Cervical cancer is a common malignant tumour that accounts for 15% of all the oncological diseases in women. Most of the illness cases happen in the developing countries. Meanwhile, cervical cancer is rarely experienced in the developed countries.
This disease mainly affects middle aged women and about 20% of the primary tumour diagnosis is carried out in the elderly patients. Illness is relatively rare in younger women.
Causes of cervical cancer
Human papilloma virus (HPV) is a main cause of the cervical cancer. This venereal infection can be transmitted even if a woman uses barrier contraception. Cancer is caused by oncogenic serotypes of HPV (16, 18, more rarely - 31 and 33). There are also virus types of medium or low oncogenic risk and they are less likely to trigger a risk of malignant growth.
Key risk factors of the cervical cancer are:
Start of sexual activity before the age of 16
Frequent change of sexual partners
Frequent abortions
Early first childbirth
Sexually transmitted infections
Having more than 10 intercourse partners during one’s lifetime increases the risk of the cervical cancer by 3 times. This risk can grow up to 5 times if a woman has a regular intimate relationship with a male who had 20 and more sexual partners previously. The more partners a male had the higher the risk of contracting HPV.
Symptoms of cervical cancer
Cervical cancer remains asymptomatic for a long period of time. If a patient has some complaints it’s an evidence of the oncologic process at the advanced stage.
First symptoms of the cervical cancer are:
Bleeding is the most common of the early signs of the illness.Bleedings mostly have a spontaneous, irregular nature. They increase significantly before and after the menstruation. Bleedings can occur due to contact (bleeding increases or appears after sexual intercourse or finger examination of the cervix).
Vaginal discharges watery in nature happen due to the leakage of lymph from those areas of the tumour that are subject to decay.
Pain can be of various nature, intensity and location. Women mostly notice the pain sensations in the lower back, under the pubic area, in the sacrum.
Late signs appear after the tumour sends metastases and grows in size. Moreover, general clinical signs appear except for the local:
Bowel and urinary tract’s function is affected
Hyperthermia (fever), weakness, fatigue is experienced
Edema of extremities develops
All the symptoms are associated to the damage of the genital tract and nearby organs. There are no specific clinical signs of cervical cancer.
Diagnostics of cervical cancer
Cervix is available for both invasive and non-invasive diagnostic procedures. However, you need to have a doctor’s exam before any symptoms appear to detect cancer early. Women who have a background or precancerous diseases, being in the risk group must be examined regularly.
Underlying conditions that increase the risk of cervical cancer are divided into the following groups:
Post traumatic (fistulas, true erosion, scars and ruptures)
Inflammatory (cervicitis)
Hormonal imbalances (leukoplakia, polyp, papilloma, endometriosis)
Dysplasia, erythroplasty, as well as any background conditions, accompanied by the appearance of atypical cells is considered to be precancerous conditions.
Mortality of cervical cancer has been significantly reduced in some developed countries like the USA, Japan, Sweden, and Germany. Women have regular check-ups there. Thus, an illness is detected at an earlier, non-invasive stage when treatment is most effective. (70-80% of cases).
Diagnostics techniques are:
Cytology swab helps to identify preclinical forms of cervical cancer, which are not yet accompanied by visible changes in the structure of the organ
Extended colposcopy allows not only to examine the epithelium at a large magnification with the help of an optical device, but also to conduct tests (with acetic acid - to identify vascular atypia, Schiller's test - to reveal pathological cells that do not contain glycogen)
Biopsy means that a tissue fragment is taken for analysis to detect abnormal cells and helps to confirm a diagnosis
Additional diagnostics techniques can be used to differentiate a stage of the pathological process like: computed tomography, MRI, lungs X-tray, cystoscopy, irrigoscopy and others.
Treatment of cervical cancer abroad
Cervical cancer is mainly treated with the help of surgery. Various operations are conducted, depending on the stage of the illness, age of a patient and her wish to preserve the reproductive function.
Cervical conization is a cone-shaped excision of pathologically altered tissues from the cervical canal and part of the cervix. Surgery can be performed during early stages, if a woman wants to maintain reproductive function, and is also prescribed for precancerous conditions treatment. It requires careful monitoring after the operation.
Extirpation of the uterus is the optimal variant of surgical treatment for middle-aged or elderly women, who no longer plan to have children. The uterus is completely removed along with the cervix. Sometimes fallopian tubes and ovaries are removed. In some modifications, ovaries can be preserved and withdrawn beyond the pelvic cavity. In all cases, the volume of surgical intervention is determined individually, together with the patient.
Chemotherapy is prescribed before surgery as well as after it. It is administered before surgery if a tumour is more than 4 cm in diameter and presence of metastases in the pelvic lymph nodes.
Radiation therapy is mostly prescribed after the surgery to prevent the recurrence. It can be applied instead of the surgery if there are contraindications or if a patient refuses to undergo a surgery.
Prognosis for cervical cancer
Prognosis depends on the stage of pathological process when cervical cancer was detected, age of a patient, quality of the treatment provided. Average 5-year survival after the diagnosis and relying of the stage of illness is:
I – 78%
II – 57%
III – 31%
IV – 8%
Stage IV of cervical cancer is peculiar with the least favourable prognosis. Average life-expectancy of such patients is only 7 months. Stage I has the best prognosis when it’s still possible to completely cure and preserve the reproductive function.
cervical cancer innovative treatment abroad
Latest innovative treatment and diagnostics techniques
Target therapy is a method of cervical cancer treatment and some other types of cancer based on the use of specific drugs that block rapid growth, development and spreading of the abnormal cells by impacting the molecules inside them. As a result, they lose the ability to differentiate and gradually die which leads to the regression of the malformation.
This method has a high selectivity for cancer cells, which avoids a number of negative side effects and complications that often occur with the use of traditional chemotherapy. The main mechanism of the drug is still blocking of neoangiogenesis (the formation of vessels feeding the malformation). The result of such an impact is the lack of oxygen in the tumour leading to its eventual death.
Neutron capture therapy is the treatment technique of cervical cancer, based on local exposure to a neutron beam, which destroys cancer cells. A patient is introduced a specific non-radioactive drug into the body before, which is absorbed by atypical cells. The activity of the medication increases at times after a week of irradiation to the affected area with a neutron beam.
This leads to a powerful anti-tumour effect with the destruction of the malformation from the inside. The dose of irradiation remains much lower than those of conventional radiological therapy. This helps to reduce the negative effects of treatment, and high selectivity of the technique ensures the safety of surrounding tissues.