What is invasive cervical cancer

Invasive cervical cancer is considered to be common malignant pathology in women. His frequent occurrence due to the mechanisms of tumor development, delayed treatment of cervical precancerous lesions, the influence of unfavorable external and internal factors.

Cervical cancer - tumor malignancy that develops from a flat stratified epithelium, located in the vaginal parts. Pathology can occur in women of all ages. However, the most widespread cervical cancer among the representatives of reproductive age.

Cervix uteri is a structural element, its lower part. The body structure of the neck a number of important functions:

• uterine cavity provides protection from infections, as a kind of barrier;
• participates in the conception and birth.

If we consider the structure of the neck, two parts of it can be identified:

• supravaginal, which is invisible;
• vaginal, is visible.

A significant part of the neck is not visualized during the inspection. The site, which is adjacent to the vagina, called vaginal. He studied during a pelvic examination for various pathologies of inflammatory and malignant nature.

Vaginal part of the cervix has a pale pink color, and its surface smoothness is different. This appearance of the vaginal part of the cervix gives stratified squamous epithelium covering its surface.

squamous cells are arranged in several layers.

1. Basal. Layer borders on stroma signifying muscles, nerves and blood vessels. Maturing elements have a rounded shape and one core, characterized by large dimensions.
2. Intermediate. Cells were raised to higher layers gradually flattening.
3. Surface. Location of mature cells, which are considered old. Such elements are distinguished by a flat shape and a small core.

Inside the cervix is ​​cervical canal that connects the vagina and the body cavity. The channel function actively glands that produce protective mucus from pathogens. Due to the mechanism of protection, including the narrowness of the channel and is continuously generated a protective slime, the uterus is protected against the ingress of harmful microorganisms.

The surface of the cervical canal consists of single-walled cylindrical cells. This causes a kind of velvet epithelium and mucosal reddish color. Above the cervical canal into the uterus is opened, forming an internal throat, and the bottom - in the vagina, forming the outer mouth.

In the external os is the transformation zone. So we call a site that connects two different epithelia.

transformation zone It is the subject of intense scrutiny by the gynecologists. It is this area considered to be sensitive to various influences that can trigger cancers.

Invasive cervical cancer is the result of complex pathological processes. Invasive cancer is localized in the cervix, it is considered a consequence of precancerous lesions. In some cases, malignant tumors can cause the background processes of the cervix.

precancerous process

Precede invasive cervical cancer precancerous dysplastic processes which imply a breach structure squamous cells. Dysplasia has varying degrees of severity, which affects the likelihood and speed of development of invasive cancer and treatment strategy.

Under the influence of various negative factors, the cells begin to change. Lost their flat shape, increasing the number of cores, and the conditional division into layers eventually disappears. If these abnormal cells acquire the ability to active the germination and multiplication of the surrounding tissue, precancerous dysplastic process proceeds to microinvasive and then into invasive cancer.

Gynecologists are three severity of premalignant process.

1. Easy. This dysplasia 1 degree or CIN I. It celebrated the defeat of atypical cells of one third of the squamous epithelium. This stage has a low risk of progression to invasive cancer. Usually dysplasia regressed on their own. Transition into a malignant tumor is observed not earlier than 5 years in immune and hormonal disorders.
2. The average or moderate. Grade 2 dysplasia, CIN II, involving in different premalignant cervical epithelium 2/3 process. The transition to invasive cancer can happen in 3 years.
3. Heavy. CIN III, or dysplasia of the third degree in a different way called preinvasive cancer. Of invasive cancer such pathology characterized by the absence of germination of tumor cells in the stroma. Invasive cervical cancer can develop in a year.

Precancerous process is completely reversible. With early detection and treatment of successful therapy is up to 100%. After conducted treatment of a woman does not lose the ability to bear children.

Classification

Cervical cancer has several varieties that determine the speed of the development of cancer, its prognosis and treatment strategy. In particular, tumors can be composed of various tissues as determined histologically:

• squamous, It consists of stratified squamous epithelium;
• glandular, including cervical tissue.

Cancer of the cervix in a different way called adenocarcinoma. The structure of malignant cervical tumors such cancer is found in 10% of cases. In gynecological practice is often diagnosed squamous form.

Prognosis of the disease and rate of progression of the formation is largely determined by the degree of cellular differentiation.

1. High-grade cancer. Such tumors vary slow development, low aggressiveness and lack of metastases even in the advanced stages. Accordingly, low-grade neoplasms prognosis is favorable.
2. moderately differentiated cancer. This is the most common tumor of the cervix. The appearance of metastases is usually observed on the third or fourth stage. Favorable prognosis when preinvasive and microinvasive form, as well as infestations on 1B-2 step.
3. High-grade cancer. Neoplasms characterized by rapid growth, malignancy and metastasis in the early stages. Typically, these tumors have a poor prognosis, but are found in gynecological practice is relatively rare.

According to the degree of infestation are three kinds of cancer of the uterus.

1. Preinvasive. This third degree of dysplasia (CIN III) or carcinoma in situ. There is a malignancy of cells without invasion into the stroma or germination. The clinical picture of disease is absent. Identification preinvasive cancer is possible by instrumental and laboratory methods. Untreated preinvasive cancer becomes microinvasive, invasive. Timely detection and therapy can completely cure a precancerous condition.
2. Mikroinvazivny. This form corresponds to cervical cancer stage 1A. In this case, invasion size is less than 5 mm, and the volume of the tumor is 1 cm. microinvasive cervical cancer is not accompanied by the formation of metastases and can be successfully treated. However microinvasive character tumor has clinical manifestations, respectively, is detected only when timely diagnosis.
3. Invasive. This is a tumor that penetrates the tissue of the cervix more than half a centimeter, that is, stage 1A - 4. In invasive cancer of the first signs of cancer pathology.

Gynecologists differentiate malignant tumor, depending on the direction of its growth:

• exophytic, with progression to cervical lumen;
• endophyte, with the development of deep neck;
• mixed.

Exophytic tumors are less aggressive. Sometimes they manage to discover during a pelvic exam. The tumor resembles a cauliflower and grows in the form of a polyp. Endophytic tumors can be considered small, and a thicker epithelium form expressions. That is why this cancer is considered to be more dangerous.

stage

In the general classification does not include preinvasive cancer, coinciding with severe degree of dysplasia. Gynecologists isolated following stages of cervical cancer.

1. The tumor is localized in the cervix. A - infestation to 5 mm, B - Distribution of more than 5 mm.
2. Neoplasm beyond the uterus, but does not hit the pelvic wall and vagina.
3. Engaging onkoprotsessa lower third of the vagina and the pelvic wall.
4. Germination of malignant cells in the rectum, bladder and other organs.

Visually identify invasive cancer and its stage does not seem possible. To confirm or refute the diagnosis is necessary to pass inspection.

Factors and causes

There are various theories that attempt to explain the etiology and pathogenesis of invasive cervical cancer, trace the mechanisms of its development. Along with the numerous factors that can act as a catalyst onkoprotsessa separately isolated the root cause of diseases - HPV infection.

In 95% of cases, infected women invasive cervical cancer of the uterus revealed the dangerous HPV strains. Papilloma virus has more than hundred strains, however, with the malignant process in the cervix is ​​usually responsible 16, 18 subtype.

Viru papilloma after his entry into the woman's body mainly through sex, is located in the epithelial cells. Some strains can cause cellular mutations, while others have an effect-producing, forming warts, papillomas and warts.

A healthy immune system copes with HPV, removing it from the body within a few months. However, with the weakening of immunity, joining hormonal and metabolic disorders, inflammatory pathologies of the virus for a long time, there is in the body, increasing the risk of developing invasive cancer.

There are the following factors that provoke the development of invasive cervical cancer:

• early sexual relations;
• promiscuity and lack of barrier contraception;
• frequent pregnancy and childbirth;
• combination of HPV and herpes;
• HIV;
• smoking;
• unfavorable environmental conditions;
• Prolonged stress;
• lack of personal hygiene on the part of the partner, as part of smegma are substances with carcinogenic effects on the cervix.

The factors of invasive cervical cancer are also considered unfavorable heredity, abortion and other intervention on the cervix. Some background pathology, for example, pseudo and leukoplakia, ectropion, may be considered as triggering factors.

symptomatology

Cervical cancer in preinvasive and microinvasive form is not clinical. The disease is latent. If you do not detect a dangerous pathology in the early stages, it becomes invasive.

At the beginning of disease a woman can look for the following symptoms:

• watery whites;
• highlight color meat slops malodorous;
• acyclic bleeding;
• contact isolation and discomfort during sexual intercourse;
• spotting at representatives after menopause.

As the onkoprotsessa symptoms increases. The symptoms of late-stage specialists include:

• intense pain, abdominal concentrated below the waist, rectum;
• constipation;
• palpitations painful urination;
• blood in the urine and feces;
• intoxication manifested losing weight, lack of appetite, low grade fever, anemia, weakness;
• edemas.

Some of the symptoms of invasive cancer that develops in the cervix, similar to the symptoms of other diseases. Determine the cause of ailments can only after passing inspection.

Diagnostics

Examination of the neck part to detect cancer include several methods, some of which are screening. These studies must be performed on a regular basis.

cytological examination

This is one of the screening methods which involves sampling of biological material from different portions of the cervix to detect abnormal cells and inflammation. Analysis is performed special tsitoschotkoy, which material is applied on a glass slide. Then, in the laboratory glass is subjected to staining and examined under a microscope.

colposcopy

Investigation by colposcope called colposcopy. Under a multiple increase in the lighting conditions, the physician examines the cervical epithelium. In identifying suspicious areas extended colposcopy is recommended.

The doctor puts on the epithelium of solutions for creating colposcopic picture. After treatment with a solution of acetic acid sites, the affected HPV have whitish color. Atypical areas are not stained brown after Lugol treatment.

Biopsy

Fence tissue samples for histological examination is performed upon detection of suspicious areas identified during a colposcopy. Investigation of undesirable conduct in pregnant women. In general, the procedure is only performed if indicated.

Scraping

endocervical curettage procedure is performed when receiving conflicting results from different types of studies. Scraping allows you to confirm or deny adenocarcinoma.

ultrasound

This is a simple way to detect cervical and uterine abnormalities. During the study it is possible to evaluate the blood flow by Doppler and identify tumors due to overgrowth of vessels.

CT and MRI

These methods allow estimating onkoprotsessa spread within the peritoneal cavity. MRI is more preferred diagnostic method.

Identification of distant metastases

In the later stages onkoprotsessa typically formed metastases. For the detection of metastases following methods are used outside of the uterus:

• X-rays;
• CT abdomen;
• scintigraphy of the skeleton.

Diagnosis of blood

SCC antigen is oncomarker cervical cancer. It is a measure commonly used to assess the effectiveness of therapy and detection of relapses.

The study is not in use as a primary diagnosis because of the possibility of false-positive and false-negative results. Index tumor marker may be increased in some somatic diseases, and cancer of the endometrium, vagina.

Treatment

To date, invasive cervical cancer is not a sentence. Doctors use different combinations of therapeutic tactics that can defeat the disease and significantly prolong the life of the patient. The choice of treatment depends on the stage prevalence onkoprotsessa, metastasis, patient's age and other individual characteristics.

conization

In the early stages onkoprotsessa, non-invasive form, the possibility of sparing surgery with preservation of reproductive function. The surgeon excised the affected part of the cervix in a cone. Operation takes place in a hospital under general anesthesia. After the procedure, possible complications in the form of narrowing of the lumen of the cervical canal, resulting in difficulties during pregnancy and childbirth.

Extirpation

Typically in invasive forms an extended hysterectomy, which involves removal of the uterus, appendages, of the vagina and its surrounding tissue. If the cancer has mikroinvazivny form perhaps only the removal of the neck.

Radiation therapy

This is one of the main methods of treatment, which means carrying out exposure. Radiation therapy is used:

• before the intervention to reduce the size of the tumor:
• postoperatively to destroy remaining cancer cells.

As an independent method of irradiation is used in advanced disease in order to facilitate the patients.

Chemotherapy

This auxiliary treatment method that complements radiation and surgical tactics. The fourth stage of chemotherapy is used as an experimental method.

After conducted treatment of women throughout their lives observed in cancers. Initially, inspection and examination are needed every three months for two years. Over the next three years of diagnosis is carried out every six months. Subsequently, a survey is conducted annually.

Upon detection of invasive breast cancer during pregnancy in the early stages, carried out interrupt. When invasive cancer is detected in the third trimester of pregnancy prolongation possibly up to 32 weeks, and then perform a cesarean section and prescribed treatment.