Cervical cancer, originating from the epithelial epithelium of two types, has two main histological variants – squamous (keratinizing and non-thirsting) cancer and adenocarpinoma from the cylindrical epithelium. Epidemiological studies show that there are two age peaks in the incidence of cervical cancer – 34–36 years old, when squamous cell carcinoma predominates, and 60–62 years, when the proportion of cervical adenocarcinoma increases. Cervical cancer is the third most common malignant neoplasm of the genital organs; The trend of recent years is the annual increase in the incidence of cervical cancer in young women by 2%. Every year around 500 thousand new diseases of cervical cancer are detected in the world. In Europe, 12.3 thousand new cases of cervical cancer are registered annually, 6 thousand women die from it.
The etiology and pathogenesis of cervical cancer associated with PVI and are similar to those in precancerous processes (discussed in the section on precancer of the cervix).
Planocellular cancer occurs in 85–95% of all cancers of the cervix, and adenocarcinoma in 5–15%. Cervical cancer may have exophytic growth, more characteristic of tumor localization on the exocernix, shandophytic growth characteristic of the localization of the malignant process in the endocervix. With endophytic forms of the disease, the prognosis is worse.
Squamous cell carcinoma of the cervix is histologically characterized by the presence of cords of anaplastic epithelium below the basement membrane, oval or polygonal tumor cells with eosinophilic cytoplasm, polymorphism of nuclei, and multiple and atypical figures of mitosis.
Adenocarcinoma of the cervical canal under a microscope is characterized by the presence of glands lined with several layers of atypical cells with high mitotic activity, cells with pale granular cytoplasm containing mucus, basally located enlarged hyperchromic nuclei with coarse chromatin.
In postmenopausal cancer in situ, located in the transition zone in the cervical canal, the method of choice is extirpation of the uterus.
At stage 1a, in young women interested in preserving the reproductive function, a high knife amputation of the cervix is performed, in patients over 50 years old – extirpation of the uterus with appendages.
At stage 1a, panhysterectomy is performed, at the second stage radiation therapy. Young women, whose plans include childbearing, have recently performed trachelotomy (extirpation of the cervix, lymph nodes and tissue of the pelvis with hemming of the vaginal walls to the inner throat of the preserved uterus) in separate oncological hospitals. With subsequent pregnancy, the risk of reproductive loss is very high, but the birth of viable children is possible.
In young women, at stage 1a2, it is also possible to extirpate the uterus with the tubes, while the ovaries are fixed in the region of the lower pole of the kidneys with a preserved vascular pedicle for their removal from the zone of subsequent irradiation. This approach allows you to save the hormonal function of the ovaries and the possibility of surrogate motherhood for women. Currently, women with cervical cancer who are interested in having a baby have cryopreservation of eggs before hysterectomy.
At stages 16 and Pa and sometimes at stage Nb, Vert-heyma operation is performed (panderectomy, removal of lymph nodes, cellulose of the pelvis, upper third of the vagina) and combined (intracavitary and remote) radiation or chemoradiation. The stages of treatment are individually determined, they are used as preoperative radiation therapy with a subsequent operation, and actions in the reverse order. Currently, with operable cervical cancer in leading clinics they began to perform operations with laparoscopic access.
At stages PB, Sha. Shb is carried out combined radiation or chemo-radiation therapy. At stage IV, palliative therapy is performed, but with distant metastases, chemotherapy with cisplatin is possible.
The prognosis for cervical cancer is determined by the stage of the disease; in stage I, the 5-year survival rate is 90-98%; at stage II, 55–60%; at stage III, 30–40%; with IV, less than 10%. Significantly worse prognosis with a combination of cervical cancer and pregnancy. Thus, the 5-year survival rate at stage I on the background of pregnancy is reduced to 25-30%. However, in cured patients who have undergone initial forms of cancer and organ-sparing operations, the onset of pregnancy is not contraindicated in the future.
Cervical cancer is a malignant tumor that can be prevented because it is preceded by a long precancerous process. Progression of dysplasia in cervical cancer occurs within a few years, timely treatment of dysplasia (CIN) is an effective measure for the prevention of a malignant tumor of this localization.
Currently, the viral theory of the origin of cervical cancer has been proven, and vaccination against PVI opens up new perspectives in the prevention of cervical cancer. A recombinant vaccine was created against the most common oncogenic HPV serotypes, 16 and 18.
For the first time, recombinant particles for the vaccine based on L structural proteins were created by J. Fraser, and since there are no functional proteins E, —E7 in the vaccine, it does not have a mutagenic and carcinogenic effect, i.e. is highly safe. On a national scale, it is advisable to immunize adolescents and non-sexually active persons; however, vaccination of individuals of other age categories is also possible, although the expected protective effect is lower than with adolescent vaccinations.
The available vaccine against 16 and 18 HPV serotypes does not provide protection against other oncogenic serotypes. That is why vaccinated individuals should not neglect other rules for the prevention of cervical cancer. The following risk factors for cervical dysplasia and cancer are known:
- early onset of sexual activity;
- early first pregnancy;
- a large number of sexual partners;
- sexually transmitted diseases in history;
- low social and cultural level of the patient and her partner; – long-term use of oral contraceptives;
- effects of diethylstilbestrol.
Familiarizing women and adolescents with contraceptive methods to prevent unwanted and early pregnancy, explaining the benefits of barrier contraception, promoting monogamous relationships, hygienic norms, anti-advertising smoking, and the like are aimed at promoting a healthy lifestyle and reducing the effect of harmful factors contributing to the development of cervical cancer.