Invasion, angiogenesis and metastasis of tumor cells - cancer. Invasive breast cancer: causes, diagnosis, treatment. Blood for tumor markers

Second most common malignant tumor in women after neoplasms of the mammary glands - cervical cancer. The pathology occurs in 8-11 women out of 100 thousand. Every year, up to 600 thousand newly discovered cases of the disease are registered around the world.

Signs of cervical cancer most often develop in patients over 40 years of age. The risk of getting sick in this group is 20 times higher than in girls 25 years old. About 65% of cases are found in the age group of 40-60 years, 25% in the group of 60-69 years old. Early stages of pathology are more often detected in women 25-40 years old. In this case, the disease can be easily cured, so it is very important to be regularly examined by a gynecologist.

In Russia, early stages of this pathology are registered in 15% of patients, advanced cases - in 40% of patients who applied for the first time.

Causes and mechanism of development

Cervical carcinoma: what is it? According to the definition of the World Health Organization, it is a malignant tumor that arises from the cells of the layer lining the surface of the organ from the outside, that is, the epithelium.

Modern medicine still does not have enough data to speak with confidence about etiological factors diseases. The mechanism of tumor development is also poorly understood. This is largely due to the difficulties of prevention and early detection neoplasms of the cervix.

It is known that the causes of cervical cancer are associated with infection types 16 and 18. Viral infection detected in 57% of patients.

Social disadvantage and promiscuous sexual relations are important. The harmful effects of smoking have been proven.

The cervix is ​​lined by multilayered epithelium. Its cells are flat in shape and arranged in layers. Under the influence of the virus, the epithelium gradually changes its structure, and malignancy occurs - tissue malignization.

Stages of malignancy:

• Epithelial cells respond to damage by dividing more rapidly to repair damaged tissue.
• Precancerous changes occur, which consist in disruption of the structure of the epithelial layer -.
• Gradually, in the thickness of the cells appear malignant changes: The epithelium begins to divide uncontrollably. Pre-invasive cervical cancer occurs (in situ, or “in place”).
• Then malignancy spreads beyond the epithelium and penetrates the stroma - the underlying tissue of the cervix. If this growth is less than 3 mm, they speak of microinvasive carcinoma. This is an early stage of invasive cancer.
• When it grows into the stroma more than 3 mm, invasive cervical cancer occurs. In most patients external signs And clinical symptoms diseases appear only in this phase.

Detection of precancerous changes is the basis for early diagnosis and successful treatment diseases. Dysplasia is accompanied by the proliferation of altered (atypical) cells within the epithelial layer, top layer however, it does not change and consists of ordinary cells with signs of keratinization.

Carcinoma in situ (pre-invasive or non-invasive cervical cancer) is accompanied by a violation of the layering of the epithelium and the presence of malignant cells throughout its entire thickness. However, the tumor does not grow into the underlying tissue, so it is well treated.

Forms of the disease

The morphological structure of a tumor is the external changes in the shape and structure of its cells. The degree of tumor growth and its malignancy depend on these features. Morphological classification includes the following forms:

• squamous cell keratinizing;
• squamous without keratinization;
• poorly differentiated cancer;
• glandular (adenocarcinoma).

Squamous cell variants occur in 85% of cases, adenocarcinoma – in 15%. Keratinizing cervical cancer has a high degree of cellular maturity and a more favorable course. It is observed in 20-25% of women. Non-keratinizing form with average degree differentiation is diagnosed in 60-65% of patients.

Adenocarcinoma predominantly develops in the cervical canal. Poorly differentiated tumors with high degree malignancies are rarely diagnosed, therefore timely diagnosis makes it possible to successfully cure most types of cancer. In 1-1.5% of patients, clear cell, small cell, mucoepidermoid and other tumor variants are detected.

Depending on the direction of tumor growth, the following forms are distinguished:

• with endophytic growth (inward, towards the underlying tissues, with transition to the body of the uterus, appendages, vaginal wall);
• with exophytic growth (into the vaginal lumen);
• mixed.

Clinical manifestations

About 10% of cases of the disease have a “silent” course, that is, they are not accompanied by any external manifestations. Signs of cervical cancer on early stage can only be detected by examination and cytological examination.

How quickly does the tumor develop?

The transformation of a precancerous condition into cancer takes from 2 to 10 years. If at this time a woman is regularly examined by a gynecologist, the likelihood of recognizing the disease at an early stage is very high. The transition of cancer from stage 1 to stage 2 and subsequent ones takes an average of 2 years.

In later stages, symptoms of cervical cancer appear:

• bloody discharge;
• leucorrhoea;
• pain.

Intensity bloody discharge may be different. They are observed in two variants:

• contact: appear during sexual intercourse, vaginal gynecological examination, and also often during defecation;
• acyclic: are spotting before and after menstrual bleeding and occur in 60% of patients.

A quarter of patients experience light-colored discharge – leucorrhoea. They may be watery or become mucopurulent. Often they acquire foul odor. Leucorrhoea appears due to damage to the lymphatic capillaries when dead areas are destroyed malignant neoplasm. If they suffer at the same time blood vessels, an admixture of blood is visible in the discharge.

How does cervical cancer manifest itself in the next stage?

Many patients complain of pain in the lower back, sacrum, spreading to the anal area and legs. The pain is associated with compression of the nerve trunks by a tumor that has spread to the pelvic tissue. Pain syndrome also occurs when the pelvic lymph nodes and bones are affected.

When a tumor grows into the intestinal wall or bladder constipation, blood in the stool, and frequent painful urination are possible.

When large lymphatic collectors are compressed, swelling of the legs appears. A prolonged slight increase in temperature is possible. Nonspecific manifestations of malignant tumors include weakness and decreased performance.

Main complications requiring immediate hospitalization and treatment:

• intense bleeding from the vagina;
• intestinal obstruction;
• acute renal failure;
• severe pain syndrome.

Diagnostics

To recognize a cervical tumor, doctors analyze the patient’s life history and illness, conduct laboratory and instrumental studies. A comprehensive diagnosis of cervical cancer is necessary to clarify the stage and determine an individual treatment plan.

Life history features that increase the likelihood of a tumor:

• early sexual life;
• multiple sexual partners;
• infectious diseases transmitted through sexual contact;
• abortions;
• cervical injury during childbirth;
• previous biopsy, diathermocoagulation or diathermoconization;

The basis for early diagnosis is an annual preventive medical examination of women with mandatory implementation superficial scraping from the cervix and its cytological examination. Cytological analysis allows you to clearly examine epithelial cells under a microscope and detect precancerous or malignant changes.

Cytological screening should be carried out in all women from the age of 18-20 years. It is enough to perform it once every 3 years, however, with an annual examination, the frequency of detecting a malignant tumor at an early stage increases. Smear analysis gives a reliable result in 90-98% of cases, and erroneous conclusions are most often false positive. Cases where an existing tumor is not recognized by cytological examination are extremely rare.

What is the test for cervical cancer called?

In many countries, cytological screening using Papanicolaou is used; in Russia, a modification of this method is used. It begins 3 years after the start of sexual activity or upon reaching the age of 21. The screening test can be stopped in women over 70 years of age with an unchanged cervix and at least three negative results smear over the past 10 years.

If precancerous changes (dysplasia) are detected, the woman undergoes an in-depth examination.

How to determine cervical cancer at the second diagnostic stage?

The following methods are used for this:

• gynecological examination;
• with Schiller's test (examination of the cervix under a special microscope with staining of its surface with Lugol's solution); areas of pathologically altered epithelium are not stained during the Schiller test, which helps the doctor take a biopsy from the lesion;
• repeated cytological and histological studies.

A complete examination allows a diagnosis to be made in 97% of patients.

Additional diagnostic methods

A tumor marker for cervical cancer, the specific antigen SCC, is examined in the patients’ blood. Normally, its concentration is no more than 1.5 ng in 1 ml. In 60% of patients with squamous cell carcinoma the level of this substance is increased. Moreover, their likelihood of relapse is 3 times higher than in patients with normal indicator SCC. If the antigen content is more than 4.0 ng in 1 ml, this indicates metastatic lesion pelvic lymph nodes.

Colposcopy is one of the main methods used to identify a tumor. This is an examination of the cervix using optical device, giving an increase of 15 times or more. The examination makes it possible to identify areas of pathology in 88% of cases and take a targeted biopsy. The examination is painless and safe.

Information content only cytological diagnostics smear without biopsy is 64%. The value of this method increases with repeated analyses. The study does not make it possible to distinguish between preinvasive and invasive types of tumor, so it is supplemented with a biopsy.

When identifying changes using histological and cytological examination, and also during colposcopy, an extended biopsy of the cervix is ​​prescribed - conization. It is performed under anesthesia and involves excision of cervical tissue in the form of a cone. Conization is necessary to assess the depth of tumor penetration into the underlying tissue. Based on the results of the biopsy, doctors determine the stage of the disease, on which treatment tactics depend.

After analyzing clinical data and results additional diagnostics The doctor should receive answers to the following questions:

• whether the patient has a malignant tumor;
• what is the morphological structure of cancer and its spread to the stroma;
• If reliable signs there is no tumor, are the detected changes precancerous;
• Is the data obtained sufficient to exclude the disease?

To determine the spread of the tumor to other organs, use radiation methods disease recognition: ultrasound and tomography.

Is cervical cancer visible on ultrasound?

You can detect a tumor that has spread into its thickness or into the wall of surrounding organs. This study is not carried out to diagnose education at an early stage. On ultrasound, in addition to changes in the organ itself, damage to the pelvic lymph nodes is visible. This is important for determining the stage of the disease.

Additionally, studies aimed at identifying distant metastases are prescribed:

• X-ray of the lungs;
• excretory urography;
• cystoscopy;
• rectoscopy;
• lymphography;
• bone scintigraphy.

Depending on the accompanying symptoms, the patient is referred for consultation to one or more specialists:

• cardiologist;
• gastroenterologist;
• neurosurgeon;
• thoracic surgeon;
• endocrinologist

Doctors of the listed specialties identify metastases in distant organs and also determine the safety of surgical treatment.

Classification

For the most successful treatment, the doctor needs to determine the extent of the tumor, the extent of damage to the lymph nodes and distant organs. For this purpose, two classifications are used, largely repeating each other: the TNM system (“tumor – lymph nodes – metastases”) and FIGO (developed by the International Federation of Obstetricians and Gynecologists).

• T – tumor description;
• N0 – regional lymph nodes are not involved, N1 – metastases in the pelvic lymph nodes;
• M0 – there are no metastases in other organs, M1 – there are tumor foci in distant organs.

Cases where diagnostic data are not yet sufficient are designated Tx; if the tumor is not detected - T0. Carcinoma in situ, or non-invasive cancer, is designated Tis, which corresponds to FIGO stage 0.

There are 4 stages of cervical cancer

Stage 1 cancer according to FIGO is accompanied by the appearance pathological process only in the neck itself. There may be such damage options:

• invasive cancer, determined only microscopically (T1a or IA): penetration depth up to 3 mm (T1a1 or IA1) or 3-5 mm (T1a2 or IA2); if the depth of invasion is more than 5 mm, the tumor is classified as T1b or IB;
• tumor visible on external inspection(T1b or IB): up to 4 cm in size (T1b1 or IB1) ​​or more than 4 cm (T1b2 or IB2).

Stage 2 accompanied by tumor spread to the uterus:

• without germination of periuterine tissue, or parametrium (T2a or IIA);
• with germination of the parametrium (T2b or IIB).

Stage 3 cancer is accompanied by the proliferation of malignant cells in the lower third of the vagina, pelvic walls or kidney damage:

• affecting only the lower part of the vagina (T3a or IIIA);
• with involvement of the pelvic wall and/or kidney damage leading to hydronephrosis or a non-functioning kidney (T3b or IIIB).

Stage 4 accompanied by damage to other organs:

• with damage to the urinary system, intestines, or tumor extension beyond the pelvis (T4A or IVA);
• with metastases in other organs (M1 or IVB).

To determine the involvement of lymph nodes, a study of 10 or more is required lymph nodes pelvis

The stages of the disease are determined clinically, taking into account the data of colposcopy, biopsy, and examination of distant organs. Methods such as CT, MRI, PET or lymphography have only additional meaning. If there is doubt about staging, the tumor is classified as a milder stage.

Treatment methods

For patients with early-stage tumors, cervical cancer is treated with radiation or surgery. The effectiveness of both methods is the same. In young patients, it is better to use an operation after which the function of the ovaries and uterus is not impaired, atrophy of the mucous membrane does not develop, and pregnancy and childbirth are possible.

There are several options for how to treat cervical cancer:

• surgery only;
• combination of radiation and surgery;
• radical radiotherapy.

Surgical intervention

Removal of the uterus and appendages can be performed using. The method avoids extensive incisions and trauma. internal organs and the formation of adhesions. The duration of hospitalization for laparoscopic surgery is significantly less than for traditional surgery and is 3-5 days. Additionally, vaginal plastic surgery can be performed.

Radiotherapy

Radiation therapy for cervical cancer can be given before surgery using a fast-track technique to reduce the size of the tumor and make it easier to remove. In many cases, surgery is performed first, then the tissue is irradiated to destroy any remaining cancer cells.

If surgery is contraindicated, a combination of external and intracavitary radiotherapy is used.

Consequences radiation therapy :

• atrophy (thinning and dryness) of the vaginal mucosa;
• infertility due to concomitant ovarian damage;
• due to inhibition of hormonal activity of the gonads, a few months after irradiation may occur;
• V severe cases communication may form between the vagina and adjacent organs. Fistulas may leak urine or feces. In this case, surgery is performed to restore the vaginal wall.

The treatment program is developed individually, taking into account the stage and size of the tumor, the general condition of the woman, damage to the pelvic lymph nodes and other factors.

Chemotherapy

Adjuvant (postoperative) chemotherapy with Fluorouracil and/or Cisplatin is often used. Chemotherapy may be given before surgery to reduce the size of the tumor. In some cases, chemotherapy is used as independent method treatment.

Modern methods of treatment:

• targeted therapy using agents of biological origin; such drugs accumulate in tumor cells and destroy them without damaging healthy tissue;
• intravaginal antiviral therapy;
• photodynamic treatment: a light-sensitive drug is injected into the tumor, and with subsequent laser exposure, the tumor cells disintegrate;
• IMRT therapy is intensity-modulated radiation that allows you to gently target the tumor without damaging healthy cells;
• brachytherapy – introduction of a radiation source in close proximity to the tumor site.

Nutrition

At home, the patient must adhere to a certain diet. Nutrition should be complete and varied. Of course, diet cannot defeat cancer. However, it is possible beneficial influence the following products:

• carrots, rich in plant antioxidants and carotenoids;
• beet;
• green tea;
• turmeric.

A variety of vegetables and fruits are beneficial, as well sea ​​fish. It is not recommended to consume the following products:

• refined carbohydrates, sugar, chocolate, carbonated drinks;
• canned foods;
• spices;
• fatty and fried foods;
• alcohol.

At the same time, it is worth understanding that with stages 3-4 of cancer, patients’ life span is often limited, and a varied diet helps them improve their psychological state.

Rehabilitation period

Recovery after treatment involves gradual expansion motor activity. Elastic leg bandaging is used to prevent venous thrombosis. After the operation, breathing exercises are indicated.

The support of loved ones is important. Many women need help medical psychologist. After consulting with a doctor, you can use some herbal remedies, but many experts are wary of this method of treatment, because the safety of herbs for cancer has practically not been studied.

A woman's health usually recovers within a year. During this period, it is very important to avoid infections, physical and emotional stress.

Features of treatment of cervical cancer depending on stage

Non-invasive cancer

Non-invasive cancer is an indication for cervical conization. It can be performed using a scalpel, as well as electricity, laser or radio waves. During the intervention, the altered cervical tissue is removed in the form of a cone, directed with its apex upward, towards the internal os of the uterus. The resulting material is carefully examined to ensure complete removal of a small malignant lesion.

Another surgical option is trachelectomy. This is the removal of the cervix, the adjacent part of the vagina and fatty tissue, and pelvic lymph nodes. Such intervention helps preserve the ability to bear children.

If the tumor has spread along the cervical canal to the internal os and/or in elderly patients, it is preferable to remove the uterus and appendages. This can significantly improve the prognosis for life.

IN in rare cases Due to severe illnesses, any surgical interventions are contraindicated. Then, to treat carcinoma in situ, intracavitary radiation therapy is used, that is, radiation using a source inserted into the vagina.

IA stage

In case of stage IA cancer, when the depth of germination into the underlying tissue is less than 3 mm, if the patient insists on maintaining the ability to bear children, conization of the cervix is ​​also performed. In other cases, patients before menopause have their uterus removed without appendages in order to preserve the natural hormonal levels. For elderly women, extirpation of the uterus and appendages is indicated.

During the intervention, the pelvic lymph nodes are examined. In most cases they are not removed. In 10% of patients, metastases are noted in the pelvic lymph nodes, then they are removed.

With a tumor penetration depth of 3 to 5 mm, the risk of spread to the lymph nodes increases sharply. In this case, removal of the uterus, appendages and lymph nodes (lymphadenectomy) is indicated. The same operation is performed when the depth of cancer cell invasion is unclear, as well as if tumor recurrence occurs after conization.

Surgical treatment is supplemented with intracavitary radiotherapy. If the germination depth is more than 3 mm, a combination of intracavitary and external irradiation is used. Intensive radiation therapy is also carried out if it is impossible to perform surgery.

Tumors IB-IIA and IIB-IVA stages

For stage IB-IIA tumors up to 6 cm in size, either extirpation of the uterus, appendages and lymph nodes, or intensive radiation therapy is performed. Using each of these methods, the 5-year survival rate for cervical cancer reaches 90%. For adenocarcinoma or a tumor larger than 6 cm, surgery and radiation intervention are combined.

Stage IIB-IVA cancer is not usually treated with surgery. However, in many cases, the stage of the tumor can only be determined during surgery. This involves removing the uterus, appendages, pelvic lymph nodes and prescribe postoperative radiotherapy.

Another treatment option: external beam radiation, brachytherapy (injecting a radiation source into the tissue of the cervix) and chemotherapy are first prescribed. If reached good effect, Wertheim's operation is performed for cervical cancer (removal of the uterus, appendages and lymph nodes). Radiation therapy is then resumed. To improve the patient's condition, preliminary movement (transposition) of the ovaries is possible. Then they are not exposed harmful influence irradiation and retain the ability to produce sex hormones.

Relapses of the disease usually occur within 2 years after surgery.

IVB stage

If the patient has distant metastases, none of the operations leads to a significant improvement in quality of life and prognosis. Radiation therapy is prescribed to reduce the size of the tumor lesion and eliminate compression of the ureters. When cancer recurs, especially if the newly appeared lesion is small, intensive radiation helps to achieve life preservation for 5 years within 40-50%.

IIB-IVB stages

In these cases, chemotherapy may be prescribed after radiation. In stage 4, its effectiveness has been little studied. Chemotherapy drugs are used as experimental method treatment. How long do patients with distant metastases live? Once diagnosed, life expectancy is on average 7 months.

Treatment during pregnancy

If a woman is diagnosed with cervical cancer during pregnancy, treatment is determined by the stage of the tumor.

At stage 0 in the first trimester, the pregnancy is terminated and conization of the cervix is ​​performed. If the tumor is detected in the second or third trimester, the woman is regularly examined, and 3 months after birth, conization is performed. In this case, radiosurgery with the Surgitron or Visalius apparatus is often used. This is a gentle treatment method.

If stage 1 cancer is diagnosed during pregnancy, there are 2 options: either termination of pregnancy, removal of the uterus and appendages, or pregnancy followed by surgery and radiation according to the standard regimen. With 2 or more severe stages In the first and second trimesters, the pregnancy is terminated; in the third, a caesarean section is performed. Then the standard treatment regimen is started.

If the patient has undergone organ-preserving treatment, she is allowed to become pregnant 2 years after completion of therapy. Childbirth is carried out only by caesarean section. After past illness the frequency and perinatal mortality in children is increasing.

Prognosis and prevention

Malignant tumor of the cervix - serious illness, but with early diagnosis it can be successfully cured. At stage 1, survival rate over five years is 78%, at stage 2 - 57%, at stage 3 - 31%, at stage 4 - 7.8%. The overall five-year survival rate is 55%.

After the course of treatment, patients should be regularly monitored by a gynecologist. During the first 2 years, analysis for SCC, ultrasound, and, if necessary, CT is carried out once a quarter, over the next 3 years - once every six months. X-ray of the lungs is performed 2 times a year.

Given the large social significance disease and poor prognosis in advanced cases, prevention of cervical cancer is very important. You should not neglect annual visits to the gynecologist, because they can save the health and life of a woman.

Prevention measures:

1. Regular observation by a gynecologist, starting from 18-20 years of age, with mandatory cytological screening.
2. Early diagnosis and treatment of cervical diseases.

The incidence of the disease is gradually decreasing. However, there is a noticeable increase in incidence in women under 29 years of age. This is largely due to women's limited knowledge about risk factors for the disease. To reduce the likelihood of precancerous pathology, you should avoid early start sexual life and infections transmitted through sexual contact. Condoms help to significantly reduce, although not eliminate, the likelihood of infection with the papilloma virus.

In order to develop immunity to the virus, it is indicated to prevent precancerous and cancer cervix, as well as genital condylomas.

Cervical cancer (CC) is a malignant tumor that occupies one of the leading positions among all cancer pathologies in women. The disease is classified as a tumor of “visual localization”, but in 40% of cases the neoplasm is diagnosed in late stages.
In Russia, more than 12,000 new cases of cervical cancer are detected annually, with the peak incidence occurring in patients aged 40-55 years. In 7% of cases, the tumor occurs in women under 30 years of age; after 70 years, the incidence rate reaches 16%. Most often, the tumor is diagnosed at the stage invasive carcinoma, which directly correlates with low treatment effectiveness, quality of life and a less favorable prognosis than with the non-invasive form of the disease.

Forms of the disease

Let's look at the main differences between invasive and non-invasive cervical cancer. The degree of invasion (germination) is assessed based on instrumental methods examinations.

In the early stages, the tumor grows quite slowly, without affecting the surrounding tissues, without provoking the development of metastases. Therefore, when malignant cells are localized exclusively in the outer layers of the epithelium, the tumor is designated as non-invasive cervical cancer. According to the TNM classification, category T (tumor) is labeled as T0.

With further growth into deeper tissues, the index is assigned to the tumor - “cancer in situ”, which indicates tumor invasion into the underlying tissues. In this case, the tumor is considered pre-invasive.

With all the above options, it is possible to perform organ-saving treatment. Women who have not given birth even retain their fertility.

Subsequently, when the tumor grows to the depth of the organ by more than 5 mm, they speak of invasive cervical cancer. The next stage is the spread of the tumor to the body of the uterus, pelvic walls, vagina, bladder, and rectum.

Thus, invasive cervical cancer includes tumors with an index of T1b or more. The process of degeneration of one form of cervical cancer into another can last for several years.

Clinical picture

Symptoms of cervical cancer are usually divided into general and specific signs. General symptoms associated with a disturbance in the patient’s well-being; women note:

• General weakness and decreased performance;
• Slight (low-grade) increase in temperature;
• Dizziness;
• Lack of appetite;
• Sharp weight loss.

Specific symptoms are directly related to damage to the cervix. In the early stages, the disease is asymptomatic. The first symptoms of the disease often develop at stages 3-4 of cancer pathology.

Signs of cervical cancer are:

• Colorless or whitish discharge (leucorrhoea), sometimes mixed with blood;
• Bloody discharge after sexual intercourse or a gynecological examination, between menstruation in fertile women, after the onset of menopause;
• The appearance of an unpleasant odor from the vagina;
• Prolongation of menstrual bleeding;
• Swelling of the legs in the presence of damage to the inguinal lymph nodes;
• Pain in the pelvic area;
• Defecation disorder;
• Difficulty and painful urination;

The appearance of urine or feces in the vagina, which indicates the occurrence of fistulas.

The listed symptoms usually develop at stages 3 and 4 of cancer. Therefore, it is necessary to regularly undergo gynecological examination in order to promptly identify and begin treatment for cervical cancer.

Diagnostics

cervical cancer is confirmed on the basis of histological examination of cervical tissue obtained as part of diagnostic curettage, biopsy or conization.

Optimal scope of examination:

1. Colposcopy.
2. Histological examination.
3. MRI of the pelvis (MRI is more informative than CT in assessing the depth of invasion and the transition of the tumor to the parametrium and adjacent organs; the accuracy of determining the depth of invasion using MRI is 71-97%);
4. CT scan of the pelvis, abdominal cavity and retroperitoneal space (when detecting metastases in lymph nodes, the information content of CT and MRI is the same).
5. Positron emission tomography (PET) or PT-CT.

Treatment

Treatment tactics are formed at a consultation of an oncologist, radiologist, chemotherapist and other specialized specialists, if indicated.

Algorithm therapeutic effects for cervical cancer is formed based on the stage of the pathological process, the patient’s health status, her age, tumor size and the extent of metastases. Chemotherapy and radiation are used before surgery to shrink the tumor or after excision of the tumor to destroy remaining cancer cells.

Treatment methods

• Surgical intervention. If with non-invasive cervical cancer it is possible to perform non-mutilating operations with good results (cervical conization in combination with curettage cervical canal), then in the presence of invasive carcinoma, such volumetric surgical interventions, such as hysterectomy (complete removal of the uterus and cervix) with lymph node dissection (removal of lymph nodes). If tumor invasion into the rectum or bladder is diagnosed, then exenteration (evisceration) of the pelvic organs is performed (removal of the uterus, cervix, bladder, rectum). However, for invasive cancer, treatment is rarely limited to surgical treatment only, but is carried out in combination with chemoradiotherapy.
• Chemotherapy. The method is based on the reception medicines, which suppress the activity of malignant cells. Chemotherapy is used as monotherapy or in addition to radiotherapy and surgery. The use of pharmaceuticals can increase the effectiveness of radiation therapy, reduce the risk of developing metastases, and control disease relapse. For this purpose, the following are prescribed: Hydroxycarbamide, Bleomycin, Cisplatin, Etoposide.
• Radiotherapy. The technique is widely used in combination with surgery in the early stages of the disease. For common forms of cervical cancer – the only way reduce the volume of the tumor mass. For treatment, internal (brachytherapy) and external irradiation are used. After a course of therapy, complications often arise in the form of post-radiation damage to the skin and internal organs.

In cases where the cervical tumor cannot be removed (significant local spread, presence distant metastases), chemoradiotherapy is used as an independent method.

Forecast

With the development of a non-invasive form of cervical cancer, in 90% of cases it is possible to achieve full recovery patients. However, as the tumor grows and malignant cells spread into surrounding tissues, the prognosis worsens significantly. Subject to timely and adequate therapy full life It is possible to recover about 60% of patients with the second stage of cancer.

With the development of stage 3 CC, tumor growth can be stopped in 30% of cases. The fourth stage is considered terminal, but the use modern techniques allows to achieve stabilization of the process in 10% of patients, subject to strict adherence to the prescribed treatment regimen.

Cervical cancer is a disease that leads to malignant transformation cover epithelium. In the early stages, oncopathology is characterized asymptomatic. However, over time, the woman begins to develop minor signs of the disease: unusual discharge, pain in the lower abdomen, difficulty defecating and urinating. Only timely diagnosis and adequate therapy can completely cure the disease.

Collapse

Already during scheduled inspection, the gynecologist will see that the mucous membrane is changed. There is damage to the entire structure of the multilayer squamous epithelium. Non-invasive cervical cancer is advanced dysplasia.

Definition

The cancer process of the cervix begins with a non-invasive stage. At this stage, the disease can be effectively treated. Pathological cells grow slowly and do not extend beyond the mucous membrane of the cervix. Sometimes the non-invasive stage is called zero.

The process of transition to the invasive stage can last for decades, but this does not mean that the body’s condition can be maintained and not taken radical measures. The outcome of the situation is the same: sooner or later the cells will begin to divide more actively, metastases will begin to form, which will penetrate into other systems and organs.

Primary diagnosis is carried out during examination using colcoscopic examination. Optics allow you to magnify the image 30 times. The specialist will see that the cells have been lost correct form, the cell nuclei differ in size and shape, and there is no visible separation between the layers.

Dysplasia, which has acquired the character of non-invasive cancer, covers the entire area of ​​the uterine mucosa. The pathology does not extend only to the main membrane. When pathological cells affected the basal or main membrane, which means the cancer has moved to the next stage.

Reasons

The main cause of congenital heart disease is human papillomavirus. Oncogenic types HPV-16 and HPV-18. If one of these viruses was identified during diagnosis, you need to be on alert for the rest of your life. This means that when exposed to a triggering factor, there is a high chance of developing cervical cancer.

The risk group includes women who have the following:

1. The presence of chronic diseases of the urinary system.
2. Presence of chronic inflammatory diseases reproductive system.
3. Previous births, abortions, miscarriages.
4. Mechanical damage to the mucous membrane during surgical intervention.
5. Early onset of sexual activity.
6. Taking hormonal medications.
7. Violation hormonal levels during pregnancy, menopause.
8. Taking immunosuppressive drugs.
9. Alcohol abuse and smoking.

An aggravating factor is also stress and poor nutrition, which negatively affect the process of cell division.

Symptoms

IN everyday life a woman may not even suspect that she has advanced dysplasia or non-invasive cervical cancer. At this stage, the disease does not affect the general and local health.

Discomfort may be present during sexual intercourse. If the penis touches the affected mucous membrane of the cervix, bleeding is possible. Most often, white or transparent discharge appears. Density and intensity are individual, so not all women can even notice them.

Diagnostics

Non-invasive cancer is detected during an examination by a gynecologist. A gynecologist can evaluate the condition of the mucous membrane using a mirror and a special microscope-colcoscope. The smears are sent to the laboratory and biopsied. PCR testing makes it possible to determine the presence of HPV, its type and quantity.

During the initial examination, two tests are also performed on the chair:

1. After treating the mucous membrane with acetic acid, healthy blood vessels narrow and swelling occurs. In the place where the vessels did not show a reaction, there are disturbances.
2. After treating the cervix with Lugol's solution, normal cells are painted in brown. The glycogen released by the cells reacts with the medication. Pathologically changed cells are not stained.

At major changes The following diagnostic tests may be prescribed:

• x-ray of lymph nodes;
• MRI and CT;
• cystoscopy;
• sigmoidoscopy;
• pyelonography;
• fluorography.

Studies will exclude the presence of metastases and also identify chronic diseases, if any.

Treatment

The chosen treatment method depends on the woman’s desire to have children in the future. There are two methods for eliminating non-invasive cancer:

1. Electroconizaya if pregnancy is planned.
2. Removal of the cervix if pregnancy is not planned.

For the life and health of a woman, the prognosis for non-invasive cervical cancer is favorable. Amputation of the cervix is ​​recommended, since the next stage is invasive metastatic cancer.

Electroconization is a gentle method of surgical intervention. Using a special instrument, a section of the cervix is ​​excised in the shape of a cone. All pathological tissues are captured.

Conization principle

Removing the cervix solves the problem forever. The operation is low-traumatic, the uterus remains unaffected. The duration of the procedure is 30 minutes, it is performed on a gynecological chair through the vagina. The surgeon uses a classic scalpel, radio rays, laser, and electric current.

Removal of the cervix

Forecast

Modern treatment methods allow a woman to completely get rid of the disease. IN further woman can become pregnant and give birth to a child. When the cervix is ​​removed, a woman can continue to carry on as usual, active image life. Pregnancy is possible, but it can be difficult and have negative consequences.

Death occurs only in 5% of cases at the first stage, and in 30% at the second stage of non-invasive cervical cancer.

Prevention

Immediately after treatment, every 3 months you must undergo a medical examination and take all tests. After 2 years, the number of visits to the gynecologist is reduced to 2 times a year.

Preventive measures are aimed at eliminating unfavorable external and internal factors. It is necessary to monitor your health and not trigger inflammatory diseases.

Any sexual intercourse must be protected. A condom will protect a woman’s body from the penetration of harmful microorganisms.

Breast cancer is considered one of the most common malignant processes. Invasive breast tumors can affect people of different age groups and genders. The disease quickly spreads to nearby tissues and organs, for this reason it is very important to diagnose a breast tumor at an early stage.

Invasive breast carcinoma manifests itself quite aggressively. In a short time, the neoplasm extends beyond the lobule or duct of the breast and begins to metastasize to the lungs, liver, and brain. Invasive cancer can proceed similarly to other malignant processes in 4 stages. Advanced forms of pathology are difficult to treat. The prognosis for early detection is generally favorable.

Ductal carcinoma

This variety Breast cancer in women is considered the most common. Infiltrative breast cancer of this type begins in the milk ducts and has large number variations in structural organization. Diagnosis of ductal cancer is complicated by the fact that the pathology for a long time does not show any symptoms. Often, the compaction is detected when the process has already moved to the isola. In this case, deformation of the shape of the nipple and areola may be observed. The species classification of invasive ductal breast cancer includes:

1. Well-differentiated carcinoma - characterized by a high similarity of tumor cells to normal ones.
2. An intermediate degree of differentiation of neoplasms - involves the formation cancer cells various structures and the presence of intraductal necrosis.
3. Poorly differentiated carcinoma - atypical cells completely line the surface of the duct mucosa. In this case, calcifications and necrotic masses are detected.

Pre-invasive ductal

Cancer mammary gland in women (in this form) it spreads to the external areas and does not extend beyond the milk duct. Preinvasive ductal carcinoma is initial stage development of the disease. In the absence of adequate therapy tumor process may malignize and become invasive. However, in most cases, treatment gives good results, which has a positive effect on the course of the disease.

Invasive lobular

In most cases of this form of cancer, the tumor is located in the upper outer part of the breast. On palpation, small compactions with uneven contours are detected. A characteristic feature invasive lobular cancer mammary gland is the presence of chains of 4-5 cells. Usually the capsule in this form of oncology is well developed, the presence of trabeculae in the form of cords is noted.

Unspecified cancer

Such a neoplasm is difficult to recognize when morphological study. Invasive breast cancer with an unspecified pathogenesis has a poor prognosis. To determine the form of oncology, an immunohistochemical study is performed, which determines the lobular or ductal nature of the lesion. The main types of unspecified cancer are:

1. Medullary – has a weak invasive ability, the tumor can reach large sizes.
2. Inflammatory - the clinic of this type completely duplicates mastitis, which complicates early diagnosis oncological process.
3. Paget's breast cancer affects the nipples and areolas.

Causes of breast cancer

Breast adenocarcinoma can develop in anyone, regardless of gender or age. However, women constitute the main risk group for breast cancer. Anatomical features mammary glands cause the fair sex to be susceptible to the formation of neoplasms. Provoking factors of development glandular cancer for women are considered:

• absence of pregnancy;
• late onset of menstruation;
• pregnancy after 30 years;
• improperly adjusted lactation;
• heredity;
• long-term hormone therapy;
• chest injuries;
• postmenopause.

Diagnosis of breast diseases

Adenocarcinoma is one of the types of cancer lesions that can be detected by the patient himself. IN lately specialists pay special attention to teaching women simple self-examination techniques, which makes possible diagnosis breast cancer at an early stage, when the likelihood of negative consequences small. You can learn about the scheme for conducting such an inspection from numerous photos and videos available to the general public. Main diagnostic measures, used to detect invasive cancer are:

1. mammography;
2. blood test for cancer markers;
3. biopsy;
4. ductography.

Treatment of breast cancer

Therapy for cancer of any location comes down to complex measures to remove atypical cells from the body. Treatment begins with diagnosis of the disease, without which it is impossible to determine the size of the formation, differentiate the tumor and the causes of its occurrence. When choosing one of the treatment methods, the following are taken into account: the patient’s age, a history of severe pathologies, and general health. Along with this, specialists are obliged to listen to the wishes of the patient himself, who for some reason does not want to undergo any course of treatment.

This type therapy is used for large sizes tumors. Chemotherapy is used in postoperative period to prevent metastasis and possible tumor relapses. However, this method can also be used to reduce the size of a tumor before surgery. Chemotherapy is carried out in 4-7 cycles. The advantage of this method can be considered a complex effect on the body. Special drugs“burrows” of atypical cells that cannot be cured by other methods are destroyed. During the course of chemotherapy the following are used:

1. alkylating agents;
2. antibiotics;
3. antimetabolites;
4. taxanes (interfering with the process of pathogen division).

Surgical treatment of malignant tumors

Invasive cancerous tumor at an early stage it is successfully treated through surgery. Recently, with this kind of intervention, the method of oncological radicalism has prevailed. This approach is accompanied by significant functional damage to the patient. It is worth saying that today new methods are being developed surgical treatment cancer with immediate reconstruction of the lost organ. The duration of rehabilitation depends on the volume of intervention performed.

The high increase in the incidence of cervical cancer in women (oncology of this localization currently ranks fourth among all types) attracts special attention doctors to study the causes of the pathology and develop treatment options, and women – to the following questions: what is invasive cervical cancer, how does it differ from the non-invasive form, is it curable. And most importantly, what symptoms should you pay attention to in order to take timely treatment measures?

General characteristics of the disease

To begin with, we note that cancer of this localization is a malignant tumor that arises as a result of the onset of uncontrolled division of epithelial cells of the cervix (this is the name of the process connecting the organ to the vagina).

What are the chances of recovery

If favorable prognoses exceed 90% of cases at the stage of non-invasive cancer, then with the appearance of symptoms of invasive cancer on the cervix, i.e. As the tumor grows, the chances decrease. But, with adequate treatment, in a clinic with modern equipment and using new methods, it is possible to return to a full life:

• at the second stage – 60% of patients,
• on the third – about 30%.

Even with the fourth stage, there is a chance in 10% of cases (although a few years ago it was called “incurable”).