvis, groin and retroperitoneum, and growing into the wall of the bladder and rectum.

Symptoms such as whitish vaginal discharge with a small admixture of blood should alert you, this means that ulcerations have already appeared on the cervix and blood vessels are ruptured, the disease is accompanied by pain in the sacrum, lower back and lower abdomen. At a later stage, disturbances in urination and defecation are observed, and fistulas appear.

Cells of the main tumor (secondary cancer cells), having its structure and the ability to grow quickly, break away from it and attach to organs with a developed network of blood vessels, such as the liver, bones, lungs, and brain. Metastases are formed from these cells, and entire colonies of them are formed. The appearance of metastases disrupts the function of organs and tissues, reaching enormous sizes, leading to their death, poisoning them with waste products of the tumor. Cervical cancer most often spreads its metastases to nearby lymph nodes.

Found an error in the text? Select it and a few more words, press Ctrl + Enter

Many studies show that most often metastases from cervical cancer are found in the pericervical, periuterine, obturator, internal iliac, external iliac and common iliac lymph nodes. Much less often, metastasis of cervical cancer is present in the peri-aortic and inguinal lymph nodes.

Cancer cells move along the main path - from the peri-cervical and peri-uterine nodes to the internal iliac nodes, then to the common iliac and peri-aortic lymph nodes. There is a path of lymphatic metastasis from the pericervical and periuterine nodes to the external iliac and obturator, to the peri-aortic and sometimes to the inguinal lymph nodes.

The spread of cancer cells can occur in parallel along both paths, on one side or on both sides. Metastases grow very quickly, affecting pelvic fat, large vascular bundles, lungs, liver and other organs. In case of single metastases, it is possible to remove them surgically, but if they are multiple, only maintenance chemotherapy is used.

A dangerous threat to a woman’s health are metastases that affect the lining of the lungs, this disrupts the permeability and level of fluid accumulation, leading to compression of the respiratory organs and heart. Patients experience shortness of breath, chest heaviness and exhaustion. Common symptoms of cervical cancer and metastasis include weakness, weight loss, loss of appetite, sweating, fever, headaches and dizziness, pale and dry skin.

Specific symptoms include pain in the lower abdomen, slight spotting, and in rare cases heavy bleeding. In the later stages, the discharge acquires an unpleasant odor as a result of infection. Late stages of metastasis are characterized by swelling of the extremities and external genitalia; this pathology occurs when large vessels that drain blood from the lower extremities are blocked by metastases and as a result of metastasis to nearby pelvic lymph nodes.

Metastases compress the lymph nodes of the ureters, disable the kidneys, after which a persistent, progressive expansion of the renal pelvis and calyces occurs due to a violation of the outflow of urine in the pyeloureteral segment, problems with urination appear, the body is poisoned with toxins because urine ceases to be produced.

Treatment uses a combination of external and internal radiation therapy.

But before proceeding with these manipulations, the presence of cancer cells in the lymph nodes and the size of the lymph nodes are assessed, for this purpose computed tomography or magnetic resonance imaging is used. If malignant cells are found in the lymph nodes of the upper abdominal cavity, additional examination is required to identify tumor metastases in other organs.

Oncological diseases - malignant tumors formed from epithelial cells, have the ability to rapidly divide and multiply in the organs and tissues of the body. The pathological degeneration of ordinary cells into tumor cells is associated with many factors. To stop the process of metastasis, traditional medicine offers many different options.

The rectum is the end of the large intestine and the end of the digestive tract. It is located in the pelvic cavity, its length is cm, the diameter at the beginning is 4 cm, at its widest part it is 7.5 cm, at the end the rectum narrows to the size of a slit at the level of the anus. The causes of rectal cancer are still being studied; it is believed that this disease is provoked.

Metastases help cancer cells spread throughout the body from the main site to other parts of the body, organs such as the brain and liver. Metastatic tumors usually appear in the later stages of cancer. The spread of metastases can occur through the blood as a result of cancer cells breaking away from the primary tumor. Penetrating into blood vessels that are pathologically altered.

Lymph nodes perform a protective function, protecting the body from infections and inflammation. They are located everywhere, surrounding every organ, accumulating in the area of ​​large vessels. They are connected to each other by vessels through which lymph flows, formed from tissue fluid, washing all tissues of the body, including tumors. Malignant tumors have a loose structure and their cells tend to break off and.

The information on the site is intended for informational purposes only and does not encourage self-treatment; consultation with a doctor is required!

Cervical cancer metastases

The cervix is ​​its lower section, in the center of which the cervical section is located; its first end enters the uterine cavity, the second into the vagina. The most common pathologies of this female organ are cancerous tumors with metastases to other organs. This cancer usually affects women whose age ranges from 40 to 60 years. However, recently there has been a rejuvenation of this deadly disease, that is, younger women also suffer from it.

Cervical cancer – what is it?

Tumor of malignant origin. Its development occurs due to the cells that line the inside of the cervix. This is the most common disease among the female half of humanity. Judging by statistics, about half a million women all over the planet suffer from it every year.

Cancer often metastasizes to bone tissue, lymph nodes, lung and liver. It is clear that their presence is a very bad sign. In medical practice, there are cases where some women managed to cure it.

Forms of cancer

Depending on the histology (cellular structure) the tumor has, this type of disease is divided into the following main types:

1. Squamous cell – cancerous cells that line the vagina.
2. Adenocarcinoma is cancer cells from the tissue of the cervical canal.

The first squamous cell type is considered less aggressive and, accordingly, easier to treat.

Reasons for the development of oncology

There are several reasons, their simultaneous action can cause this deadly type of oncology.

papillomavirus

Today, this virus is considered one of the main causes of the development of this type of cancer. It can cause the degeneration of healthy cells into malignant ones. According to research, out of 100 currently known papilloma viruses, 18 of them, having high oncogenic properties, can and do cause the appearance of cancer cells.

Age

Women of mature and old age are most often at risk. Less often - younger women.

Oral contraceptives

According to research, the use of oral contraceptives affects the female body in two ways. On the one hand, with prolonged use, the risk of developing cancer increases. On the other hand, their use reduces the risk of cancer of the ovary or the uterus itself.

Smoking

Smoking also contributes to the appearance of cancer in the body. Especially in combination with an infection of human papillomavirus origin and taking birth control pills.

Cancer during pregnancy

It is very rare that cancer develops during pregnancy. But if such a nuisance occurs, treatment depends on the stage of the cancer and the stage of pregnancy. If, for example, he is in the first stages, and the pregnant woman is in the third trimester, then treatment may be postponed by doctors until delivery. Childbirth is carried out only by caesarean section. Otherwise, if treatment must be started immediately, the pregnant woman may be offered the option of terminating the pregnancy.

Metastases: risk factors

A cancerous tumor may appear due to the following risk factors:

• Chronic injections cause cervical cancer

poor ecology, increased levels of radiation;

from exposure to chemicals on the body;

viral infection: human papillomavirus or herpes;

promiscuity in sexual relations;

a large number of women having abortions;

with long-term use of hormonal medications;

chronic injections of recurrent significance.

Metastases - what is it?

Metastases in cervical cancer are one of the characteristic features of the course of this disease.

• The process by which cancer cells are separated from the tumor formation;
• The integrity of the walls is disrupted, resulting in cancer cells entering the circulatory system and lymphatic bed;

If this disease is present in the body, the lymphatic system is considered the most important way for it to spread to the tissues of other organs, especially in the later stages of oncology development. Metastases can also appear in the early stages along two currently known pathways:

1. Lymphogenous into the lymphatic system of the groin or pelvis.
2. Retroperitoneal into the walls of the rectum or into the bladder.

Secondary cancer cells, having the structure of the lesion itself and the ability to grow very quickly, are separated from the tumor, attaching to healthy organs that have a developed vascular network. This could be the brain or liver or lung.

Damage to a healthy organ by such cells first leads to dysfunction and then to death. Metastases most often affect the peri-cervical, periuterine, common iliac, internal or external iliac, and obturator areas. Less commonly, they can appear in the groin areas or near the aortic lymph nodes. Growth occurs quite quickly, poisoning the larger choroid plexus, lung, liver or kidneys with waste products from the cancer focus.

Symptoms and signs

Cancer can be asymptomatic for a long time and appear only after metastases have already appeared. Therefore, all women are recommended to undergo examination or examination by a gynecologist regularly. This is how cervical cancer can be detected in the early stages, and with effective treatment, one hundred percent recovery is not a myth, but a reality.

Symptoms of cervical cancer:

• spotting: scanty, not associated with the menstrual cycle, astringent, very often they can appear after intimacy;

Very important! If this type of discharge appears during menopause, especially if six months have passed since the cessation of menstruation, the woman should immediately undergo examination at a antenatal clinic. Any discharge with blood during this period may indicate cancer in the cervix until the result of the examination proves otherwise.

• pain during or after sexual intercourse in the perineum or lower back;
• bloody manifestations in the urine;
• other vaginal discharge that has a very unpleasant odor.

Clinical symptoms and treatment

Common clinical manifestations include:

• Excessive sweating is a sign of cervical cancer

increased body temperature;

heavy sweating;

frequent headaches or dizziness;

general weakness of the body;

pale or dry skin;

complete or partial lack of appetite;

weight loss;

Specific symptoms of manifestation:

• pain in the lower abdomen;
• bloody discharge;
• unpleasant-smelling discharge

At later stages of cancer development and metastases, urination problems and swelling on the outside of the genitals may appear. As you can see, the symptoms of the clinical manifestations of this oncology are very diverse. Therefore, at the first signs or when at least one of the above points is identified, you need to contact your treating gynecologist for a full examination.

Survival prognosis

The stages of development of cervical cancer and the survival rate are approximately as follows:

• Stage 1. At this stage, the cancerous tumor has not yet spread beyond the body of the uterus. The chance of recovery is 90%.
• Stage 2 of development. The cancer grows beyond the uterus, but there is no harmful effect on other organs yet. The chances are 75%.
• Stage 3 of development. The tumor spreads to both the uterus and the vagina. The chances of survival at this stage will be 40%.
• 4 last stage of development. The tumor affects nearby organs, and there is an intensive process of metastasis. The chances are reduced to 15%.

Post navigation

Leave a comment Cancel

You need to contact a dermatologist and surgeon. Treatment methods may vary depending on what your case is. These lesions are usually treated with cauterization, surgical excision, or radiation. .

Cancer - treatment and prevention can accept any traffic thanks to WP Super Cache caching

Metastases in uterine cancer

If cancer cells move from the main tumor through the bloodstream or through the lymph to other organs, secondary tumors can form - metastases.

Metastases in cervical cancer occur in the late stages of the disease. Sometimes they can manifest themselves before the main tumor.

Types of metastases in cancer

The spread of metastases in this type of oncology can occur in two ways:

1. Lymphogenic – cancer cells through the lymph affect the lymph nodes;
2. Hematogenous - atypical cells move with the bloodstream and affect distant organs (liver, lungs, bones).

Usually the tumor is located so that it is easy to detect when examined by a gynecologist. However, diagnosis of the disease (uterine cancer) in 40% of cases occurs in an advanced stage.

In later stages of cancer, metastatic tumors appear. Due to the loose structure inherent in malignant tumors, cancer cells (altered) break away from the tumor and enter the blood or lymph.

Circulating with the blood, pathological cells enter healthy tissues and organs. Tumors appear there and are called metastases. This process of spreading metastases is called hematogenesis.

Metastasis occurs in the lymph nodes (first in the nearest ones, then in the distant ones). Cancer cells enter the peri-cervical and peri-uterine lymph nodes, then into the internal iliac, then into the iliac and peri-aortic lymph nodes. This is a lymphogenous process of metastasis.

The most difficult task in the treatment of cancer is the fight against metastases.

Secondary malignant cells grow rapidly and separate from the primary tumor, infecting and engulfing tissues of other organs. The lungs, liver, and brain, which have a developed vascular system, are especially at risk. To stop the rapid spread of metastases, it is very important to diagnose the disease and begin treatment as early as possible. Metastases in the early stages can manifest themselves:

• In the lymphatic system of the groin or pelvic area;
• The walls of the bladder and rectum.

They can progress in several directions simultaneously. Very often, a tumor of the cervix spreads to the vagina due to their close proximity. With carcinoma, metastases in the uterus spread even faster. Enlarged lymph nodes often indicate the appearance of a tumor. CT and MRI are performed to check the condition of the lymph nodes. Sometimes their increase indicates the appearance of a tumor.

After treatment, the tumor may recur (reappear) in the same place where it was or in distant areas. If cancer cells are found in the lymph nodes of the upper abdominal cavity, examinations must be carried out to detect metastases in other organs.

Metastases in the pelvic area affect adipose tissue, vascular bundles, liver, and lungs. If single metastases appear, they can be removed; in case of multiple metastases, chemotherapy is used.

Symptoms of the spread of metastases

Loss of appetite and weight, weakness and sweating, pallor, headaches, fever. In advanced cases, pain in the lower abdomen, vaginal discharge with blood, subsequently accompanied by an unpleasant odor due to infection of tissues and organs. In later stages, swelling of the extremities and external genitalia appears as a result of damage to the pelvic lymph nodes.

Symptoms depend on the organ that is affected:

Lungs. Shortness of breath. There are few nerve endings in the lungs and therefore pain does not occur. When the lungs are damaged, fluid accumulates, pressing on the heart and respiratory tract. The patient develops shortness of breath, a feeling of heaviness inside, blood in the saliva, and sputum with an unpleasant odor.

Liver. Changes in the functioning of the liver and gallbladder will be shown by special tests. There may be yellowing of the whites of the eyes, nausea, vomiting, and dull pain in the liver area.

Kidneys. Poor blood tests, urine tests, swelling, pain. When the kidneys are damaged, the outflow of urine is disrupted, difficulty urinating, and the body is poisoned by toxins.

If the tumor has metastasized, then it is almost impossible to control how many and to what tissues and organs the malignant cells have spread. If metastases have affected distant organs, then this may not be noticed, given the patient’s already very poor indicators. Therefore, it is necessary to periodically do ultrasound and fluorography of the abdominal organs so as not to miss the initial appearance of metastases.

Treatment of metastases in uterine cancer

By removing the primary tumor (the initial focus of the disease), it is impossible to be sure of a complete cure. Patients who have undergone cancer surgery must be observed by a doctor for two years, re-examined every 3 months.

During organ-conserving surgery, only the tumor is removed, preserving the uterus so as not to deprive the woman of childbearing function. There is a very high risk of relapse; the uterus may already be affected by metastases.

Relapse is possible if the uterus and appendages are removed, but the process goes beyond the reproductive organs and affects the removed organs

During late-stage surgery, cancer cells from the organs being removed can spread to the edges of healthy incisions. Therefore, in later stages, surgery is not performed (starting from stage 2B).

If a relapse occurs, pelvic exenteration (partial or complete) is performed. Removal of the uterus, vagina, rectum with installation of a stoma (colostomy bag). Positive effect - in 40% of cases. If such a radical operation does not help, the only option left is chemotherapy to slow down the process and prolong life.

Chemotherapy aimed at destroying cancer cells and stopping their growth. Of course, this method has a number of side effects, negatively affecting healthy organs. But it is impossible to do without it. To reduce the harmful effects of chemotherapy on the patient’s body, drugs, their doses and duration of use are carefully selected.

Radiation therapy. External internal is used. Drugs with radioactive elements are administered intravenously, which can destroy cancer cells. With the help of radiation therapy, it is possible to achieve complete disappearance of single metastases. This method is used to reduce the patient's excruciating pain.

The arsenal of available medications for the treatment of cervical cancer is constantly expanding thanks to modern research. This allows doctors to prolong the life of cancer patients and ensure a decent quality of life. And with timely detection of the disease, a complete cure can be achieved.

Patient survival

Depends on the stage of the disease, invasion (degree of penetration into neighboring tissues) of the tumor, and the success of treatment.

With invasion deeper than 1 cm, 54% of patients develop metastases, which are most often found in patient cells.

5-year survival rate is:

• at the first stage 86%;
• with the second – 48%;
• with the third – 22%;
• with the fourth, 11% - two-year survival rate.

In advanced cases, palliative treatment is indicated: maintaining terminally ill patients with severe disease, protection from severe manifestations of the disease, relief from pain and other symptoms.

Diagnosis, treatment and risk factors for metastasis in cervical cancer

Of particular danger are relapses of oncological pathologies: the transfer of microscopic cancer cells and the formation of secondary foci - metastasis. A similar situation with uterine cancer occurs already in the later stages of cancer. Often a woman learns about the appearance of metastases even earlier than about the formation of a cancerous focus in the uterus itself.

Main types of metastasis

Atypical cells in cervical cancer can move from their primary focus to distant tissues and organs in only two main ways. Based on this, experts consider 2 types of metastasis:

The first type is lymphogenous and is detected much more often, since, knowing about the characteristics of the lymph system in the area of ​​the uterus, specialists purposefully examine the nearest lymph nodes. For example, the periuterine, internal iliac, as well as peri-cervical, external iliac and common iliac groups of lymph structures are most susceptible to cancer metastases.

In the second type - hematogenous metastasis - the movement of the mutated cell occurs through the flow of aortic blood. A secondary focus of metastases in uterine cancer can occur in the most distant organs. For example, in the structures of the liver, lungs or bones. Diagnosing them can be quite difficult, because it requires an extensive set of instrumental research procedures.

Main location of metastases

With a malignant lesion of a healthy organ (uterus), a gradual impairment of its functional ability is observed. However, for a long time a woman may not even suspect that she already has such a dangerous disease with its complications as cervical cancer.

The experience of oncologists allows them to claim that most often in uterine cancer, its metastases are found in 6 subgroups of lymph nodes:

• periuterine, pericervical (primary);
• iliac external and internal, as well as obturator (intermediate);
• peri-aortic, common iliac, inguinal (secondary).

The prognosis of a woman’s survival and ability to work is greatly influenced not only by the specific area in which the secondary tumor focus was diagnosed. The total number of metastases, the initial state of health of the cancer patient, as well as the susceptibility of her body to the ongoing treatment measures are important.

Distribution mechanism

The general structure of the uterus, its structure and the proximity of the vagina determine the frequent spread of malignant neoplasms to the vaginal tissue. And only then, in most cases, the pathological process spreads further - with damage through the lymphatic pathways of the nearest regional and distant lymph nodes.

Atypical cells in the early, but more often later, stages of the oncological process, having the structure of the focus itself and the ability to grow quickly, move with the bloodstream and attach to healthy tissues and organs. The process occurs faster in those areas of the human body where the circulatory network is better developed. For example, by hematogenous metastases from the area of ​​the uterus spread to its appendages, omentum, as well as to distant organs - liver cells, lung structures and the skeletal system.

To prevent this tendency of the tumor to secrete atypical cells, it is recommended to undergo an annual preventive medical examination with the collection of biomaterial from each suspicious area.

Possible risk factors

Representatives of the beautiful part of humanity, who can be classified as a subgroup at risk for cancer of the genital organs, should be wary of metastases in the uterus and its structures:

• with diagnosed primary infertility;
• with existing menstrual cycle disorders of various etiologies;
• absence of childbirth;
• menopause period;
• obesity;
• tumors and polycystic ovaries;
• hormonal storms;
• uncorrected hormone replacement therapy;
• long-term use of estrogens;
• diabetes;
• negative hereditary predisposition.

It is especially recommended to carefully monitor the situation for those women in whose family there have already been cases of death from any neoplasms. Timely detected and treated uterine cancer significantly improves the prognosis and chances of a full recovery, without the risk of recurrence.

Symptoms

At an early stage of their occurrence, metastases from cervical cancer may not manifest themselves in any way. However, most often they behave much more aggressively than the main tumor. Thus, damage to the pelvic lymph structures is necessarily accompanied by swelling of the tissues of the lower extremities.

With the hematogenous spread of metastases, their symptoms will directly depend on the organ in which the secondary focus has formed. For example, localization of a malignant neoplasm in the structures of the lungs will not only be accompanied by persistent coughing, but also hemoptysis, hyperthermia, as well as increasing shortness of breath and general intoxication.

If the liver parenchyma is affected, the main clinical manifestations will be intense pain impulses in its projection – the right hypochondrium. And also - a change in the coloration of the skin and mucous membranes to a jaundiced tint, dyspeptic disorders in the form of the urge to nausea and vomiting, alternating constipation with diarrhea.

Malignant lesions of bone elements are accompanied by a pronounced pain syndrome with the occurrence of pathological fractures. Compression syndrome with limited mobility is possible in severe cases of the pathology.

Diagnostics

Any deviations in a woman’s well-being should be alarming and subject to careful analysis and examination by a specialist. Early diagnosis of the cancerous focus in the uterus, as well as its metastases, is half the success on the path to recovery.

Diagnostic procedures are aimed at establishing not only the location of the neoplasm, but also its histological structure and the stage of the pathological process. All this information allows the oncologist to assess the criticality of the situation and predict the further course of the disease, as well as draw up an adequate plan for treatment.

In order to timely detect cancer metastases, a woman is recommended to undergo the following set of diagnostic studies:

• various blood tests;
• gynecological examination with collection of biomaterial from suspicious areas;
• Ultrasound of the pelvis, abdominal structures;
• radiography;
• CT or MRI of organs.

Only completeness of information allows us to judge the presence of metastases and the further prognosis of the patient’s life.

Treatment tactics

The pathological process of formation of secondary cancer foci requires an integrated approach to drawing up a treatment plan. Main directions in the treatment of cancerous lesions:

• the use of x-rays - radiation therapy;
• use of specific medications - chemotherapy;
• pharmacotherapy – medications that help strengthen and raise a woman’s body’s own defenses;
• supportive, palliative care – in severe cases of the cancer process, identification of many secondary malignant foci in various organs.

Surgical excision of a tumor as a grown metastasis is possible only if it is single and accessible for such a procedure. Otherwise, treatment tactics are based on chemotherapy and radiation therapy.

The selection of the optimal set of treatment methods is carried out by a specialist individually after assessing information from laboratory and instrumental studies.

Among the preventive measures to prevent recurrence of uterine cancer, experts indicate the following. This is the implementation of all recommendations given by an oncologist to a woman during primary treatment procedures and a timely visit to the attending physician with dynamic monitoring of women’s health parameters.

If you find an error, please select a piece of text and press Ctrl+Enter.

They explained quite clearly what and how happens due to this disease. CC is a scary word nowadays, it is important to take care of yourself and visit a gynecologist once a year.

I agree with you, Fiory. However, I would like to note that if there is a predisposition to cancer, including cervical cancer, practicing oncologists recommend undergoing a preventive examination and testing once every six months.

Even if you visit a gynecologist once a year and carefully monitor your health, such serious consequences can be avoided. But cervical cancer is not such a terrible disease as it seems, and in our time everything is perfectly treatable.

© 2016–2018 – Oncology portal “Pro-Cancer.ru”

Described methods of diagnosis, treatment, traditional medicine recipes, etc. It is not recommended to use it yourself. Be sure to consult a specialist so as not to harm your health!

Content

One of the most common malignant tumors in women is cervical cancer. The danger of cancer is that over time it metastasizes to surrounding and distant organs.

Cervical cancer occurs in both young and older women. However, the most common age range for cancer patients ranges from thirty to fifty years.

As with other malignant neoplasms, cervical cancer is accompanied by metastases. Typically, cancer metastasizes at the third or fourth stage. However, with some types of cervical cancer, metastases can occur at the first or second stage. The danger of metastases is associated with the growth of new tumors. The spread of metastatic malignant cells poisons the woman’s body with the products of their vital activity.

Structural features

The cervix is ​​part of it, a structural element. The cervix is ​​a muscular tube several centimeters long. The neck can be either conical or cylindrical. This indicator depends on the woman’s reproductive function.

The cervix is ​​considered the subject of research by gynecologists. The condition of the cervix indicates the presence of a woman’s reproductive health. In particular, the condition of the cervix can be used to judge inflammatory, and sometimes precancerous, malignant pathologies.

A significant part of the cervix is ​​inaccessible for inspection, as it is adjacent to the uterus. This is the supravaginal part of the cervix. During a gynecological examination, only a small area is visualized, which is directly adjacent to the vagina.

The vaginal part of the cervix is ​​examined by gynecologists using a speculum. Normally, this area looks like pale pink mucosa with a smooth and shiny surface. Any deviations from the norm, for example, uneven color and ulcers, may indicate the presence of pathology.

The mucous membrane of the vaginal area of ​​the cervix is ​​formed by flat stratified epithelium. Squamous epithelial cells are arranged in several rows.

1. In the basal lower layer the rounded cellular elements are immature and include one large nucleus.
2. In the intermediate layer flattened cells are not mature enough.
3. In the surface layer flat cellular elements are distinguished by their maturity and ability to exfoliate, renewing the epithelium.

The lower basal layer borders the stroma, in particular nerves, muscles and blood vessels. Pathological processes arise precisely in this layer, and then spread to the upper ones.

An important role in the functioning of the cervix belongs to the cervical canal, which connects the uterus and vagina. The cervical canal is quite narrow and is lined with another type of epithelium. The surface of the canal contains single-layer cylindrical cells, due to which the mucosa appears reddish and velvety.

Since the uterus communicates with the vagina through the cervical canal, there is a danger of harmful flora entering the sterile cavity. The protective mechanism is provided by the mucus produced by the glands of the cervical canal.

Glands of the cervical canal may be the tissue from which a malignant tumor is formed. Such cancer occurs in 10% of cases of the total number of malignant neoplasms and is called adenocarcinoma.

Flat epithelium also serves as material for the formation of cancerous tumors. This type of oncology is called squamous cell carcinoma and occurs in the vast majority of cases.

It is noteworthy that precancerous and malignant changes often occur in the transformation zone. This transitional region is localized deep in the external pharynx. The upper edge of the cervical canal forms the internal os, while the lower edge forms the external os.

Precancerous changes

A malignant tumor and its metastases develop as a result of dysplastic changes, which are precancerous. Cancer metastasizes at least five years after the first precancerous changes in the cervical epithelium.

Dysplastic changes involve cell structure, maturation and differentiation. The appearance and functioning of cells depends on their location in the stratified squamous epithelium. During the process of dysplastic changes, the round cells of the basal layer become shapeless. The number of nuclei of cellular elements may increase. Over time, the necessary division into layers, which signifies the process of cell maturation, is lost.

Dysplasia has several degrees of severity.

1. Atypical cells appear in the lower epithelial layer and are single in nature (CIN I). At this stage, the occurrence of cancer and subsequent metastases is unlikely. This is due to the fact that in 90% of cases atypia is eliminated due to internal reserves. However, in the presence of concomitant diseases and provoking factors, after five years, first-degree dysplasia can progress to cancer and metastasize to surrounding tissues.
2. Damage to atypical cells is noted in the two lower epithelial layers (CIN II). The appearance of cancer and metastases can be observed after three years.
3. The entire squamous stratified epithelium (CIN III) is involved in the dysplastic process. The appearance of cervical cancer and metastases is expected within a year if left untreated.

Gynecologists emphasize that the development of cervical cancer and metastases can be avoided if diagnosed and treated in a timely manner. At an early stage, therapy is medicinal in nature. In advanced cases, surgical intervention and excision of the pathological focus is required. Otherwise, cancer develops, which can metastasize over time.

Reasons

The etiology and pathogenesis of the pathology have not been sufficiently studied. There are several theories about the occurrence of cervical cancer. As reasons for the development of a malignant process, experts consider various factors that can trigger precancerous processes in the female body.

In particular, among the factors that provoke cervical cancer, experts identify:

• the role of heredity;
• bad habits, such as smoking;
• poor nutrition, which does not provide the body with necessary substances;
• early or promiscuous sexual life, which increases the risk of sexually transmitted infections and trauma to the epithelium;
• numerous interventions on the cervix;
• inflammatory and infectious processes, especially those that last for a long time;
• impact on the epithelium of smegma, which has carcinogenic properties.

In the development of oncology, specialists are actively developing a genetic theory. The issue of the influence of benign pathologies on the development of cancer remains controversial. In a small number of cases, pseudoerosion, leukoplakia and ectropion can be the background to the appearance of cervical cancer.

The main cause of the malignant process that occurs in the cervix is ​​infection with the papilloma virus, and dangerous, highly oncogenic strains. HPV strains 16 and 18 are detected in 95% of smears of cancer patients. It is these viruses that usually cause cervical cancer, in particular the squamous and glandular varieties.

The effect of HPV on the body is ambiguous. There are more types of the HPV virus, which can have both transforming and producing effects. With a transforming effect, the cell undergoes mutation, dysplasia develops, and then cancer. When exposed to production, papillomas and condylomas are formed on the skin and mucous membranes.

It should be remembered that dangerous strains of HPV can cause cancer only in women with concomitant pathologies. Normally, the immune system eliminates the virus within a few months.

Patients who have been diagnosed with HPV of highly oncogenic strains for a long time, are at risk.

Varieties

The risk of metastases is significantly influenced by the type of cancer process. It is known that cervical cancer can progress in different forms. In some types of cervical cancer, the tumor metastasizes earlier.

Depending on the location, there are two forms of cancer.

1. Squamous cell neoplasm affects the vaginal part of the cervix.
2. Glandular tumor located in the cervical canal.

In addition, the likelihood of metastases is related to the degree of cell differentiation.

1. Well-differentiated cancer has a favorable prognosis, which is associated with its slow development. In addition, the tumor is non-aggressive and rarely metastasizes, especially in the early stages.
2. Moderately differentiated cancer is the most frequently diagnosed pathology. Typically, the tumor metastasizes at the third or fourth stage.
3. Poorly differentiated cancer rarely occurs. The tumor metastasizes aggressively and early.

Based on the degree of invasion, the following forms of cancer are distinguished.

1. Pre-invasive. This is dysplasia of the last degree, in which the appearance of a tumor without concomitant invasion into the stroma is noted. At this stage, the cancer does not metastasize and has a good prognosis with timely detection and adequate treatment.
2. Microinvasive. Invasion into adjacent tissues is up to 0.3 cm. At stage 1A, which corresponds to the microinvasive form, the cancer usually does not metastasize.
3. Invasive. The depth of spread of malignant cells is from 3 mm. With the development of this type of cancer, the neoplasm metastasizes to surrounding tissues and distant organs.

Depending on the direction of cancer growth, the following options are distinguished:

• exophytic;
• endophytic;
• mixed.

Squamous cell carcinoma of the cervix may be keratinizing and without signs of keratinization. Often the non-keratinizing type of cancer is isolated, which metastasizes earlier.

Stages

The stages in which cervical cancer develops are called stages. Gynecologists distinguish four main stages, which also involve a gradation of the pathological process.

1. At this stage, damage to the cervical tissue is observed. With option A1, the invasion is up to 3 mm, which implies microinvasive cancer. Typically, with this pathology there are no metastases. Substage A2 means the progression of cell sprouting, which means invasion up to 5 mm. If the tumor grows up to 4 cm, doctors identify substage B1, and if invasion exceeds 4 cm, substage B2.
2. With this pathology, damage to the uterine body occurs. Substage A means uterine involvement without parametrium. In substage B, the tumor spreads to the serosa.
3. As part of the oncological process at this stage, the pelvic wall and part of the vagina are affected. In option A, the neoplasm grows into the lower third of the vagina, and in substage B, it penetrates the pelvic wall. In most cases, at the third stage, cancer metastasizes, for example, to the lymph nodes.
4. At the last stage, the cancer spreads to neighboring and distant organs, and multiple metastases are observed. If only the intestines and bladder are affected, they speak of substage A. In the case of distant metastases, doctors determine substage B.

Gynecologists note that determining the stages is necessary to make a prognosis and choose treatment tactics. Determining the stage becomes possible only by performing a histological examination of the tissue.

Metastases

Any localization is dangerous due to the appearance of metastases. If the tumor metastasizes, the prognosis worsens significantly. As a result of metastases, multiple tumors are formed in various organs and tissues. When cancer metastasizes, the body's condition rapidly deteriorates due to its poisoning by waste products of malignant cells.

Metastases occur as a natural stage in the progression of a malignant neoplasm. When a tumor grows in size, some cellular elements do not have enough nutrition to continue growing. This leads to the fact that some cells are detached from the main tumor and spread throughout the body. Typically, cells settle in tissues with a well-developed and small vascular network.

Typically, cervical cancer initially metastasizes to regional lymph nodes. Lymph nodes are known to function as filters. At first, the body copes with the emerging malignant elements. However, if there are a large number of malignant cells, the filter becomes clogged. Thus, cellular elements settle and develop, forming new tumors. Over time, the cancer metastasizes to other lymph nodes.

In addition to the occurrence of metastases through the lymphogenous route, there are other options for the spread of cervical cancer. Cancer can metastasize in the following ways:

• hematogenous;
• implantation

The implantation route of metastasis is spoken of when cancer occurs in the abdominal cavity. Hematogenous spread of metastases occurs rarely in cervical cancer.

Single metastases can be removed surgically. Typically, cervical cancer metastasizes to the lymph nodes, lungs, and less often to the brain. If metastases are multiple, doctors prescribe radiation and chemotherapy. However, the prognosis depends mainly on the stage, the condition of the woman’s body and the characteristics of the occurrence of metastases.

When the tumor metastasizes, the patient's condition deteriorates significantly.

Clinical picture

Symptoms of cervical cancer depend on the presence of metastases. It is known that if the tumor metastasizes, the clinical picture becomes pronounced.

As cervical cancer progresses and the tumor metastasizes, the following symptoms appear.

1. Dysfunction of the excretory organs. Typically, the tumor grows into the wall of the bladder and intestines. In such cases, blood appears in the stool and urine, and the process of urination and defecation is disrupted.
2. Pain of various types. When metastases occur and organs are compressed, pain occurs. The pain is usually long-lasting, localized in the rectum, lower abdomen, and back.
3. Swelling of the lower extremities. Swelling of the arms and legs occurs if cancer metastasizes to the lymph nodes. It is known that metastases initially appear in the lymph nodes.
4. Bleeding. This symptom can occur in both young women and older representatives.
5. Bloody discharge. With cervical cancer, acyclic and spotting discharge often appears. When the tumor decomposes, a foul-smelling discharge appears that has the color of meat slop.
6. Purulent discharge. This symptom is observed when an infection occurs.
7. Beli. Abundant liquid whitish discharge indicates damage to the lymphatic capillaries.

In addition, when metastases appear, symptoms of general malaise develop, which include:

• loss of appetite;
• weight loss;
• weakness;
• nausea and vomiting;
• increase in temperature;
• pallor;
• brittle nails and hair.

It is impossible to determine cervical cancer by symptoms alone. Moreover, the clinical picture develops at advanced stages. It is possible to identify oncology by visiting a doctor and undergoing an examination.

Diagnostic methods

Detection of cervical cancer and metastases occurs during the diagnostic process. Some examination methods are screening and are recommended for regular performance in order to prevent the development of cervical cancer and metastases.

Gynecological examination

This study is performed at every visit to the gynecologist and is one of the main ones. Visual examination can reveal pronounced changes in the epithelium. However, it is not possible to detect pathology at an early stage of the oncological process. In addition, if the cancer has metastasized, additional examination methods are needed.

Colposcopy

The method can be carried out in both a simple and advanced way. During colposcopy, the doctor examines the mucous membrane in detail using a magnifying and lighting system of the device. If, during a simple visual assessment of the epithelium, signs of atypia were identified, an extended study is recommended.

As part of the extended procedure, the cervical epithelium is treated with solutions, in particular, Lugol's and acetic acid to create a colposcopic picture. Damage to HPV is indicated by whitish spots after applying a vinegar solution. Unpainted spots after treatment with Lugol indicate possible atypia.

Biopsy

Tissue sampling for histological examination is necessary if atypical areas are identified. The procedure can be performed in different ways.

Cytological examination

Ultrasound

An ultrasound examination is carried out to assess the condition of the internal genital organs, identify tumors and other pathologies.

Curettage of the cervical canal

The curettage procedure is performed if adenocarcinoma is suspected. After curettage, the material is sent to the laboratory for histological examination.

If the cancer has metastasized, this can be determined through various methods, for example:

• X-ray of the lungs.

To detect metastases consultation with specialists and examination of the bladder, rectum and lymph nodes are also required. It is recommended to perform cystoscopy, urography, rectoscopy, bone scintigraphy, and lymphography.

Treatment tactics

The prognosis and treatment of cervical cancer depends on the stage of the pathology, the degree of cell differentiation, and the direction of tumor growth. If the tumor metastasizes, treatment is more intensive.

To treat cervical cancer, three main tactics are used, as well as a combination of them:

• surgical method;
• radiation, radiation therapy, or radiotherapy;
• chemotherapy.

Surgical techniques

It is advisable to use surgery in the initial stages of cancer. This is because when cancer metastasizes, surgical removal of the tumor alone is not enough.

As part of surgical treatment, the following tactics are used.

1. Conization and amputation of the cervix are used in young women in the pre-invasive and first stages. Conization involves excision of pathological tissue in the form of a cone using radio waves, a scalpel, or a laser. Amputation of the cervix is ​​often performed together with regional lymph nodes, into which cancer often metastasizes. This treatment allows you to preserve reproductive function. It is undesirable to use irradiation so as not to disrupt ovarian function.
2. Removal of the uterus, cervix and lymph nodes is recommended at the second stage, as well as at the stage of microinvasive cancer in older patients. In the most difficult cases, it is possible to remove the ovaries, tubes, part of the vagina and surrounding tissue. Treatment is often supplemented with radiation and chemotherapy.

Radiotherapy

Radiation is the main method used to eliminate cancer cells and shrink tumors, especially if the cancer has metastasized. Thus, radiotherapy is used after and before surgery.

There are two methods of using radiotherapy.

1. Intracavitary radiotherapy involves irradiation in close proximity to the pathological focus. A tube is inserted into the vagina and cervix through which radiation is delivered. The advantage of this technique is its minimal impact on the body as a whole.
2. External beam radiotherapy means the implementation of a general impact. The procedure has more side effects due to damage to healthy cellular elements.

Typically, doctors use radiation tactics in combination, and extremely rarely in isolation. This makes it possible to increase the effectiveness of treatment, especially if the tumor metastasizes. If surgery is contraindicated, intensive radiation therapy can be used.

Chemotherapy

This method of treatment can be classified as auxiliary tactics. Like radiation therapy, chemotherapy can be used:

• before surgery to reduce formation;
• after an intervention to eliminate remaining cancer cells, particularly if the tumor has metastasized.

The chemotherapy treatment plan is developed individually depending on the stage of the cancer, the presence of metastases, and the individual characteristics of the patient. The first chemotherapy procedure is carried out under the supervision of a doctor. Both outpatient and inpatient treatment are then possible.

There are several main chemotherapy drugs. Some of the medications are used as independent treatment, while others are used in combination with other drugs. Medicines can be in the form of tablets and injections.

It is noteworthy that the duration of chemotherapy also varies from person to person. Chemotherapy is usually carried out in courses. The interval between these courses ranges from several weeks to several months. The interval within one course between procedures may also vary.

The cervix refers to the lower section of the uterus. In its center is the cervical canal, one end of which goes into the uterine cavity, the other into the vagina. Among the pathologies of diseases that affect the cervix, the most serious ones can be identified - cancer, metastases to other systems and organs. This pathology affects women aged 40 to 60 years, but it is increasingly observed in young women.

Risk factors for this cancer include:

• Radiation;
• Chemicals;
• Viruses (herpes, HPV);
• Promiscuous sex life;
• A large number of abortions;
• Long-term use of hormonal drugs.
• Chronic recurrent infections.

What are metastases in cervical cancer

Metastasis is one of the most characteristic features of the course of malignant neoplasms.

Main stages of metastasis:

• The process of separating cancer cells from the main tumor node;
• Entry of cells into blood or lymphatic vessels (violation of the integrity of the walls due to destruction).

If present, the leading routes of spread include direct growth and metastases through the lymphatic system; in the later stages, hematogenous metastases are observed. Metastases occur in the lymphatic system at all stages of the tumor process, but their frequency directly depends on the location and size of the primary lesion.

Metastases can be observed in the initial stages of uterine cancer, the path of spread is lymphogenous - to the lymph nodes of the groin, pelvis and retroperitoneum, and can grow into the wall of the rectum and bladder. Secondary cancer cells, which have its structure and the ability to grow rapidly, separate from it and begin to attach to organs with a developed vascular network (brain, lungs, liver).

The appearance of metastases leads to dysfunction of tissues and organs and tissues (poisoning by waste products of the tumor), leading to their death. Most often, metastases from cervical cancer affect the nearest lymph nodes (pericervical, circumuterine, obturator, common iliac, internal and external iliac).

Much less often, metastases are present in the inguinal and peri-aortic lymph nodes. Metastases grow quite quickly and affect large choroid plexuses, liver, kidneys and lungs.

Diagnosis of metastases during a tumor process in the cervix includes:

• clinical examination;
• excretory urography;
• X-ray contrast and radioisotope lymphography;
• pneumopelviography;
• angiography (arteriography, venography).
• X-ray of the lumbar muscles.

Clinical picture and treatment

Common manifestations of cervical cancer are as follows:

1. sweating;
2. weakness;
3. dizziness and headaches;
4. pale and dry skin;
5. weight loss;
6. lack of appetite;
7. elevated body temperature.

For specific symptoms:

• pain syndrome in the lower abdomen;
• spotting bloody discharge;
• unpleasant smell of discharge (the result of a bacterial infection.

In the later stages of metastasis, disturbances in urination and defecation, the occurrence of fistulous tracts, and swelling of the external genitalia are characteristic. Thus, the clinical manifestations of a malignant process of the cervix are very diverse; for more accurate information, you should contact a qualified specialist.