Cervical cancer is a malignant tumor originating from cells covering the cervix. The cervix is a structure that is as a bridge between the body of the uterus and vagina. This is a tubular structure, inside which is a channel (the cervix). The cervix acts in the lumen of the vagina as a hemisphere (Dunleavey, 2009).
Statistics show that cervical cancer takes the fourth place among malignant tumors (after cancer of the stomach, skin and breast cancer), and the second for mortality. Earlier, women had this disease at the age of 40-60 years. However, in the recent years, cervical cancer was found in women fewer than 40 and who had pregnancy. The source of the cancer of the cervix is normal cells that cover the cervix. Each year, the tumor is detected in more than 600,000 patients (Dizon, Krychman & DiSilvestro, 2009).
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Risk factors for cervical cancer are old age, the effects of radiation and chemical carcinogens. In addition, scientists have shown that there is a direct link between cervical cancer and viral infections such as genital herpes and HPV. For example, human papilloma virus - HPV is detected in 95% of patients with cancer. And for women who are infected with both viruses, a chance to get cervical cancer is increased in 2-3 times compared to healthy women. Thus, it appears that cervical cancer has a tendency to be sexually transmitted, and for these malicious viruses, even a condom is not a barrier. Doctors have found that when a woman has six or more sexual partners, the risk of developing cervical cancer increases in 11 times. Especially prostitutes have a high level of morbidity (Dunleavey, 2009).
A tumor occurs most often in women who:
- early (before 16 years) began to be sexually active;
- suffered an early pregnancy and early first birth (16 years);
- are promiscuous;
- made many abortions;
- are suffering from inflammatory and sexually transmitted diseases;
- smoke too much;
- take hormonal contraceptives for a long time;
- suffer from immune disorders (Dunleavey, 2009).
In the occurrence of cervical cancer, the so-called underlying diseases attach great importance, which include all hyperplastic processes in the cervix: dyskeratosis (leukoplakia, akantopapillomatoz, erythroplakia) and glandular-muscular hyperplasia (papillary or follicular erosion, follicular hypertrophy). Dysplasia is considered to be a precancerous condition. The initial stage is minimum epithelial dysplasia of the cervix, by which in the lower third of the epithelium is abnormal proliferation of epithelial cells. In most cases, these changes have spontaneously reversible type, and epithelium returns to a normal state. However, more severe dysplasia with abnormal proliferation covering 2/3 of the depth of the epithelium often develops into carcinoma in situ, where all layers of cells have abnormal structure. Once the cancer cells pass basal membrane and begin to proliferate in the stroma of the body, the invasive stage of cancer starts (Dizon, Krychman & DiSilvestro, 2009)
Precancerous lesions are characterized by such symptoms as atypical proliferation of tissue elements, chronic and constant symptoms, resistance to conservative treatment and recurrence after surgical excision. Cervical cancer usually develops from the epithelium of the vaginal cervix. In this regard, there are two histological forms - squamous cell carcinoma (carcinoma planocellulare) and glandular cancer (adenocarcinoma) (Hirschmann, 2010).
First, the tumor affects only the cervix, and then gradually begins to sprout to surrounding organs and tissues. In the course of the disease, tumor cells can be transported with shock lymph to nearby lymph nodes and can form new tumor nodules there (metastases).
The transformation of pre-cancer to a cancerous tumor is from 2 to 15 years. Subsequent transition from the initial to the final stage of cancer lasts 1-2 years.
Depending on the prevalence, cervical cancer is classified into clinical stages.
- Stage 0 - intraepithelial carcinoma.
- Stage I - tumor limited to the cervix.
- 1a - micro invasive cervical cancer, which is subdivided into:
- 1A1 - the depth of invasion 3 mm (1% incidence of metastases);
- 1A2 - the depth of invasion 3-5 mm (4-8% incidence of metastases);
- 1b - invasive cancer of the cervix (the depth of invasion more than 5 mm).
- Stage II - the tumor spreads beyond the cervix:
- IIa - infiltration of the upper and middle third of the vagina or uterus;
- IIb - infiltration of parameters, not reaching to the wall of the pelvis.
- Stage III - tumor outside the cervix:
- IIIa - infiltration of the lower third of the vagina;
- IIIb - spread of infiltration to the pelvic wall, infiltration with hydronephrosis or secondary contracted kidney.
- Stage IV - tumor invades adjacent organs or spread beyond the pelvis.
- IVa - germination of the bladder or rectum;
- IVb - distant metastases (Hasan, 2009).
Cervical cancer often (40-50% of cases) affects the vagina. The spread of cancer to the vagina occurs through the lymph vessels and contact implantation. The body of the uterus is affected very rarely. Tubes and ovaries are also rarely involved in the process, and especially ureters are affected very rarely (S. Markovic & O. Markovic, 2008).
A woman is unlikely to guess about the development of cervical cancer in early stages of the disease. Usually everything is taking asymptomatic. Most often, an early stage of the cancer accidentally reveals a gynecologist on the planned examination of a patient. However, a woman should be alerted if she has whitish bloody vaginal discharge. The larger the tumor, and the longer it exists, the more likely that there will be vaginal discharge after intercourse, heavy lifting, straining and douching. These symptoms occur when the cervix has ulcerations with rupture of blood vessels. In the future, with the development of cancer, nerve plexus of pelvic squeeze, which is accompanied by pain in the sacrum, lower back and lower abdomen. With the progression of cervical cancer and the spread of tumors to the pelvic organs, such symptoms as pain in the back, legs, swelling of the legs, impaired bladder and bowel appear. There may be fistula connecting the intestine and vagina. During germination of the tumor in the bladder or rectum clinical picture associated with these bodies appears (dysuria, intestinal, constipation, blood in the urine and feces, fistula) (Hasan, 2009).
It is very difficult to make a diagnosis of cervical cancer in the early stages. Patients with suspicions on tumor should be under supervision of a doctor and undergo periodic examinations by a gynecologist. A complex of clinical examination of patients with cervical cancer include blood tests, bimanual vaginal examination, inspection with a speculum, recto- vaginal research, diagnostic tests, colposcopy, vaginal smears and biopsies (Hasan, 2009).
For a smaller trauma of tumor, it is recommended to examine vagina by using an index finger. In the initial stages of cancer the infiltration (hardening) with no clear boundaries, the rigidity of the cervix can be palpated. At later stages, a shape of the tumor (exophytic, endophytic, mixed and peptic), the mobility of the uterus, a condition of the appendages, the vaginal walls, par uterine fiber and of nearby organs (rectum and bladder) is determined (Hirschmann, 2010).
In cases when the cervix is intact on the touch, vaginal bimanual examination should be supplemented by inspection of a speculum. This allows determining the type of tumor. Exophytic tumor looks like a cauliflower covered with dark crusts (areas of decay), and it bleeds even with a light touch. The cervix with endophytic forms of tumors is dense and swollen; mucous membrane is dark purple with a network of small, easily bleeding vessels. In the decay of the tumor, ulcers are formed. The examination with the use of a speculum has a particular value in the early stages of the disease. The erosion, knotty and papillary growths can be seen. For the early detection of cancer and precancerous conditions, colposcopy is a very valuable research (Hirschmann, 2010).
Treatment of cervical cancer includes effects on the primary tumor (surgery, radiotherapy) and zones of regional metastasis. Surgical treatment is only possible if a woman has I and IIa stages. It is carried out in combination with radiotherapy. The depth of invasion determines the probability of metastases in regional lymph nodes and recurrence of cervical cancer, which is accounted for the planning of radiation therapy (Hasan, 2009).
Health promotion, formation and monitoring risk groups, early detection and treatment of background and precancerous lesions of the cervix are the most applicable measures of primary and secondary prevention of cervical cancer (Hasan, 2009).
Acquaintance with methods of contraception to prevent unwanted and early pregnancies, explanation of the advantages of barrier contraception, promotion of monogamous relationship, hygiene, counter advertisings of smoking are aimed to promote a healthy lifestyle and the erosion of harmful factors contributing to the development of cervical cancer (S. Markovic & O. Markovic, 2008).
Henrietta Lacks was a young mother who had five children. One day, she entered the hospital to begin cure of cervical cancer. As she was black, she was treated in the hospital for black people. She did not receive good treatment because of her race. She got to know that she had cancer at the age of 30. It is supposed that because of her poor life conditions, she got cancer at such an early age (Skloot, 2010).