Squamous carcinoma of the cervix

Squamous cell carcinoma of the cervix assumes a malignant process in the epithelium of the vaginal portion. This disease is the most common cancer among cervical pathology department.

Carcinoma or cervical cancer develops mainly in women after forty years. However, the tumor may be diagnosed in relatively young patients.

Squamous kind of cervical cancer means the development of tumors from a flat multilayered epithelium that covers part of the cervix adjacent to the vagina.

The cervix, in fact, is the link. Sheika performs several important functions, including uterine cavity provides protection against infection, outflow menstrual blood during the critical days, the passage of sperm, and thus the conception, birth child.

Vaginal portion of the cervix epithelial lined with special view, which has a multilayered neorogovevayuschy planar structure. This structure provides a protective mechanism. The neck of the uterus protects against internal and external adverse factors.

Stratified squamous epithelium is formed by the following layers:

• basal, consisting of immature round cells with large nucleus one;
• intermediate, comprising ripening flattened cells;
• surface, containing old mature cells flat shape, having one small core.

Constant exposure to adverse factors lead to structural changes in the cell. As a result of developing cervical carcinoma, such as squamous cell variety.

Structural cellular changes occur when dysplastic processes. Due dysplasia cells become misshapen, have multiple cores. These abnormal cells can not adequately function. Over time, they can acquire the ability to reproduce the aggressive, causing squamous cervical carcinoma.

Gynecologists are three degrees of dysplasia:

1. Easy. At this level there is loss of one third of the epithelial layer. Abnormal changes in the majority of cases regress alone in women with healthy immune systems. The development of squamous cell cervical cancer can happen in five years.
2. Average. There is a loss most of the epithelial thickness. The appearance of squamous cervical carcinoma can be expected in three years.
3. Heavy. The whole process involves malignant epithelium, with division into layers is lost. In fact, third-degree dysplasia - a preinvasive cancer. cell penetration into the stroma, meaning nerves, muscles and blood vessels, is not observed. A year later, this pathology progresses in microinvasive squamous cervical carcinoma.

Cervical Dysplasia It responds well to treatment and is completely reversible with timely diagnosis and treatment.

It is noteworthy that the squamous cell carcinoma of the cervix often occurs in the so-called zone of transition. This is an area of ​​transition of one type of epithelium in the other.

Vaginal part of the cervix, as seen during the inspection is covered by a flat stratified epithelium. That is why the surface is as smooth and pale pink.

Inside cervical determined cervical canal that connects the vagina and muscular body cavity. Cervical canal monolayer covered by columnar epithelium, and the surface looks reddish, velvety. The cervical canal gland functioning, producing protective mucus from malicious flora.

Transition zone squamous epithelium in a cylindrical is vulnerable to external and internal factors portion. About 90% of malignant tumors are localized in the transformation zone.

Causes

Squamous cell carcinoma of the cervix is ​​the result of dysplasia. Scientists to the end unclear mechanism of precancerous (dysplasia) and malignant (carcinoma) pathologies. In addition, some benign cervical education can become the background to the development of squamous cell carcinoma.

Numerous scientific studies and observations have proved the leading role of HPV in causing cervical carcinoma, including squamous cell type. HPV entering the body, it is integrated in the cell's DNA. A healthy immune system eliminates the virus within a few months. However, the presence of precipitating factors may cause squamous cervical carcinoma.

It is known that papilloma virus has more than hundreds of varieties. Some of them have-producing action, leading to the formation of papillomas. While other strains can cause cellular degeneration. This so-called strains with high tumorigenicity. cervical carcinoma causes 16 and 18 subtype in 70% of cases.

Experts identify the following predisposing factors.

1. Active and passive smoking, characterized carcinogenic. Of considerable importance is the number of cigarettes smoked. Risk of cervical squamous cell carcinoma increases with the number of cigarettes smoked.
2. Immune imbalance. Abnormalities in the immune system lead to numerous pathologies, including squamous cell carcinoma of the cervix.
3. Early sexual relations. Sex contribute to injury immature epithelium, which causes pseudo. This background state of the cervix is ​​seen as a background to the development of squamous cervical carcinoma.
4. Chaotic nature of sexuality. This factor greatly increases the risk of infections, including HPV. The combination of certain infections, such as HPV and herpes is also a risk of squamous carcinoma of the cervix.
5. Failure to comply with partners personal hygiene. Accumulated under the foreskin glans penis smegma has a carcinogenic effect.
6. Cervical benign pathologies. Erosion, ectopia and pseudo and leukoplakia, polyps are considered to be factors in the appearance of squamous cell carcinoma.

As precipitating factors experts consider the age-related changes, poor diet, lack of some essential substances, long reception of COCs, frequent in the cervical area of ​​surgical intervention.

Classification

There are several classifications of squamous cervical carcinoma, allocated on the basis of different criteria.

By histological type

The histological structure of the tumor is essential. According to the histological type identified two kinds of cervical squamous cell carcinoma.

1. Stratum. Tumors comprise the features keratinization cells, which manifested form of so-called cancer pearls and keratogialinovyh granules. Epithelial cells are large, pleomorphic and have an uneven contour. It notes the paucity of mitotic figures.
2. Neorogovevayuschy. There is a lack of "keratin pearls." Malignant cells differ large size, polygonal or oval shape. Miotic activity is quite high. The degree of differentiation is characterized as moderate, and high or low value.

In the direction of growth

The growth direction is set to the detection of malignant tumors. In addition, tumors characterized by different growth direction, have it at different speeds.

Experts identify three areas of growth of cervical squamous cell carcinoma:

• exophytic;
• endophytic;
• mixed.

Ulcerous-infiltrative species It is a sign of the advanced stage squamous cervical carcinoma. Its formation is caused by the disintegration and subsequent necrosis of tumors endophytic.

According to the nature of the invasion

Neoplasm seen mainly in the degree of germination or invasion of cells into the epithelium and the surrounding tissue.

Experts note the following types of squamous cervical carcinoma.

1. Preinvasive squamous cell carcinoma. It coincides with the labeling of the third degree dysplasia (CIN III). This is due to the same tactic detection and treatment. In another way, this process is called "cancer in situ». Determined by defeat all of the epithelial thickness. However, signs of germination in the stroma (vessels, muscles, nerves) is not observed. This pathology is successfully treatable with early diagnosis.
2. Micro-invasive squamous cell carcinoma. At this stage has no significant tumor size, however, there is the introduction into the stroma of malignant cells. The prognosis for adequate timely treatment also has a favorable character.
3. Invasive squamous cell carcinoma. With this disease develops intense symptoms associated with impaired functioning of organs. For this phase is characterized by the formation of metastases, which are unique islands of cancer cells.

Metastases reach distant organs together with blood and lymph. When germination can form new tumors.

stage

Experts identify several degrees characterizing progression of the malignant process. Identification of squamous cell carcinoma in a certain step may be the basis for prediction.

In its development of squamous cell carcinoma goes through four stages.

• stage 0 different arrangement of malignant cells throughout the epithelium. However, signs of germination in the stroma are missing, which eliminates the possibility of metastasis. The prognosis of the zero stage, which implies preinvasive carcinoma or CIN III, characterized by favorable.
• stage 1 It means a tumor which invades deeper tissues at a small depth. Isolate I A and B variants in which the infestation is 3 and 5 mm. Prompt treatment can facilitate full healing.
• stage 2 It means the distribution of the malignant process on the uterine body. The survival rate is about 60%.
• stage 3 It implies involvement in pathological process pelvic wall and the bottom third of the vagina. There may be compression of the ureter, causing hydronephrosis develops.
• stage 4 accompanied by the formation of distant metastases, which are growths of malignant cells. Tumor in the rectum, the sacrum.

Multiple metastases due to tumor progression. Cells were deprived of nutrition, detached from neoplasm and spread throughout the body together with the flow of lymph and blood. Typically, they are deposited on a shallow well-developed vascular network organs, e.g., brain, liver, lung. Malignant cells negatively affect a woman's body, causing it to poisoning of life products.

symptomatology

Late diagnosis of cancer is largely due to its lack of symptoms until advanced disease. Latent disease progression dangerous due to the fact that in squamous cell carcinoma of the structural changes occur at the cellular level, causing the formation of malignant tumor.

In the early stages of the disease symptoms are absent. Typically, symptoms occur in the third stage. The clinical picture may include the following features.

1. Abnormal discharge. The patient may disturb separation after contact intimacy, gynecological examination. Highlight meat slops with the putrid smell of decay indicate a tumor. Profuse watery as are natural with the progression of cancer.
2. Bleeding. Usually heavy bleeding not associated with menstruation. In women after menopause such bleeding are quite alarming symptom, you should pay attention.
3. Pain syndrome. Usually localized pain in the lower abdomen and can be given in the rectum, sacrum and lower back. In the later stages the pain is constant symptom.
4. Edemas. Over time, there is swelling of the legs and external genitalia. This feature is associated with tumor metastasis in the lymph system.
5. Asthenic manifestations. Women notice the constant fatigue, drowsiness, weakness. Usually there is a weight loss and signs of anemia.
6. Disruption of the functioning of the affected organ. Squamous cervical carcinoma usually affects the uterus, bladder and bowel. The patient can be confusing pain during urination and defecation. Often develops hydronephrosis.

At advanced stages pronounced signs of toxicity, which are caused by the influence on the organism of malignancy metabolic products.

Diagnostics

Prognosis of the disease is largely dependent on the stage at which the squamous cervical carcinoma was detected. Since the initial stages of progress asymptomatically, gynecologists emphasize the need for regular check-ups with mandatory inspection.

In early stages the disease can detect dangerous only through laboratory and instrumental diagnostics.

Smear on onkotsitologiyu

Smear on onkotsitologiyu is a simple and informative methods for the detection of atypical cells. During a pelvic examination, the doctor makes a fence biological material from the different areas of the cervix using special brushes, and then puts it on a special glass. Under laboratory conditions, stained glass with special reagents and examined under a microscope. Smear on onkotsitologiyu reveals signs of atypia and inflammation. Gynecologists recommended to perform this analysis every six months.

Colposcopy and biopsy

This is one of the most informative methods to detect characteristic changes, which are inherent in the malignant process. Research carried out by means of a colposcope which is equipped with a magnifying and lighting system. In a simple version of the procedure the cervix is ​​examined under a multiple increase, which allows to observe changes in the epithelium.

In case of deviations recommended implementation extended procedures, during which a specialist on the cervix causes acetic acid solution. In this case the affected areas become HPV whitish color. Then the cervix is ​​exposed staining Lugol's solution. NOT, sites may indicate the presence of dysplasia. In this case must be fulfilled biopsy, which involves sampling a tissue sample for histological examination.

Gynecological examination

This method is compulsory diagnostic stage. However identify visually and by palpation malignant changes only in advanced stage of disease. The doctor may notice a change in shape of the cervix, which is the barrel. The study may cause contact discharge.

complementary diagnostics techniques such as ultrasound, CT, MRI and X-rays, determining SCC levels in the blood, urography, cystoscopy and sigmoidoscopy. In some cases, need to consult other doctors.

therapeutic tactics

Treatment is individual and depends on the stage of the pathological process, the woman's age and the presence of her reproductive plans. The young women of ability to pursue conserving therapy, particularly surgical. Age women are often recommended for radical intervention.

Treatment of squamous cervical cancer can be:

• surgery;
• radiotherapy;
• chemotherapy;
• complex.

Women of childbearing age, having 0 or IA stage recommended conization, amputation uterine cervix. After successful treatment possible pregnancy planning. Stage IB - IIA are an indication for hysterectomy comprising removing the upper third of the vagina. The treatment can be supplemented by chemotherapy. Elderly patients spend pangisterektomiyu.

When the third and fourth stages of recommended radiation and chemotherapy. In some cases the operation. If surgery is not possible, held intracavitary radiation therapy.

The forecast is largely determined by the presence of metastases. If the identified individual metastases, assigned to remove them surgically. When multiple metastases is only possible maintenance chemotherapy.