Cervical cancer (CC) is a common malignant disease of the female reproductive system. Modern oncogynecology has great potential for the treatment of pathology. Surgery is still considered one of the most effective ways. The choice of intervention protocol depends on the stage of development of the process, the desire of the woman to have children in the future, and other factors.
What is cervical cancer
CC (cervical cancer) is a malignant neoplasm that affects the cervix. It is characterized by rapid progressive development. The initial stages of the disease are asymptomatic. It is found more often by chance, during a visit to the gynecologist. A cytology smear taken during colposcopy helps to diagnose pathology.
The basis of carcinogenesis is infection with papillomavirus. Infectious agents are embedded in the chromosome apparatus of the cells of the basal epithelium of the mucous membrane, where they produce their own proteins and multiply. This causes mutations and uncontrolled division.
Cells with damaged DNA are able to spread to other organs and systems. Metastasis occurs in two ways:
- contact (retroperitoneal): into the vagina, bladder, rectum, etc.;
- lymphogenous (according to the system of lymphatic vessels): to the lymph nodes (nearby and remote), bones, liver, brain, etc.
Classification of cervical cancer
Histological forms of neoplasm (by type of origin):
- Squamous cell carcinoma (with and without keratinization). It is diagnosed in more than 70% of women with cervical cancer.
- Tumors from glandular epithelial tissue: endocervical adenocarcinoma (10-20% of clinical cases).
- Vitreous cell, adenosquamous carcinoma, other rare types (less than 1%).
Symptoms and signs
At the stage of precancerous changes and at the beginning of tumor growth, there are no pathological signs. Symptoms appear when the neoplasm begins to grow into the tissues of neighboring organs. The clinical picture in cervical cancer is nonspecific (all observed changes may be signs of other pathologies):
- discomfort in the lumbosacral spine;
- pelvic pain;
- discharge with traces of blood from the vagina after sex or examination on an examination chair;
- vaginal bleeding during menopause, between days of menstruation;
- unpleasantly smelling watery leucorrhoea from the vagina, etc.
As the pathology progresses, other symptoms appear: swelling of the legs, impaired urination, defecation, fatigue, weight loss for no apparent reason, etc.
Stages of the cancer process
According to the severity of the pathological process, stages of CC are distinguished:
- zero: all transformed cells are localized within the boundaries of the superficial layer of the neck. The condition is sometimes called precancerous;
- the first: tumor growth within the boundaries of the cervical canal. There are 2 subtypes of the stage. 1A – the formation begins to grow in depth (by 3–5 mm) and in breadth (up to 7 mm). 1B – neoplasm is determined by the naked eye during the examination (size from 4 cm);
- the second: 2A — a tumor without germination in parametrium (periouterine tissue), 2B — parametrical invasion was detected;
- third: 3A – pathology covers the lower part of the vagina, but does not affect the pelvic organs. 3B – neoplasm invades the pelvic walls, is the cause of renal dysfunction. 3C – metastasis to the para-aortic and pelvic lymph nodes is added to the previous signs;
- fourth: involvement in the process of the urinary system, the lower intestine. The appearance of distant metastases.
The disease develops under the influence of adverse factors. The greatest risks are:
- early onset of sexual activity;
- promiscuous sexual relations;
- weakening of the body’s immune system;
- prolonged use of hormonal contraceptives;
- nicotine addiction.
The volume of measures taken depends on the extent of the pathological process. The most effective are complex programs that include several methods:
- invasive or minimally invasive surgery;
- radiotherapy: III–IV stages are the main indication for radiotherapy;
- chemotherapy – treatment with cytotoxic drugs;
- photodynamic, activation therapy;
- therapeutic electrohyperthermia, etc.
Surgery is the treatment of choice for this diagnosis. Intervention can be carried out in various ways, including:
- High amputation – complete removal of the cervix along with the pharynx.
- Total abdominal trachelectomy. During the operation, the following are excised: the cervix (entirely), part of the vagina (upper), pelvic lymph nodes.
- Conization is the cone-shaped removal of a fragment of an organ. It is carried out using a scalpel or an electric loop. Excision of the site occurs within healthy tissue. Additionally, the surgeon scrapes the mucous membrane of the cervical canal. Used in the early stages of the tumor process.
- Hysterectomy (total, radical). Depending on the clinical case, the operation can be performed with the removal of the fallopian tubes and ovaries or with their preservation.
When is the cervix removed?
The decision to remove the cervix is made by the gynecologist-oncologist based on the data obtained during the examination. Amputation is indicated for conditions such as:
- cancer tumor;
- atypical location of myomatous nodes (cervical fibroids);
- erosive inflammation of the mucosa, which is not amenable to conservative treatment for a long time;
- recurrences of cysts, polyps against the background of sluggish inflammation;
- cervical deformity during childbirth;
- chronic inflammation of the cervical mucosa.
Indications and contraindications for surgery
Removal of the cervix is indicated for the rapid progression of dysplasia, or when a malignant tumor has already been diagnosed (stages 1–2). Total surgery in some clinical cases can be performed at the 3rd stage of the disease. Intervention contraindications:
- violations of hemostasis;
- acute respiratory diseases;
- urinary infection;
- decompensation of somatic pathologies (diabetes mellitus, hypertension, unstable angina, etc.);
- bulk neoplasia, etc.
Features of the operation
The procedure is performed by open or laparoscopic method. Open surgery involves a large incision in the peritoneum. The duration of this intervention is 1-2 hours. Endoscopic technologies are less traumatic: laparoscopic tubes are inserted into the cavity through minor skin incisions. The duration of this operation is 1.5 hours.
The operation to remove cervical cancer can lead to undesirable consequences, such as:
- bleeding (due to insufficient stabilization of hemostasis and injury to the mucosa);
- generalized infection;
- necrosis of the tissues of the vagina;
- spotting before the onset of menstruation;
- spikes, etc.
Survival forecasting is carried out on the basis of the obtained statistical data for a five-year period:
- more than 90% – with a local neoplasm (lack of invasion into other structures);
- 51-56% – with the growth of cancerous tissue within closely spaced neighboring tissues (stages II, III);
- 7-8% – at stage IV of the disease;
- 15-18% – in case of early detection of metastases.
How to prepare for the operation?
Preparation for surgery consists in a complete diagnostic examination, which includes:
- biochemistry and KLA;
- control of hemostatic parameters;
- ELISA for HIV, hepatitis, syphilis;
- the study of blood serum for tumor markers;
- biopsy histology;
- urinalysis (general analysis);
- chest x-ray;
- examination of the cervix, vagina and external genitalia with a colposcope;
- Ultrasound scanning of the pelvic organs.
If the presence of metastases is suspected, additional instrumental diagnostics may be prescribed: hysteroscopy, sigmoidoscopy, MRI of the head, etc. If the patient has a history of chronic inflammatory diseases of the female genital organs, then conservative therapy with medication is performed before surgery. On the eve of the intervention, it is necessary to remove pubic hair, cleanse the intestines, and take a shower.
What is an operation?
Surgical intervention consists in removing the cervix and part of the tissues that surround it. The body of the organ remains intact and continues to perform its functions.
What are the features of the postoperative period?
The first time after removal of a cancerous tumor, the patient remains in the hospital under the supervision of medical staff (7-10 days in the absence of complications). During the recovery period (about 2 months), pain, weakness, fatigue, dizziness may occur. Recommendations after discharge from the hospital:
- limit physical activity;
- refrain from sexual contact;
- do not use hygienic tampons;
- refuse hormonal contraceptives, drugs that thin the blood;
- do not visit the bathhouse, swimming pool, beach, solarium, etc.
14-21 days after the operation, a woman needs to make an appointment with her gynecologist. After the follow-up examination, the doctor will set a date for a follow-up visit to take a smear for cytology and video colposcopy. Gynecological examination after removal of cervical cancer must be done quarterly during the first year.
Is it possible to have a child?
The probability of conceiving a child after surgery for cervical cancer depends on the extent of the operation performed. If only the cervix with a tumor was removed from a woman, and the body of the organ was preserved, then attempts to get pregnant will be successful in 70% of cases. With a long absence of conception, it is recommended to use in vitro fertilization.
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