Advertising on the portal

All of the cervical cancer was removed. What approaches does surgical treatment of cervical cancer involve? Forecasts for the course of the disease

Daria asks:

How it goes surgery with a malignant tumor of the cervix?

Volume surgical intervention primarily depends on the stage of the disease.

At stage 0, gentle operations are performed to destroy the altered cells. For this purpose, cryotherapy, laser cauterization, and cervical conization (removal of a cone-shaped piece of tissue from the cervix) are used.

  • The cryosurgical technique makes it possible to produce deep freezing and subsequent destruction of the changed cells. The effect occurs only on the part of the cervix affected by the tumor process; healthy tissues are not affected.

  • Laser therapy destroys pathological cells using a directed, focused beam of light that burns the affected area and a small portion of nearby healthy tissue.

  • Conization of the cervix is ​​used on early stages stage 1 and allows you to remove the changed cells while preserving the rest of the organ. Conization is used as separate method treatment or in combination with chemoradiotherapy.
These techniques are used in relation to women who want to maintain reproductive function.

There is another type of gentle surgical treatment - trachelectomy. During this operation through the vagina or anterior abdominal wall Only the cervix and the upper third of the vagina are removed. This method has an undeniable advantage - in the future, the woman retains the ability to bear a child, and childbirth occurs through cesarean section.

After such a surgical intervention, a woman becomes infertile, but remains able to have sex and experience orgasm.

The most extensive intervention is required when tumor cells grow into neighboring organs and surrounding tissue or when re-emergence cancer During the operation, the entire uterus, ovaries with fallopian tubes, lymph nodes, and subcutaneous fat tissue are removed. If indicated, the bladder, rectum, or adjacent portion of the large intestine may be removed. The operation is always performed under general anesthesia and is usually combined with chemoradiotherapy.

After surgical treatment, the woman is in the hospital for 1.5-2 weeks. The time required to restore the body is on average 5-6 weeks.

Find out more on this topic:
  • Tumor markers - interpretation of blood tests. When there is an increased and decreased level of tumor markers secreted by cancer cells (CA 125, CA 15-3, CA 19-9, CA 72-4, CA 242, HE4, PSA, CEA)
  • Tumor markers - what are they, how many are there and what do they show? Who and when should take a blood test for tumor markers? How much can you trust the analysis results? How to accurately determine the presence of cancer cells?
  • Keratoma (keratosis) - types (follicular, seborrheic, actinic, horny), cause of formation, treatment (removal), folk remedies, photo
  • Lipoma (fat) of the breast, kidney, brain, back, face, head, etc. – types, causes and symptoms, methods of diagnosis and treatment (removal), reviews, price, photos

This is a disease caused by malignancy of the tissue cells of the mucous membrane or walls of the uterus - the endometrium or myometrium. The inner layer of the walls of this organ is built from endometrial cells, on which a fertilized egg develops, and if this does not happen, the layer is torn off and removed through the vagina to the outside during next menstruation. Myometrium is the building material of the muscle tissue of the uterus itself and its cervix, with the help of which the organ makes contractile movements.

Minimum required knowledge about tumors

Cancer of the body or cervix occurs when the normal process cell growth and replacement of dead cells with new, healthy ones. A failure and cell division occurs, which becomes uncontrolled - their number begins to rapidly increase and form into tumor tissue. A neoplasm occurs, most often in the cervix, which can be either benign or malignant, giving metastases.

If benign neoplasms are relatively harmless and their timely treatment, for the most part, leads to a complete and final recovery - relapses occur extremely rarely, while malignant tumors, especially the cervix, often lead to surgery to remove the woman’s reproductive organ. And even after such an intervention, not all patients live long.

Neoplasms with malignant histology often lead to irreparable consequences and even death of the patient. Treatment is complicated by the fact that such tumors are prone to relapse and often affect neighboring organs and tissues, and sometimes quite distant ones. The spread (metastasis) of the tumor occurs by the transfer of its cells through the lymphatic and blood channels. Metastases can occur anywhere, in the liver, lungs and even in bone tissue and in the brain - the brain and spinal cord. Having established themselves on the organ, malignant cells begin to actively divide and form an additional focus - metastasis. If not accepted timely measures, such metastases quickly affect almost all organs, and in such a situation even surgery is often powerless. Knowing this, it becomes clear that early diagnosis of cervical cancer is of paramount importance, especially for women at risk.

Categories of people at increased risk of this disease

First of all, women whose close relatives have had similar problems at a young age, up to 40 years. The following conditions increase the risk of uterine cancer:

  • Endometrial hyperplasia is the excessive growth of endometrial cells on the inner surface of the uterus and its cervix. This type of tumor is not malignant in nature, but is prone to degeneration into it. External manifestations of hyperplasia are painful and excessively heavy periods with bleeding between them, and after menopause periodic bleeding;
  • Excess weight also increases the risk of cancer of the endometrial cells of the uterus;
  • Early, before 12 years and late after 55 years of menstruation indicate a physiology predisposed to disorders of cellular genesis and the appearance of a malignant focus in the uterus;
  • Long-term use hormonal drugs, for example, estrogen, for replacement treatment menopause or tamoxifen, in the treatment of breast cancer;
  • Radiation therapy focused on the pelvis;
  • Not proper nutrition. Women whose diet is dominated by fatty food of animal origin, vegetarians are more likely to get sick.

Belonging to a risk group is far from a reason to panic and rush to the doctors, but it is still worth reconsidering your lifestyle. It may be worth changing your diet - add plant products, play sports, and give up bad habits, at least twice a year, undergo an examination by a gynecologist and, at the slightest suspicion of oncology, seek help immediately.

Signs of a cancerous tumor in the uterus

More often primary symptom tumors in the uterus become atypical for a woman vaginal discharge. At first, they are mostly watery with a small amount of blood, and as the tumor develops, the discharge turns into full-fledged bleeding. As additional symptoms note:

  • Impaired urination - the process causes difficulties and becomes painful;
  • Pain in the pelvic area;
  • Discomfort that turns into pain during sexual intercourse.

The difficulty of early diagnosis lies in the similarity of the symptoms of uterine cancer with the manifestations of other pathologies, so if you notice something similar in yourself, be sure to undergo an examination. Even if the symptoms are not cancer, but another disease, early diagnosis It won't hurt at all, on the contrary.

Diagnostics, treatment, rehabilitation

Any treatment begins with quality diagnostics which should include the following series of studies:

  • Gynecological examination and palpation;
  • Ultrasonic;
  • Hysteroscopic;
  • Biopsy.

We will not go into the details of each, we will only note that the most informative, and therefore important, is considered to be a biopsy. Only it allows a clear differentiation of the tumor by histological affiliation, and this makes it possible to determine the approximate rate of development oncological process. Tumors of high differentiation grow most rapidly and vice versa.

In addition to differentiating the tumor, it is extremely important to determine the degree of development of the pathology. To do this, determine the extent of the affected area, the presence and number of metastases (if any) of the primary tumor.

There are five stages of tumor development, we will describe them briefly and in the order of development:

  • 0 - Cancer cells were found only on the inner lining of the uterus;
  • 1 – The tumor has grown into the endometrium;
  • 2 – Damage to the cervix is ​​observed;
  • 3 – Tumor growth is significant. All layers of the reproductive organ, its neck, are affected, metastases have appeared in the vagina and local lymph nodes;
  • 4- The most severe degree of damage - in addition to local authorities pelvis, distant lymph nodes and organs are affected by metastases, body temperature is increased.

Therapeutic measures

Treatment of uterine cancer, like any other malignant tumor, can only be successful if complex application known methods - surgery, radiation, chemical and hormonal therapy. The number of methods and their combinations are selected by the doctor depending on the indications for each patient individually.

Surgery

It is believed that, without surgery surgical removal tumor focus, reach positive results It is extremely difficult, and sometimes impossible, therefore, most often, to combat uterine cancer, a hysterectomy is performed - complete removal body of the uterus.

Depending on the indications, the operation can be extended to – ovaries with fallopian tubes, vaginal area and regional lymph nodes affected by metastases of the primary tumor.

The operation is relatively simple and the patient is often discharged from the hospital within a week after the operation, and 1 to 2 months are enough for rehabilitation and return to a normal lifestyle. Sometimes there are postoperative side effects, for example, nausea, increased fatigue and weakness, problems with urination, but this is a temporary phenomenon, over time everything will return to normal.

Patients who underwent hysterectomy in childbearing age, lose the ability to become pregnant and bear a child. After the operation, they experience fever attacks for some time, increased sweating(especially at night) and unusual vaginal dryness. This is due to a significant decrease in the amount of female hormones.

When lymph nodes are removed, swelling often occurs lower limbs– lymphedema. To relieve this symptom, use therapeutic massages and creams.

Radiation therapy

Radiation therapy is used both before surgery to minimize the size and activity of the tumor, and after, to reduce the risk of relapse. Irradiation is also used in cases of severely advanced disease, when surgery impossible or impractical.

Radiation therapy is divided into 2 types according to the site of application - external and internal. In the first case, irradiation is carried out into the pelvic area from outside. The course of treatment, as a rule, lasts from one to several weeks - the tumor is irradiated 5 times a week, for several minutes. In the second case, a special micro-emitter is used, inserted into the vagina - closer to the tumor site.

Combining radiation and chemotherapy gives good results.

Radiation therapy has proven its effectiveness in the fight against cancer over time, but it has a significant drawback - serious consequences for the body:

  • Nausea;
  • Vomit;
  • Diarrhea and, on the contrary, constipation;
  • Urinary disorders;
  • Local baldness;
  • Radioactive burns of the irradiated tissue area;
  • Prolonged weakness and fatigue.

If the scope of the operation is limited to removal of the uterus, there is Great chance dysfunction of the ovaries and cessation of the menstrual cycle. Unfortunately, these problems do not always normalize, especially in women over 40. These phenomena are accompanied by symptoms typical of menopause.

When properly organized rehabilitation activities In the vast majority of cases, these symptoms disappear over time.

Chemical therapy

Chemotherapy involves the use special drugs, which have a destructive effect on cancer cells. It is carried out in patients with cancer stages 2, 3 and 4, as a treatment that reduces the likelihood of relapse or together with surgery. Like radiation, chemotherapy is also used if surgery is impossible or if there is uncertainty about complete removal of all tumor foci. At the last stages - 3 and 4 stages of cancer, it is combined with radiation therapy for a more severe effect on cancer cells.

Chemotherapy is carried out cyclically, with a regularity determined by the doctor, by intravenous administration drug into the blood. Depending on the patient’s condition, treatment is carried out both on an outpatient basis and in inpatient conditions under constant supervision.

Cytostatics are drugs used in chemotherapy that destroy cancer cells, and healthy ones also suffer. In addition, chemotherapy introduces a fairly decent dose of toxins into the body, which cannot but lead to unpleasant side effects:

  • Susceptibility to infectious diseases;
  • Bleeding;
  • Hair coloring and hair loss;
  • Constipation, diarrhea;
  • Loss of appetite;
  • Nausea and vomiting.

All this is accompanied by weakness chronic fatigue and apathy.

Hormone therapy

This type of treatment is only effective if hormonal tumors– requiring certain hormones for their vital functions and dying in the presence of others. As a rule, hormonal therapy is used to treat an extensively metastatic tumor, to reduce the rate of progression of the disease, or to treat the early stages of uterine cancer, provided that removal of the uterus is not acceptable - the woman wants to maintain the opportunity to have a child.

Side effects depend on the hormone used. If progesterone is used, the patient may gain significant weight and experience swelling and tenderness in the breasts.

Diet during treatment

Proper nutrition during treatment for uterine cancer helps the body recover faster. It is necessary to maximize the consumption of vegetables and fruits, and, on the contrary, exclude food products containing animal fats. They are replaced with fish meat, which is rich fatty acids, and they have properties that inhibit cancer cells. Must be included in your diet dairy products and green tea.

Your doctor or specialist nutritionist will prescribe a specific diet.

Where to get treatment?

Israeli medicine is rightfully considered the best, but one should not neglect domestic specialists. For example, at the nuclear medicine center in Kazan, they use a unique method complex treatment any forms of cancer of the uterus and its cervix with subsequent rehabilitation. For this purpose, modern unique installations are used, of which there are only two in the world.

The treatment here is so successful that women from all over the country and even foreigners come to Kazan. Kazan Center for Nuclear Medicine, in addition to the highest level services provided, has another advantage - for Russian women, examination and treatment are absolutely free, but for foreign women who are not averse to getting into Kazan treatment center, are forced to pay for their treatment. This interest of foreign citizens is due not only to the cost of treatment, which in their countries is significantly higher than in the Kazan Nuclear Medicine Center, but also to its high quality.

Forecasts for the course of the disease

The main question is how long do women with uterine or cervical cancer live? The answer depends primarily on the stage of the disease and the histology of the cancer cells.

Zero – the stage of appearance of cancer cells, the least dangerous – a complete cure is almost always possible. Such patients live after anti-cancer therapy, live as long as they want. At the first stage of the disease, at least 8 women out of 10 complex therapy, live more than five years. The second stage leaves only 6 out of 10 patients a chance of five-year survival; the third stage is treated very poorly, only a third survive for 5 years. But how long do patients with 4 live? last stage Uterine cancer is a complex and practically unpredictable issue. It all depends on large quantity factors – how old is the patient, what is the general physical state the body – its susceptibility to radiation and chemotherapy, what is the degree of tumor differentiation. And even with the most favorable combination of all these factors, patients with stage 4 uterine cancer have a low chance of five-year survival - no more than 7%.

Video on the topic

A malignant process in the cervix is ​​called cervical cancer. If glandular tissue is affected, the disease is histologically classified as adenocarcinoma, otherwise as squamous cell carcinoma.

Stage 1 cervical cancer is classified in accordance with the rules of the international TNM system, which can be used to determine the spread of the tumor, the presence or absence of distant metastases, and metastases in the lymphatic system.

In this system, stage 1 of cervical cancer is designated as T1, where T (tumor) is an indicator of the extent of the primary tumor. This means that the malignant process exclusively affects the cervix. The body of the uterus is not affected. But stage 1 also has its own classification:

  1. The tumor process affects the cervix - T1.
  2. Tumor penetration into tissue can be detected microscopically – T1a:
  • Tumor growth into the stroma (the basis of the organ, consisting of connective tissue, in which blood vessels and lymphatic vessels) in depth up to 3 mm and up to 7 mm on the surface – T1a1;
  • Tumor growth into the stroma up to 5 mm deep and up to 7 mm on the surface – T1a2.
  1. The tumor can be detected visually during a physical examination, or microscopically, but the size will exceed T1a and its subtypes - T1b:
  • Visually detectable lesion up to 4 mm in size – T1b1;
  • Visually detectable lesion larger than 4 mm – T1b

There is another classification of cervical cancer stages according to FIGO:

  • Stage I, corresponding to T1 according to TNM;
  • Stage IA divided into I.A.1 And I.A.2 and is equivalent to stages T1a1 and T1a2 according to TNM;
  • Stage I.B. divided into I.B.1 And I.B.2 and is equivalent to stages T1b1 and T1b2 according to TNM;

Despite the fact that the TNM classifier is better known, in diagnosis the tumor is initially described by FIGO. Russian specialists letters of the Russian alphabet are often used. It looks like this: A1, B1 etc.

The initial stage of cervical cancer includes the so-called cancer in situ (stage 0). Unlike stage 1, malignant cells have not yet invaded (have not grown) into the underlying tissue. Tumor cells proliferate, but at the same time die, which prevents the tumor from growing.

With adequate and timely treatment The prognosis for stage 1 cervical cancer is favorable. According to statistics, the five-year survival rate of patients with this pathology exceeds 90%.

Treatment of stage 1 cervical cancer can be carried out in several ways, including a combination of them. The choice of one or another treatment method or their combination depends on histological type tumor (squamous cell carcinoma or adenocarcinoma), its stage, presence accompanying pathologies in the patient, etc.

Important! If you are diagnosed with cervical cancer at any stage, it is very important to consult a specialist in a timely manner. You should not look for treatment methods on forums and other resources. Treatment of cancer requires systematic approach and must take place in a hospital setting under the supervision of a physician. Traditional medicine is powerless.

There are several types of surgeries for excision of cervical tumors. These include:

  • Amputation of the cervix;
  • Knife conization;
  • Radical trachelectomy;
  • Pelvic exenteration;
  • Various types of hysterectomy.

In the case of stage 1 cervical cancer treatment (T1a and T1b), hysterectomy is predominantly used, in in some cases radical trachelectomy.

Trachelectomy is called complete or partial removal cervix, parts of the vagina, groups of iliac and lymph nodes, as well as some groups of ligaments. The advantage of such an operation will be the preservation of the woman’s reproductive function.

A hysterectomy is an operation to remove the uterus. Several types of such manipulation are classified. When treating stage 1 cervical cancer, I, II and III types(there are 4 in total).

  • Type I – Performed for stage T1a1 and cancer in situ. Involves removal of the uterus and a small part of the vagina (up to 1 cm);
  • Type II – Performed for stages T1a1, T1a2, T1b This type involves radical hysterectomy. The uterus and a small part of the vagina (up to 2 cm) are completely removed along with the ureters;
  • Type III - Performed at stage T1b. It involves the removal of paravaginal and paracervical tissue, part of the vagina, uterus and uterosacral ligaments.

In the treatment of stage 1 cervical cancer, such therapy is predominantly used as an auxiliary therapy. Used in cases where there are contraindications to combined radiation therapy or when the patient does not tolerate it well. In this case, the tumor must be reduced to allow surgical treatment. Designed for this purpose special schemes on the administration of cytostatics. Typically, the patient undergoes 3 courses of polychemotherapy; if the tumor responds positively to the cytostatic drug (it decreases), excision of the tumor is possible.

Radiation therapy

This treatment method can be carried out alone or in combination with chemotherapy and surgery. There are several types of radiation therapy:

  • External beam radiation therapy - with this method, the radiation source (usually a linear accelerator) does not come into contact with the tumor;
  • Intracavitary radiation therapy – the radiation source is in direct contact with the tumor;
  • Combined radiation therapy – combines both of the above methods.

Radiation therapy can stabilize the oncological process, improve the patient’s quality of life, reducing the severity of symptoms, and also lead to a complete recovery.

It has a number of contraindications: fibroids, adhesions, endometritis, some diseases of the genitourinary organs.

When treating cervical cancer at stages defined as T1a1 and T1a2, hysterectomy is usually used in combination with radiation therapy (external + contact).

When treating stage T1b1, hysterectomy is used in combination with external beam radiation or chemotherapy. It is possible to use exclusively combined radiation therapy.

Stage T1b2 is usually treated with chemotherapy and radiation therapy. In some cases, it is possible to use hysterectomy in combination with radiation therapy.

After complete cure of the disease, the risk of relapse cannot be excluded. It may occur after six months (or more). Indicates the incurability of the malignant process. The tumor can be located both in the cervix and in any other organ in the form of metastases. Decisions about treatment methods are made individually. Usually they combine everything possible methods. Polychemotherapy is prescribed to improve the patient’s quality of life (palliative therapy).

Etiology and pathogenesis

Scientists have identified several factors that increase the risk of cervical cancer. Among them: smoking, early sexual activity and frequent change sexual partners. But most probable cause The disease is human papillomavirus types 16 and 18, which is sexually transmitted. Up to 75% of cases of malignant process in the cervix are associated with this virus.

During normal operation immune system body, the human papillomavirus is destroyed. But if it is suppressed, then the virus instantly develops, takes chronic form and provides negative impact on the epithelial layer of the cervix.

Clinical manifestations

In the early stages of the malignant process, cervical cancer practically does not manifest itself at all, which makes diagnosis much more difficult. Therefore, it is very important to undergo regular gynecological examinations. In the presence of an oncological process in the body, there are general somatic manifestations in the form general weakness, increased sweating at night, weight loss and persistent low-grade fever. Upon delivery general analysis blood, leukocytosis (increased white blood cells), possibly slight anemia and an increased erythrocyte sedimentation rate (ESR) will be observed.

Symptoms such as: bleeding, spotting and other discharge, pain in the pelvic area, difficulty urinating, etc. are characteristic of stages 3-4 of cervical cancer; at stage 1 they appear extremely rarely.

An integrated approach must be taken to the diagnosis of cervical cancer.

Physical examination

Assumes general examination women. Palpation of peripheral lymph nodes and abdominal cavity. Examination of the cervix in a chair using mirrors and bimanually. A rectal examination is required.

Laboratory diagnostics

First of all, the gynecologist takes smears from the cervical canal and human papilloma. Next, you need a biochemical and general clinical tests blood and urine. Blood serum, tests for tumor markers.

Non-invasive diagnostic methods

The main methods of non-invasive diagnostics include ultrasound of the pelvic organs and internal organs. Tomographic examination (MRI, PET). Positron emission tomography will help determine the presence of metastases in organs and tissues. If necessary, can be applied additional methods: cystoscopy, sigmoidoscopy, colonoscopy, etc.

Invasive diagnostic methods

These methods include taking a biopsy for an accurate diagnosis, determining the stage, tumor proliferation. In some cases (presence of metastases), diagnostic laparoscopy may be necessary.

If stage 1 cervical cancer is suspected, when making a diagnosis it must be differentiated (distinguished) from venereal diseases. Sometimes with syphilis, the surface of the cervix becomes covered with small ulcers, which may resemble a malignant process. Next, it should be distinguished from ectopia, papillomas, and other similar diseases of the cervix. From sexually transmitted infections and from uterine cancer that has spread to cervical canal and vagina.

IN preventive measures in the fight against cervical cancer were against human papillomavirus, which are successfully used in developed countries. At the same time, positive statistics have already been determined to reduce the incidence of cervical cancer and (dysplasia). It is recommended that girls and boys aged approximately 9-13 years be vaccinated before sexual activity. Vaccination is also recommended for women under 45 years of age.

Video: Early stage cervical cancer surgery

Video: Treatment of dysplasia and cervical cancer in situ

Most cases of cervical cancer are squamous cell carcinoma, in 20-25% of cases - adenocarcinomas and adenocellular sarcomas. Sarcomas are also found less frequently.

Symptoms

Initial signs of cervical cancer - postcoital, intermenstrual and postmenopausal vaginal bleeding. In patients who are not sexually active, they may occur during late stages diseases (except for patients with endometrial cancer, in which bleeding always occurs early). As the disease progresses, profuse vaginal discharge appears in the pelvic area, legs and frequent urination. In developing countries, the tumor is often detected only when urine or feces are discharged through a fistula from the vagina.

Objective examination

As a rule, patients with cervical cancer have no signs of disease during physical examination. Loss of body weight - characteristic feature late stage. In addition, it is possible that the inguinal and supraclavicular lymph nodes, the occurrence of swelling of the legs and rarely hepatomegaly.

During vaginal examination, ulcers or exophytes are visualized on the cervix. Bleeding often occurs on palpation. Serous, purulent or bloody issues from the vagina. The damage may involve the vagina and extend to the entrance to the uterine cavity.

The purpose of a rectovaginal examination is to determine the degree of development of the disease. The extent of the tumor in the parametrium is easier to determine through a rectal examination.

Preoperative examination

The International Federation of Obstetricians and Gynecologists has defined criteria for the classification of cervical cancer based on physical examination and non-invasive testing. The list of necessary studies includes biopsy, cystoscopy, sigmoidoscopy, radiography chest and bones, intravenous pyelography and liver tests. Metastases in the lungs in the late stages of cancer are found in 5% of patients, and in initial stages Cervical cancer - almost never.

CT or MRI of the abdomen and pelvis can be performed during routine examination, but the results of the studies are not taken into account when determining the stage of the disease. MRI for cervical cancer is especially informative in establishing the size of the primary lesion and the degree of cancer penetration into the parametrium, bladder or rectum. MRI cannot detect metastasis to lymph nodes. For this purpose, positron emission tomography is performed. In stage 2 cervical cancer, para-aortic lymph nodes are detected in 20% of cases, and in stage 3 cancer - in 30% of cases. Involvement of para-aortic lymph nodes in the pathological process is a very important prognostic sign.

In advanced stages of cervical cancer laboratory research make it possible to detect, caused by bleeding, an increase in the concentration of urea and creatinine (with ureteral obstruction) and positive liver tests (with metastasis to the liver). Ureteral obstruction occurs in 30% of patients with stage 3 cancer, and in 50% of patients with stage 4 cancer. Hypercalcemia may indicate bone metastasis.

Treatment

Treatment for cervical cancer differs depending on different stages tumors.

Stage 1a (microinvasive carcinoma)

The preoperative diagnosis of microinvasive carcinoma can only be made on the basis of tissue biopsy after wedge resection. For the sample, many small areas are taken, located at a distance of 2 mm from each other. With a puncture biopsy, the area taken for examination is limited, so a large tumor focus can be easily missed. Previously, microinvasive carcinoma was understood as areas of altered squamous epithelium. Currently, this term also describes glandular lesions, although adenocarcinoma occurs higher up, in the area of ​​the cervical canal.

Surgery

When the depth of invasion during a wedge biopsy does not exceed 3 mm, the horizontal size of the tumor is no more than 7 mm (stage Ia1), and there is no involvement of blood vessels or lymph nodes, extrafascial abdominal or vaginal hysterectomy is recommended. Wedge resection of the cervix can be independent method treatment if the patient wants to preserve reproductive function, and the resection edge is not affected by the tumor and the tissue is not histologically changed during curettage (after resection). At stage Ia2, when tumor process vessels or lymph nodes are involved, most gynecological oncologists recommend radical hysterectomy with lymph node dissection of the pelvic lymph nodes. If a woman wishes to preserve reproductive function, it is possible to perform an extended wedge resection or radical trachelectomy (cervical) in combination with lymphadenectomy of the pelvic lymph nodes.

Stages 1b1 and 1b2

At stage 1b of the disease, surgical treatment of cervical cancer (radical hysterectomy with bilateral lymphadenectomy of the pelvic lymph nodes) or radiation and chemotherapy is possible. The advantage in case of cervical cancer is the possibility of preserving the ovaries in young women, as well as preventing the development of chronic complications (vaginal stenosis, proctitis, cystitis). Surgery is the treatment of choice for patients at stage 1b1.

The results of both treatment methods are equally successful with proper qualifications or. Radiation therapy is the treatment of choice in patients with stage Ib2 disease. Considered a good alternative surgery with subsequent exposure external exposure. Patients with deep damage to the tissue stroma and vessels, but without involvement of the lymph nodes in the pathological process, undergo pelvic radiation therapy. Patients with iliac or para-aortic lymph node involvement receive irradiation to a larger body surface area, often in combination with cisplatin.

Radical hysterectomy. During this procedure, the uterus, uterine part of the vagina, cardinal and uterosacral ligaments, as well as part of the bladder are removed.

Most common complication surgery - bladder dysfunction caused by damage to the autonomic nerve fibers located in the cardinal and uterosacral ligaments. Bladder function is normally restored within 1-3 weeks. In 1-2% of patients, recovery does not occur, and therefore lifelong catheterization of the bladder is required.

Most serious complication radical hysterectomy - fistula, or ureteral stricture (1-2% of cases). A less frequently reported but more serious complication is deep vein thrombosis with pulmonary embolism or without it. To prevent venous thromboembolism, it is recommended to use an external corset during surgery, early activation of the patient and prophylactic appointment low doses of heparin sodium or enoxaparin sodium administered subcutaneously. Lymphedema occurs in 15-20% of patients after lymphadenectomy of the pelvic lymph nodes.

Radical trachelectomy. In young women with early manifestations of a malignant tumor (diameter less than 2 cm), this intervention allows preserving fertility with high chance cure.
Radiation therapy for cervical cancer. Patients with stage 1b2 disease are most often treated with chemotherapy and radiation using cisplatin as a sensitizer. Treatment usually begins with exposure to external radiation. This allows you to destroy the main tumor and optimize the dose of subsequent intracavitary therapy.

External radiation is also sometimes used in patients with lymph node metastases or residual tumor in the postoperative period. Additional administration of cisplatin (intravenously at a dose of 40 mg/m2) for a week during a course of external irradiation is considered effective.

Stage 2a

In patients with minimal tumor lesion the vaginal vault is carried out radical treatment or chemotherapy and radiation therapy. If the upper third of the vagina is significantly involved in the pathological process, radiotherapy is considered the treatment of choice.

Stage 2b

Most patients at this stage receive combination treatment external irradiation and intracavitary brachytherapy. If preoperative examination revealed tumor metastasis to the iliac or para-aortic lymph nodes, the area radiation exposure expand to cover all lymph nodes up to the diaphragm.

Stages 3a and 3b

At this stage, chemotherapy for cervical cancer in combination with radiation (usually external radiation with intracavitary brachytherapy) is considered optimal. If the tumor grows locally, disruption of the integrity of the cervix and vagina under the influence of radiation may complicate further brachytherapy. In this case, a large dose of external radiation may be required (up to 7000 cGy). As an alternative, it is better to use intestinal therapy for cervical cancer instead of intracavitary therapy.

Stage 4a

At this stage, chemotherapy and radiation to the pelvic area are most often used. If the tumor has partially regressed after a course of radiation, residual exenteration can be performed. This method is rarely used as an initial treatment, usually when the patient has a rectovaginal or vesicovaginal fistula.

Stage 4b

Patients at this stage receive radiation therapy to reduce bleeding from the vagina, bladder and rectum. Due to the presence of distant metastases, chemotherapy is used, but the treatment is palliative.

Recurrent cancer and metastases of cervical cancer

Chemotherapy. When cervical cancer metastasizes, chemotherapy has limited effectiveness. The effectiveness of several drugs has been experimentally confirmed in 35% of cases. Most results are temporary and cervical cancer usually recurs within 12 months of treatment. The most active drugs for cervical cancer are cisplatin, bleomycin, mitomycin, methotrexate and cyclophosphamide.

Pelvic exenteration. As a rule, it is performed after a course of radiation therapy in patients with partial tumor regression. Total exenteration involves removal of the visceral layer of the pelvic peritoneum, including the portion covering the uterus, fallopian tubes, vagina, ovaries, bladder, and rectum. Depending on the location and size of the tumor, the scope of the operation can be reduced to anterior exenteration, which involves removing part of the visceral peritoneum covering the rectum, or posterior exenteration, which involves removing the peritoneum of the bladder.

After hysterectomy, pelvic reconstruction is required. If the bladder is removed, the ureters are sutured to a loop of the small or large intestine, allocated specifically to form an outlet tube. An artificial urine outflow pathway can be formed (especially in young patients). When the tumor is limited to the vaginal vault and rectovaginal ligament, bottom part The rectum and anus can be preserved to form an anastomosis with the sigmoid colon. A temporary colostomy is placed to protect the anastomosis after previous radiation. Reconstruction of the vagina is carried out using bilateral musculocutaneous fibers m. gracilis, musculocutaneous part of m. rectus abdominis or segment of the colon.

Only a relatively small number of patients with recurrent cervical cancer can undergo exentration due to distant metastases or tumor fixation to vital structures that cannot be resected (eg, the lateral pelvic wall). If cancer cells are not found during the study of metastases, a diagnostic test is performed for further extentation. If it turns out that the tumor has spread to the pelvic cavity, para-aortic lymph nodes or visceral peritoneum, then intervention is contraindicated.

When selecting patients for pelvic exentration, it is necessary to pay attention to the triad of signs (lateral thigh swelling, pain in sit bones and ureteral obstruction), indicating the presence of an unresectable tumor in the patient.

Prognosis for cervical cancer

The prognosis depends on the stage at which it is diagnosed malignant tumor. On high stages the incidence of lymph node metastasis is significantly higher, and life expectancy is a maximum of five years. With adenocarcinomas and adenosquamous cell tumors, patients live on average five years less than with squamous cell carcinoma, discovered at the same stage.

Primary prevention of cervical cancer

Two preventative vaccines have been developed. The quadrivalent papillomavirus vaccine (Gardasil), manufactured by Merck, protects against viruses 6, 11, 16, 18. The vaccine is approved American management By sanitary supervision in June 2006 and is recommended for women from 9 to 26 years old. GlaxoSmithKline's bivalent human papillomavirus (cervarix) vaccine protects against HPV types 16, 18 and has been approved by the Australian Health and Safety Authority. medicines in April 2007 and is recommended for women from 9 to 45 years old.

Vaccination against cervical cancer in women before sexual activity is especially effective. The vaccine also has an effect after the onset of sexual activity and even when SIN is detected, but is significantly less effective after HPV infection. Australia was the first country to include HPV vaccination in its vaccination schedule. In 2007, Gardasil immunization was introduced for all girls aged 12 years.

The article was prepared and edited by: surgeon