Signs and symptoms of cervical cancer.
In patients with background and precancerous diseases of the cervix, complaints are usually absent, and only occasionally there are patients with minor pains in the lower abdomen, lower back, genitalia, acyclic bleeding. However, none of the symptoms of cervical cancer listed above is pathognomonic for this type of pathology and therefore has little practical significance.
Inspection of the cervix.
Macroscopic examination of the cervix in the mirrors also does not allow to sufficiently assess the degree and severity of the disease, the nature and extent of the lesion, and sometimes even generally diagnose it. This circumstance may be due to the presence of dysplasia, combined with a visually unchanged cervix. Due to the fact that microscopic changes in the organ usually outrun the clinical manifestations of the disease, a complex research method that includes a smear on oncocytology from the surface of the cervix (PAP-smear) and colposcopy plays a decisive role in the diagnosis. If necessary, the examination is supplemented with a cervical biopsy followed by a histological examination of the tissue.
Colposcopy research, first proposed in 1924 by H. Hinselmann, consists in examining the mucous membrane of the cervix using a binocular lens equipped with a lighting system and color filters. The perfection and development of apparatuses and colposcopic techniques led to the emergence of many of its varieties.
A simple colposcopy is a study using the colposcope of the vaginal part of the cervix.
Expanded colposcopy associated with the use of a 3% acetic acid solution (during the treatment it undergoes spasm of the subepithelial vessels and swelling of the mucosa promoting a better view), as well as Lugol’s solution (abnormal areas, the epithelium of which is devoid of glycogen, do not turn brown, allows you to determine the boundaries of defeat.
Colposcopic pictures of the vaginal part of the cervix are very diverse. To understand the essence of the pathological process, they are divided into two large groups: benign (most often found in background processes) and atypical (typical for precancer and cancer.
1. Benign colposcopic pictures.
ectopia – the location of the cylindrical epithelium on the vaginal part of the cervix.
the transformation zone is a portion of the mucous membrane of the cervix, where the cylindrical epithelium is replaced by a multilayered planar epithelium. Here, it is possible to detect excretory gland ducts or retention cysts.
true erosion is a mucosal site devoid of epithelial cover.
inflammatory process – looseness, swelling, hyperemia of the mucosa, vessels with normal architectonics and a pronounced reaction to the vinegar sample.
atrophy of the mucosa – a condition associated with age-related changes. The epithelium is atrophic, thinned, its surface is dry, shiny, underneath it there are many small-dotted hemorrhages.
subepithelial endometriosis – under the epithelium, dark purple formations of various shapes and sizes with a smooth relief are determined, before the months producing dark red excretions.
2. Atypical colposcopic pictures.
leukoplakia – a white spot with a pearly hue, slightly rising above the surrounding mucosa, with a smooth or fine-grained relief.
puncture, mosaic are pathological changes in the mucous membrane of the vaginal cervix, caused by a disturbance of the epidermisation process. These changes in the epithelial cover are revealed only when colposcopic examination.
atypical vessels – vessels located chaotically, bizarrely shaped (in the form of strokes, dots, commas) that do not ananastomize with each other unlike normal and do not disappear after treatment with acetic acid.
Cytological examination (PAP-smear.
Particular importance in the diagnosis of pathological conditions of the cervix is attached to the cytological method of investigation. First proposed by E. Pachet in 1847 and improved to the possibility of clinical application by S. Stockard and G.N. Papanicolaou in 1917, this method is currently represented by various modifications. Cytological diagnosis is a morphological method of research based on a microscopic study of the nature of cellular changes in the norm and pathology.
A sample of the result of the analysis in the laboratory of the Center (the conclusion is issued on the international system Bethesda.
Oncocytological examination is the study of smears of scarify from the vaginal portion of the cervix and the cervical canal. Diagnosis is based on the division of smears into 5 classes (according to the Papanicolaou) or on the issuance of an opinion on the international system Bethesda. Papanicolaou classification.
Absence of atypical cells.
Cells with signs of atypia in a small number.
Cells with marked signs of atypia.
Suspicion of malignant process.
Convincing signs of malignancy.
The main goal of the cytological study is to identify the morphological features of cells that characterize a specific process. There are up to 80 signs of an atypical cell, with about 10 of them being the most constant.
The decisive role in the formulation of the final diagnosis belongs to the histological method of studying the biopsy material obtained under colposcopic control. This, as a rule, is the final stage in the complex diagnosis of the pathological conditions of the cervix. In this connection, it is necessary to note a reliable histological diagnosis of cancer and often observed difficulties in the recognition of epithelial dysplasias, especially their initial forms, as well as the inability to repeatedly apply this method of diagnosis when examining the same patient.
EPIDEMIOLOGY OF CANCER CANCER.
Lifestyle, bad habits.
The first studies on the epidemiology of cervical cancer, appeared in the nineteenth century. Rigoni-Stern in 1842 published data based on the study of the death register in Verona from 1760 to 1830. He noticed that cervical cancer was much more likely to cause the death of married women and widows and did not occur in virgins and nuns. This circumstance allowed the scientist to make a hypothesis about cervical cancer as an infectious disease. In a study of 13,000 cases of nuns of Montreal and Quebec, F. Gagnon (1950) noted that cervical cancer was not detected once. The author linked such results with a low incidence of inflammatory diseases of the cervix in nuns.
The results of epidemiological studies concerning the role of early onset of sexual activity, early early pregnancy, frequent changes in sexual partners, and sexually transmitted infections have been published. At present, there is convincing evidence of an increased risk of cervical cancer in women who smoke. Some authors (Hellbberg, Greenberg, Winkelstein, Brinton) note the relationship of smoking with the early onset of sexual activity and frequent changes in sexual partners, others (Hoffman, Sasson) point to the carcinogenic role of nicotine and cotinine in tobacco smoke.
Currently, more than 100 types of human papillomavirus (HPV) have been identified. More than 70 types are described in detail. It is firmly established that certain types of HPV can infect a strictly defined type of epithelium and cause characteristic changes. Through the identification of the multivariate genotypes of HPV. identification of specific types of HPV. accumulation of data on malignant transformation of genital warts and oncogenic potential of various types of HPV. it became possible to treat papillomavirus as an etiological factor in the development of cervical cancer. Viruses with papillomas infect the basal layers of the epithelium. The most vulnerable site is the zone of transition of multilayered planar epithelium into the cylindrical epithelium.
An important role in the pathogenesis of cervical disease belongs to the system of immunity. The pronounced connection of immunological reactions with atypical proliferation of the ectocervix epithelium indicates the effect of cellular and humoral immunity, on processes supporting the existence of background and precancerous diseases, and also the relapses that provoke them.