Cervical cancer - is the most common malignancy of the female reproductive system in the world;He is the second most common in women after breast cancer.It is often found in women from 45 to 50 years, but can occur at a young age.The incidence is higher in developing countries.For example, in India, cervical cancer is the most common cause of death among women aged 35 to 45 years.In Russia, the incidence is about 11 cases per 100 000 population.Diagnosis of cervical cancer - subject of the article.
There are differences in the incidence of cervical cancer in different socio-economic groups within a state.For example, in the US black women almost twice as likely to suffer from cervical cancer than white, but rather, it reflects their lower standard of living and lack of access to medical services than ethnic predisposition.During studies in Scotland, similar results were obtained: among low-income women the risk of cervical cancer increased three times compared to the more affl
Types of Cervical Cancer
Squamous cell carcinoma - the most common kind of cervical cancer is more than 90% of cases.It affects squamous cells lining the cervix.Currently, however, all more common adenocarcinoma (tumor of the secretory epithelium).This stage of the disease, not the cellular composition of the tumor determines the outcome for the patient.
value of screening
In developed countries, the incidence of squamous cell carcinoma of the cervix in recent years reduced through early detection during screening and effective treatment of precancerous lesions.Screening is not so effective for the detection of adenocarcinoma;perhaps this is one reason for the relative increase in the incidence of this disease.Pathology of the cervix can be detected during a pelvic exam.The sooner a cancer is diagnosed, the better the survival of the patient.Reasons for the development of cervical cancer is not completely clarified, but proved significantly its relationship with the human papilloma virus (HPV).There are more than 70 known types of this virus.Types of 16.18, 31 and 33 are oncogenic (capable of causing malignant transformation of cells) and are associated with the development of cervical cancer.
Early onset of sexual activity and frequent change of sexual partners increases the risk of cervical cancer in the future.In electron microscopy, the human papilloma virus has a characteristic appearance.Some of its types are associated with cervical cancer.In addition, its probability is higher if the patient's partner, there are numerous sexual contacts with other women.It is believed that smoking is also associated with an increased risk of developing cervical cancer.
Women with lowered immunity are at greater risk of preinvasive cervical carcinoma (cervical intraepithelial neoplasia - CIN).Patients receiving immunosuppressive medication, for example, about the kidney transplant, are at increased risk.HIV-infection is accompanied by suppression of the immune system, also increases the likelihood of developing the disease.We know that cervical cancer is preceded by recognizable preinvasive (precancerous) changes in the mucosa.At this stage, pathological lesions in the superficial epithelium of the cervix have a specific location in the transition ektotserviksa (lining of the vaginal part of the cervix) in the cervical canal.These changes can transform into cancer if left untreated.
precancerous changes in cervical epithelium and the early stages of cancer are asymptomatic, are detected in the study of cervical smear during screening.The cells of the cervical epithelium sent to cytology (analysis of cell structure).At the histological preparation visible groups of cells of the cervical epithelium.During the screening of all cells examined for pathological changes.Upon receipt of an abnormal cytology smear patient is sent for colposcopy.
Colposcopy Colposcopy - a visual examination of the cervix and upper vagina with the endoscopic device.Technical capabilities allow colposcopy to examine the cervix under magnification and eliminate any visible lesions, erosions or ulcerations on the surface.The study may make biopsy tissue for analysis.With the colposcope can illuminate the cervix and examine it under magnification to detect cancerous changes early.To determine the prevalence of tumor process performed bimanual (two-handed), vaginal or rectal examination.In some cases, to clarify the size and extent of the pathological process inspection is performed under anesthesia.Classification of cervical cancer reflects the prevalence of cancer.Staging of cancer is important for the choice of treatment and prognosis.There are four steps (MV), each of which is sub-divided into a and b.Stages a and b are divided by 1 and 2. According to the classification of FIGO (International Federation of Obstetricians and Gynecologists) stage 0 corresponds to precancerous changes, a IVb stage - the most difficult.The degree of involvement of pelvic and para-aortic (aorta surrounding) the lymph nodes increased with increasing stage.
invasive cancer confined to the cervix.Invasive cancer is defined only by microscopy.Cancer invades cervical stroma thickness of not more than 5 mm and a width of not more than 7 mm cancer stroma germinate at a depth of 3 mm and a width of not more than 7 mm.Germination depth into the stroma of 3 to 5 mm and a width of not more than 7 mm.Clinically apparent cancerous changes in the cervix or defeat determined microscopically larger than the step.Clinically visible lesion is not more than 4 cm. Clinically visible lesion more than 4 cm. Cancer spread beyond the cervix to the vagina and surrounding connective tissue.Cancer spread beyond the cervix to the upper two-thirds of the vagina.Cancer spread beyond the cervix to the surrounding connective tissue.Cancer spread to the side walls of the pelvis or to the lower third of the vagina.Tumor affects the lower third of the vagina, but does not extend to the side walls of the pelvis.Cancer spread to the side walls of the pelvis or ureter.Cancer spread beyond the pelvis, or the involvement of the bladder and / or rectum.Cancer spread to adjacent organs
preinvasive cervical carcinoma corresponds to severe stages of cervical intraepithelial neoplasia (CIN).CIN is classified depending on the depth of tumor spread in the epithelium, as well as the degree of differentiation of tumor cells:
• CIN I - change capture no more than 1/3 of the thickness of the epithelial layer;
• CIN II - change capture 1/2 thickness of epithelial layer;
• CIN III - affected the entire thickness of the epithelium.
When abnormal cells grow epithelial basement membrane, talk about the transition of precancer to invasive cancer.In 20% of patients with CIN III, untreated, over the next 10 years developing cervical cancer.