Clinic for Gynecology and Obstetrics
Chief Physician

Cancer of Uterine Cervix

PD MD Heiko B. G. Franz

Chief Physician

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Statistics 2017
  • 6205 patient admission
  • 20 physicians
  • 40 medical staff
  • 192 endosonography of the female sex organs
  • 91 excisions and destructions of ovarian tissue
  • 95 removals of the fallopian tube and ovary
  • 142 removals of the uterus
  • 867 caesarean section

Cancer of Uterine Cervix

Cancer of uterine cervix (cervical carcinoma) is a common cancerous female disease. It’s on the fifth place in the list of cancerous diseases, because 7% of cancerous tumors are cervical carcinomas.

Statistics shows that this disease is typical of women from 35 to 50 years old. However, recently, tumors are being diagnosed in women older than 20. This type of disease is more widespread in Africa and Latin America, while it occurs twice less often in Eurasia.

Peculiarities of disease

First, we should understand the physiology of female body to understand what cancer of uterine cervix is. Cervix is the lower part of the uterine where so-called cervical canal is situated. Its upper end goes to the uterus, and the lower – to the vagina.

There’s one peculiarity of female body contributing to development of this disease. The thing is that there’s a special zone in the external gorge where multi-layer vaginal epithelium links up with cervical epithelium of uterus cervix. This zone is vulnerable, and malignant cells tend to develop there.

Risk factors and causes of disease

According to doctors, HPV, or human papilloma virus is the key factor of cancer development in female body. 95% of patients with cervical carcinoma had this virus revealed. The most dangerous types of human papilloma virus are 16 and 18. They tend to trigger development of cancerous tumors more often, and they are revealed in 70% of women with cancer of uterine cervix.

Since this virus is sexually transmitted, cervical cancer is typical of women who often change partners and disregard contraception. Sometimes barrier contraception (condoms) cannot prevent transmission of the disease. It’s proved that human papilloma virus in female body can increase the risk of cancer of uterine cervix ten times! However, presence of this virus does not necessarily mean that cancer will develop.

Together with human papilloma virus, there can be other factors contributing to development of tumor in uterine cervix:

  • erosion of uterine cervix;
  • early start of sexual life;
  • weak immune system;
  • long-term use of oral contraceptives;
  • regular contact with cancer-producing substances;
  • infections transmitted sexually (cytomegalovirus infection, genital herpes, chlamydeous, or HIV);
  • nicotine addiction.

Besides, heredity plays crucial role in development of cervical cancer. Women whose relatives suffered from similar oncologic diseases are under 3 times higher risk of having cancer of uterine cervix.

Symptoms of cancer

Cancer of uterine cervix is a dangerous disease that may either progress slowly, or, vice versa, be very aggressive and quick.

At the first stages, cancer develops without symptoms in 40% of women, which is bad, because it may actually be cured. Other 60% of women experience symptoms but tend to ignore them and don’t try to find the cause of feeling unwell. This is why the diseases usually progresses till the stage when treatment won’t solve the problem.

Early cancer symptoms

At early stages of carcinoma, women can develop the following symptoms:

  • smudging discharge or bleeding between periods;
  • minor discharge after sexual intercourse that looks like bloody substance of dirty pink, or brown color that shouldn’t appear normally;
  • subfebrile temperature (37,0–37,5°C) that occurs regularly or from time to time;
  • disorders in menstruation period;
  • acute or dragging pain in the lower abdomen (appears periodically, most often – after sexual intercourse).

Later cancer symptoms

When the disease progresses, cancer of uterine cervix becomes pronounced and is accompanied with other more pronounced symptoms like:

  • frequent desire to urinate;
  • blood in urine;
  • anal bleeding;
  • swelling in legs;
  • excessive perspiration;
  • disorders in defecation;
  • prolific vaginal bleeding that’s not connected with periods;
  • nephrohydrosis, e.g. kidney disease connected with abnormal widening of renal pelvis caused by problems with urine flow;
  • dragging pain that typically appears in the lower abdomen or intestine.

Classification of cervical carcinoma

Depending on the type of affected epithelium, there can be two forms of cancerous tumors:

  • dermoid cancellation (takes place in 93% of cases);
  • adenocarcinoma (7% of cases).

Also, depending on the intensity of cancerous tumor growth, cancer of uterine cervix can be divided into the following types:

  • Pre-invasive cancer. This is a cancer that only starts forming (Stage 0), and the process does not spread over epithelium;
  • Non-invasive cancer. This can be called the first stage of diseases. In this case, tumor is developing slowly and does not spread over the edges of cervical tissues;
  • Microinvasive cancer. The tumor is superficial and may grow into adjacent tissues on 5 mm and more. Metastases are formed rarely.
  • Exophytic cancer. The tumor is growing and starts reminding a cauliflower. This is a widespread form of cancer that can grow into vaginal tissues. Such cancer is pretty easily diagnosed on initial stages.
  • Endophytic carcinoma. This tumor visually reminds of ulcer that bleeds because of a minor touch. This tumor can grow into the uterine.

How uterine cancer develops?

This kind of cancer can be developing during years and even decades. Prior to formation of cancerous tumor, changes on the surface of cervix take place: these are called “dysplasia of uterine cervix”. If dysplasia is not treated, a woman may need to treat cancer in a few years, because benign cells can turn into malignant ones down the road.

Stages of disease

  • Stage 0. At this stage, cancerous cells are placed in mucous membranes of cervical canal. Healthy cells are slowly being reborn into malignant ones. At this stage, 100% of patients get rid of the disease and survive.
  • Stage 1. In this state, cancerous cells form a tumor that’s located in superficial layer of the cervix. Cells do not affect surrounding organs. Survival rate is 98–100%, and qualified surgeons perform operations so that a woman could become a mother in the future.
  • Stage 2. The tumor is progressing, but it does not spread to the adjacent organs. However, the tumor grows into lymph nodes, and this is when the first symptoms typically appear. Treatment at this stage guarantees 76–80% survival rate. However, if the tumor starts growing into the uterus, it complicates treatment and decreases survival rate.
  • Stage 3. The tumor is steadily developing and actively grows into adjacent tissues, which affects functioning of kidneys and bladder. Patients admit poor well-being. In this state, even correctly chosen treatment does not guarantee that a woman can totally recover. According to statistics, 5-year survival rate at Stage III of cancer does not exceed 30%.
  • Stage 4. This stage is called “terminal”, because it’s impossible to cure the disease totally. All doctors can do is prolong patient’s life and relieve some symptoms. The tumor spreads to the bladder, intestine and bones. The prognosis is poor: 5-year survival rate is lower than 10%.

Why the disease is dangerous?

As it has been mentioned, early detection of cancer of uterine cervix gives chance to live a long normal life. However, it’s almost impossible to avoid serious complications after the disease. The happiest end in such case is removal of cervical canal. Of course, a woman cannot have children after that. The same results are faced when the uterus, ovaries and appendages are cut out. If vagina is removed, a woman cannot have sex anymore. Cancer of uterine cervix affects reproductive system in young women, and the chance of having a child after treating the malaise is minor.

Diagnostics of the disease

Diagnostic procedures for cancer of uterine cervix can be divided into several stages. Initially, a gynecologist performs a visual examination in a gynecological examination chair. After that, a patient needs to have laboratory tests. These include general research like general and biochemical blood analyses, and specific tests, including testing for human papilloma virus, bacterioscopical and bacteriological test of vaginal discharge, etc.

To confirm the diagnosis, doctors may also use such test methods as X-ray, renal nephrography, colposcopy (minimally invasive examination of organs with the help of a tiny camera), biopsy of uterine cervix tissues, and ultrasound of pelvic organs, as well as computer tomography and magnetic resonance tomography.

There’s also a Pap smear test (Papanicolaou smear) that allows revealing carcinoma of cervical walls at early stages. The precision of this method reaches 90%, and 9 out of 10 women can reveal the disease when it can be easily cured. All women from 25 to 50 years old are recommended to go through this test at least once in three years.

Treatment of cancer of uterine cervix

At its early stages, the disease is easily treated, and surgical removal of tumor is considered to be the best method. Doctors try to perform the surgery so that to remove the tumor so that to save reproductive function of a woman. If the tumor is revealed at the stage when it started spreading metastases (Stages III and IV), doctors have to remove the uterus, fallopian tubes, the ovaries and sometimes – vagina.

Surgical treatment can be performed several ways. It can be hyperthermia, cryodestruction, ultrasound, laser therapy or traditional removal of surgery with a scalpel. The choice depends on patient’s age, overall health, organs that should be removed, and many other factors.

After the surgery, radiation therapy can be applied, e.g. tumor treatment with radiation that decreased the amount of malignant cells and inhibits progression of tumor. It also helps to shrink the tumor.

Besides, a patient has to go through a chemotherapy course after the surgery. As a rule, this kind of treatment implies intake of anticancer agents that are injected intravenously. Chemotherapy is typically administered for patients in postmenopause period, because this kind of treatment affects both cancerous and healthy cells, being very harmful for overall health. It also affects general well-being and has a wide range of unpleasant side effects.

Prevention of cervical cancer development

Vaccination against human papilloma virus is the key method of prophylactics for the cancer of uterine cervix. Gardasil vaccine prevents contamination with four types of human papilloma virus, including types 16 and 18 that provoke 70% of all cervical carcinomas. Specialists recommend performing vaccination of 11-13-year-old girls. A woman up to 26 years old can be vaccinated, but only in case when she does not have such types of viruses in her body.

Besides, to prevent development of cancer of uterine cervix, a woman should necessarily treat diseases of her female genitals. First and foremost, these include dysplasia of uterine cervix. In most cases, it takes 10-15 years to have precancerous state turn into the real cancer. It means that theoretically, every woman can avoid developing a cancerous tumor.

Of course, a woman should not forget that condom is the most reliable method of contraception. Use of barrier contraception means helps to protect body from human papilloma virus and, as the result, from development of cancerous diseases.

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