Cervical cancer: the verdict is overturned!.

Cervical cancer is one of the most common malignancies in women, causing more than half a million new cases per year worldwide. In Russia, according to statistics, there are about 14-16 such cases per 100,000 population. Unfortunately, the tumor is often detected in late stages, when the chances of recovery are low. While the arsenal of modern medicine has all the means to not only diagnose uterine cancer in time, but to cope with the disease.

Cervical cancer: about the symptoms and treatment of the insidious disease - first-hand

What should be done to prevent the development of cervical cancer? What preventive measures are there? What to do if uterine cancer has already made itself felt? We addressed these and other questions to Honored Health Worker, Senior Researcher at the Russian Cancer Research Center named after. N.N. Blokhin RAMS, gynecological oncologist of the highest category, Doctor of Medical Sciences Lyubov Ivanovna Korolenkova.

ProPedia: What is cervical cancer?

Korolenkova L.I.: Uterine cancer is a disease of the female genital area, which is characterized by the appearance of a malignant tumor on the cervix (that part of it that is located between the vagina and the body of the uterus). 

Uterine cancer, unfortunately, is a fairly common cancer among young women aged 15 to 39 years.

It should be noted that the formation of cervical cancer is a long process that progresses over time. This makes it possible to diagnose the disease in the early stages, before invasive uterine cancer, in which altered cells grow deep into the tissue of the cervix and even into neighboring organs. As a rule, this is preceded for 8-10 years by the development of precancerous conditions - cervical intraepithelial neoplasia (CIN), which do not affect the well-being and fate of the woman.

If you imagine the gradations of tumor formation, then first there are precancerous lungs and moderate intraepithelial lesions (CIN I and II), and now the third degree (CIN III) is the zero form of cervical cancer. In the absence of treatment, the process for several years rises up the folds of the cervical canal and deep into the cervix, capturing more and more new areas. Increasing in size, the tumor can grow beyond the uterus into neighboring organs (bladder, rectum), and also give metastases through the lymph and blood (“screenings” of cancer in the lymph nodes and other organs). Treatment in these cases is much more difficult and ineffective.

ProPedia: What is the main cause of cervical cancer?

Korolenkova L.I.: Today it is known that the development of uterine cancer is facilitated by infection with the human papillomavirus (HPV) of high oncogenic risk. As a rule, these are 16 or 18 types, which are the most common. They are responsible for more than 70% of all cases of cervical cancer. But this does not mean that if an infection is detected, the woman will definitely get sick.

Cervical cancer can develop only in a few against the background of a persistent viral infection, that is, if the virus is re-detected more than 2-3 years after the initial detection. Most cases of HPV infection (about 90%) end in self-healing due to the body’s protective functions. When persistent, only 10% develop varying degrees of CIN, of which the majority of mild lesions regress spontaneously.

Human papillomavirus infection, which often causes uterine cancer in women, is transmitted sexually through direct contact of the genital mucosa. This virus does not exist in the blood. In the male body, the virus may not cause any disease or even condylomas, but remain for years and infect healthy women.

To dispel doubts and make sure of your own health regarding uterine cancer, it is best for a woman to undergo the so-called digen test.

The Digen test is a quantitative analysis for 13 types of high oncogenic risk HPV. Despite the presence of traces of the virus in the cervix, it is positive only at clinically significant concentrations of the virus. Using the test, you can, firstly, exclude patients whose infection cleared up on its own without causing severe neoplasia (their test is negative), and secondly, evaluate the effectiveness of treatment by changing the viral load (the amount of virus in the tissues of the cervix).

In women with preinvasive and microinvasive cervical cancer, the Digen test is always positive and with a significant viral load. If surgery to remove uterine cancer is successful, the test will come back negative.

ProPedia: What are the main symptoms of uterine cancer?

Korolenkova L.I.: The insidiousness of the disease is that cervical cancer is asymptomatic and for a long time practically does not manifest itself in any way, is not detected when examined in mirrors or looks like an ordinary “pseudo-erosion”. The precancerous period can last up to 10 years before the process progresses to the invasive (cancerous) stage.

Initially, the disease can only be detected by abnormal smear results, a positive HPV (human papillomavirus) test, or colposcopy. However, you should be wary if you experience spotting or leucorrhoea with a small admixture of blood from the vagina during sexual intercourse. A growing tumor can put pressure on the nerve plexuses of the pelvis and cause pain in the sacrum, lower back and lower abdomen, as well as in the back and legs. Further growth of the tumor is accompanied by its disintegration with the appearance of profuse liquid leucorrhoea with an unpleasant odor.

ProPedia: It turns out that uterine cancer can only be detected in the early stages by chance?

Korolenkova L.I.: In many countries, there is organized state screening that makes it possible to detect the disease at the CIN stage. For this purpose, cytological examination is used, often combined with HPV testing. The studies are carried out on a massive scale and cover the vast majority of women from 20 to 65 years old: up to 50 years old - every 3 years, after 50 years - every 5 years. Simultaneous testing for HPV increases the likelihood of detecting the disease.

Diagnostic techniques and tests to detect uterine cancer:

1. Examination of the cervix and mucous membrane in the speculum.
2. Obtaining a scraping smear for cytological examination to look for abnormal and cancer cells under a microscope. One common test is the Papanicolaou or PAP test. It is important that the smear is not represented only by mucus, but contains epithelial cells, so the material must be taken with special brushes. Today there is a new technology for cytological research - liquid, when several smears can be obtained from one “scraping” for additional examination of HPV and tumor markers.
3. Colposcopy (simple) - examination of the mucous membrane of the vagina and cervix using an optical device. In an extended version of the study, the vaginal part of the cervix is ​​treated with a 3% solution of acetic acid, which causes swelling of the abnormal epithelium (becomes glassy white). The speed at which swelling occurs and the duration matter. The more time passes after exposure to acetic acid, the more severe the damage.
4. Limited biopsy is used less and less often - a histological examination of a small area, which does not always correctly reflect the extent of damage achieved. All over the world, electrosurgical loop excision of the entire zone where the tumor process develops, or conization, is increasingly being performed as the most complete diagnostic and therapeutic measure with the study of all abnormal epithelium.

Quite often, a neoplastic process is discovered during a desired pregnancy, when the expectant mother comes to the antenatal clinic to register.

ProPedia: And what to do in this situation?

Korolenkova L.I.: In Russia, it is believed that there is no need to carry a pregnancy to term if you have uterine cancer; women are encouraged to have an abortion, since this is the first trimester, up to 12 weeks. However, world standards are focused on preserving the fetus. Here, in the scientific advisory department of the Federal State Budgetary Institution “Russian Scientific Research Center named after. N.N. Blokhin" of the Russian Academy of Medical Sciences has considerable experience - more than fifty cases - of carrying pregnancy to term in precancerous conditions. Treatment is usually postponed until the postpartum period. Everyone gave birth successfully. Now both mothers and babies are alive and well. Of course, this happens if there is no visible form of the tumor. But even in this case, if a woman wants to carry the pregnancy to term, then this is possible. As a rule, against the background of chemotherapy. True, there are very few such cases. In my practice, for example, there were six such patients,

Of course, to be honest, there is a risk. During pregnancy, natural physiological immunosuppression occurs (suppression of immunity), which accompanies gestation. Against this background, cervical cancer can progress, so we always monitor such women three times during pregnancy and 6-8 weeks after birth to assess the condition of the cervix and perform the necessary treatment.

Abortion does not provide any guarantee that the disease will not recur. In addition, the possibility of another pregnancy may be in question.

ProPedia: Today in Russia there are vaccines against HPV. Can vaccinations protect women from the risk of cervical cancer?

Korolenkova L.I.: The positive effect of vaccination is the creation of an immune response in the blood, which, as a rule, prevents infection with the virus. As a result, a significant, up to 70%, reduction in the incidence of cervical cancer and the development of severe neoplasia is expected. By the way, vaccination is recommended in adolescence before sexual activity begins. But, alas, there are lesions caused by other types of viruses that are not included in the vaccines registered today, and even vaccinated people require routine screening.

ProPedia: What treatment methods for cervical cancer exist?

Korolenkova L.I.: I adhere to excisional manipulations, when the affected area is removed within healthy tissue and it can be examined histologically. Any destructive effect (abnormal tissue is destroyed) has the risk of destroying the epithelium with a large degree of damage, which we will never know about. And, as a result, due to insufficient diagnosis of invasion and incomplete destruction of damage in depth, further development of the cancer process occurs.

ProPedia: What advice can you give to women on how to protect themselves from the risk of developing cervical cancer?

Korolenkova L.I.: My advice is purity of intimate life. I understand that these words sound at least naive these days, especially in the context of such a serious disease as cervical cancer. But it is so. Do not smoke, as smokers have significantly reduced protective properties of the cervical epithelium, which becomes much more vulnerable to the virus. And also try to explain to teenage girls that early onset of sexual activity can also cause the development of the disease. In adolescence, the tissues of the cervix are still immature, which significantly reduces local immunity.