Cervical cancer is a fairly common malignant tumor. Its development is preceded by cervical dysplasia. Cancer changes occur as a result of the activity of HPV – the human papillomavirus. The first symptoms of cervical cancer are vaginal bleeding, vaginal discharge, pelvic pain, and pain felt during intercourse. Prevention includes a timely visit to the gynecologist, regular cytology and vaccination.
What is cervical cancer?
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Cervical cancer (lat. carcinoma cervicis uteri, cervical cancer) – cancer of epithal, less often glandular, cervical cells, i.e. the lower part of the uterus that connects it to the vagina. This is a malignant tumor that is difficult to treat. The development of cancer is a special condition – cervical dysplasia. This term describes pre-invasive cancer, a transitional state leading to the development of cancer.
Dysplasia does not give symptoms of cervical cancer, therefore, in the prevention of pathology, regular cytological examinations are of great importance, thanks to which early changes in the structure of cells can be detected.
In addition to breast, lung, endometrial, colon and ovarian cancer, cervical cancer is the most commonly diagnosed malignancy among women.
Types of cervical cancer – squamous cell carcinoma and adenocarcinoma
The type of cells in which the initial genetic mutation occurs determines the specific type of cervical cancer. Diagnosis of the type of cancer allows you to properly plan and carry out treatment.
The main types of cervical cancer are squamous cell carcinoma and adenocarcinoma.
- Squamous cell carcinoma . It begins to develop in thin and flat cells lining the cervix. This type of cancer is responsible for the vast majority of cervical cancers.
- Adenocarcinoma . It is found in the glandular cells that line the cervical canal. This type of cancer is responsible for a small number of cases of cervical cancer.
Sometimes both types of cells are involved in the development of cervical cancer symptoms. Cancer can also occur in other cells of the cervix, but these cases are very rare.
Cervical cancer – causes
A malignant neoplasm of the cervix begins to develop at the moment when healthy cells undergo a genetic mutation. The initial state of tumor development is cervical dysplasia. Physiologically unchanged cells grow and divide at the right frequency until they eventually die.
Cancer cells grow and divide out of control and do not die. As a result of the accumulation of altered cells, a tumor is formed. Cancer cells attack nearby tissues. They can also break away from the original tumor and spread to other parts of the body, forming metastases.
The cause of cervical cancer is not fully understood. However, a sexually transmitted infection caused by the human papillomavirus is known to play a role in this process. With the help of e6 and e7 proteins, this virus is integrated into the host’s genetic material. Traces of HPV are visible in almost all cases of cervical cancer.
When exposed to HPV, a woman’s immune system usually does not allow any damage to the body. However, in a certain group of women, the virus can survive for years, interfering with a process that causes some of the cells on the surface of the cervix to become cancerous.
However, HPV is a very common virus, and most women who become infected with it do not have cervical cancer. This, in turn, indicates the presence of other risk factors – genetic conditions, environment, lifestyle.
Not all types of HPV are oncogenic. An example is types 6 and 11, which are the cause of genital warts. HPV types 16 and 18 are mentioned among the types with the greatest potential to cause cervical cancer. However, it should be remembered that women who are not infected with oncogenic HPV types can also develop cervical cancer.
What is cervical dysplasia?
In the first stage of the disease, the symptoms of cervical cancer are almost invisible. This is the period when treatment brings the best chance for a full recovery. Before the onset of symptoms suggesting the possibility of developing cervical cancer, the course of the disease may be latent, without any disturbing symptoms.
At this time, the stage of cancer is usually low, and as a result, early detection of pathology is associated with a good prognosis – this gives a good chance for effective treatment of cervical cancer and recovery.
Cervical cancer does not appear suddenly, on the contrary, it develops slowly, and the substrate for its formation is a condition called cervical dysplasia (cervical neoplasia, preinvasive cancer). Distinguish dysplasia of small, medium and high degree (CIN – cervical intraepithelial neoplasia). Only high-grade dysplasia, ie. CIN3 can be considered pre-invasive cervical cancer (carcinoma in situ – CIS).
Pre-invasive cervical cancer is the lowest stage. It is estimated that it takes from 3 to 10 years before low-grade dysplasia develops into cervical cancer. But having minor dysplasia does not necessarily mean that it will turn into moderate dysplasia and then cancer. Some of them regress spontaneously or remain unchanged for many years.
Cervical cancer – risk factors
The basis for the prevention of cervical cancer is the passage of regular Pap smears. In order to effectively prevent cervical cancer, it is essential to know and avoid the risk factors that increase the likelihood of developing the disease.
The priority is to avoid exposure to the human papillomavirus (HPV for short). This virus is now recognized as the most important risk factor for cervical cancer. The virus is transmitted through sexual contact.
Factors that increase your risk of developing cervical cancer include:
- Multiple sexual partners – the more of them, the greater the likelihood of HPV infection;
- Early onset of sexual intercourse – beginning sexual intercourse before the age of 18 increases the risk of HPV infection;
- Weakened immune system – most women infected with HPV never develop cervical cancer, but in the case of HPV infection, when the immune system is weakened, the risk of developing cervical cancer increases;
- Other sexually transmitted diseases – women who have been diagnosed with a sexually transmitted disease (eg, chlamydia, gonorrhea) have a higher risk of contracting HPV;
- Smoking and HPV infection can increase the risk of developing cervical cancer.
The first symptoms of cervical cancer – the initial stage
Clinically, the presence of dysplasia indicates the presence of cervical disc erosion. During this period, the pathology should not give any symptoms at all. Contact bleeding (eg, during or after intercourse) or pain during intercourse is rare. Erosion can be a completely random finding during a gynecological examination.
Its very presence does not necessarily indicate the presence of dysplasia. You can detect a precancerous condition of the cervix using a test – a Pap smear, in which you can detect dysplastic cells in the smear being studied.
The mere detection of their presence does not yet determine the presence of cancer. The next step should always be a biopsy for histopathological examination, which will give a definite answer whether the lesion is cervical cancer.
Early symptoms of cervical cancer
Abnormal bleeding – during and after intercourse – an important symptom of a cervical tumor
The rest of the symptoms are not typical – many of them occur with other diseases, not necessarily cancerous. The mere presence of symptoms of cervical cancer can never be the basis for its diagnosis.
One of the first symptoms of the disease is bleeding during or after intercourse. We are talking about contact bleeding, which is not associated with menstrual bleeding.
During sexual intercourse, mechanical irritation of the growing tumor focus occurs. Microherbs can be manifested by the appearance of blood during or after intercourse, which should always cause concern for a woman.
If the bleeding persists after each intercourse, you need to urgently go to the gynecologist to conduct an examination and find out the cause of contact bleeding.
Intermenstrual bleeding and postmenopausal bleeding
The presence of cyclic menstrual bleeding is an indicator of physiology. Bleeding between periods (especially repeated) or bleeding after menopause is a cause for concern, as they suggest the presence of disorders – hormonal in nature or associated with the presence of organic changes. Intermenstrual or postmenopausal bleeding in cervical cancer is caused by the bleeding cancer.
Bleeding in cervical cancer
The appearance of bleeding is a very alarming signal. While the appearance of vaginal discharge in itself may indicate the presence of an intimate infection, the admixture of blood in the vaginal secretion should always draw attention to the possibility of cancer.
The focus of cancer is characterized by dynamic growth. This is due to the fact that cancer cells, intensively dividing, cause the formation of a tumor. Cancer hyperplasia in the case of cervical cancer is twofold.
- Exophytic tumors form masses similar to cauliflower growing into the lumen of the vagina. They are very fragile, break apart easily and bleed when touched.
- Endophytic tumors , in turn, grow in the opposite direction, penetrate deep into the wall of the cervix, giving a picture of an ulcer.
Since cancer cells grow rapidly and divide rapidly, they need a lot of nutrients and oxygen in particular. That is why cancerous tumors are extremely abundantly vascularized. The blood vessels supplying them are fragile, small, giving numerous branches. They are easy to damage spontaneously, and thus cause bleeding.
An important symptom is an unpleasant smell. This is due to another important feature of cancer cells. Their growth is so dynamic that the development of pathological blood vessels is not able to keep up with the energy needs of the tumor. Therefore, it is easy for cancer cells to feed on the perimeter of a cancerous tumor, and those inside simply die, forming a central necrosis, which, when destroyed, gives a picture of an ulcer. Gray necrotic masses are separated and have a very unpleasant odor.
Symptoms of cervical cancer
- Pain in the lower abdomen, back and pelvis. After crossing the serous membrane of the cervix, the tumor begins to cover the surrounding structures – blood and lymphatic vessels, nerves, surrounding organs. Pelvic and lower abdominal pain may simply be a symptom of cancer destroying surrounding nerves or nerve plexuses. Infection of bone structures can cause pain in the lower back (in the sacro-lumbar region).
- Weight loss. Weight loss is a sign of advanced cancer, often with accompanying metastases, leading to complete destruction of the body. An alarming symptom is a loss of 10% of body weight in the last 3 months. Cancer cells, which grow and divide intensively, need a large building and energy component, so they take them away from normal body cells. An organism suffering from cancer is malnourished, and its protein-energy requirements increase with the severity of the disease.
- Asymmetric swelling of the legs. This symptom is due to the presence of metastases of cervical cancer in the surrounding lymph nodes and is usually present at an advanced clinical stage. Cancer cells, spreading through the lymphatic vessels, clog them. This, in turn, disrupts the circulation of lymph inside the lower extremities, difficulties in its outflow are responsible for the formation of edema.
- It is important to note that the swelling of the lower extremities is asymmetrical – it affects one of the legs, and only later can appear in the other. This is due to the fact that metastases appear primarily in the lymph nodes and lymphatic vessels located closer to the tumor focus. In conclusion, edema will first appear in this limb, after which the primary tumor will be located.
- Pain during urination and stool. The tumor may lead to involvement of the uterus, rectum or bladder and urinary tract. If the passage of the stool is accompanied by difficulties, it becomes painful, or an admixture of fresh blood is noticed in the feces – these are symptoms of an advanced cancer process. An alarming symptom of cervical cancer is pain during urination associated with sealing of the back wall of the bladder or tracts that excrete urine. In extreme cases, urination may stop completely. Sometimes it is also possible to determine the presence of hematuria.
Cervical cancer and kidney failure
In the case of a significant progression of the cancerous process, symptoms of kidney failure, exhaustion of the body and pain during urination or stool appear. Chronic renal failure is a late symptom of cervical cancer. There are many reasons for this condition.
Undoubtedly, the influence of chemotherapeutic agents damages the kidneys. Also, one should not forget about the possibility of the appearance of metastases in the kidneys. Also, the tumor can induce ureters or ureteral bladder outlets, which can contribute to urinary stasis, hydronephrosis, and, as a result, symptoms of kidney failure.
Cervical cancer – prevention, cytology
The success of treatment depends on early detection of cervical cancer. All women should be regularly screened for cancer and precancerous lesions of the cervix. Such examinations should begin no later than 25 years in the case of virgins or 3 years after the onset of sexual intercourse. Normal Pap results allow for follow-up intervals every 3 years.
Separate stages of the examination can detect cervical cancer. The most important of these is cytology. During a Pap smear, the doctor takes a sample of tissue lining the cervix and then sends it to a laboratory to diagnose possible abnormalities. Cytology can detect abnormal cells in the cervix, including cancer cells and abnormally structured cells that increase the risk of developing cervical cancer.
A gynecologist may also order a DNA test to diagnose if you are a carrier of HPV, which can lead to cervical cancer. Like cytology, a DNA test involves taking a sample of cells from the cervix and sending it to a laboratory.
The risk of cervical cancer can be reduced by:
- using condoms during intercourse;
- the onset of sexual activity at a later age;
- reducing the number of sexual partners;
- quit smoking cigarettes;
- HPV vaccinations.
Cervical Cancer Vaccine
The HPV vaccine can prevent cervical cancer. Cervical cancer vaccines protect against the most dangerous types of HPV, which play a significant role in the development of most cervical cancers.
Vaccination is carried out for girls aged 9-12 years and women aged 13-26 who have not previously been vaccinated. The vaccine is most effective when administered to girls who have not yet begun sexual activity, as the virus is transmitted by men.
Most scientists believe that this vaccine is able to counteract the disease, but it does not guarantee 100% protection against infection with a virus that can cause this type of cancer. It is also necessary to take Pap smears before vaccination to make sure that the virus is not yet in the body.
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