Quite often, one has to deal with situations when a patient has a high oncogenic risk human papillomavirus (HPV) and it is immediately reported that there is a risk of developing cervical cancer.

Quite aggressive treatment is often prescribed, a biopsy is performed, and in general it is not clearly explained what is really happening and what is the further prognosis. The main thing is that the doctor does not follow a clear algorithm that has existed in the world for quite a long time.

So, if you have a high oncogenic risk human papillomavirus (HPV) detected by PCR, do not panic. There is nothing serious in this finding, it is just an excuse to undergo an appropriate examination.

Important

  • The fact that you have HPV of a high oncogenic risk does not mean that you will definitely develop cervical cancer - there is a chance, but it is very small and if you visit the gynecologist regularly, the disease can be detected at the earliest (precancerous) stages and completely cured.
  • The human papillomavirus enters the cells of the cervix and may not cause any changes in them for a long time. This virus can be suppressed by the immune system, and is subsequently not detected during the analysis. Most often this happens by the age of 30-35. The presence of the virus in the body after this age makes it necessary to be more careful in assessing the conditions of the cervix.
  • Of great importance is the amount of virus in the body. The usual analysis by the PCR method indicates only the presence of the human papillomavirus in the body, but does not reflect its amount. There is a special analysis that can detect the amount of HPV virus.
  • In the world there is not a single effective drug for the treatment of human papillomavirus, as well as immunomodulators and other drugs are not used. The human papillomavirus cannot be cured. The immune system can suppress its replication, but no drugs (no matter how it is claimed by the manufacturers) can help the immune system suppress this virus. All treatment regimens prescribed in our country, including (allokin-alpha, polyoxidonium, panavir, cycloferon, isoprenosine, etc.) have no proven effectiveness. There are no analogues of these drugs in the world.

What to do?

  • Once a year, it is mandatory to undergo an examination by a gynecologist with a mandatory examination of the cervix.
  • A simple examination of the cervix is ​​not enough - it is imperative to do tests, that is, answer two questions - do you have a human papillomavirus and are there changes in the cells of the cervix that could potentially lead to the development of cervical cancer.

Most often, clinics take a regular cytological smear and a PCR smear to determine the virus (that is, an analysis that simply answers the question of whether this virus exists or not).

These assays have several significant drawbacks that may affect their accuracy.

Disadvantages of conventional cytology and PCR smear:

  • A smear from the cervix is ​​taken with a flat brush and the material is “smeared” on the glass -
    • the doctor may not pick up cells from the entire surface of the cervix;
    • when applied to glass, a smear is obtained with an unevenly applied material (somewhere thicker, somewhere smeared), which does not allow a cytologist to fully examine it and evaluate all the cells obtained;
    • the glass with the smear applied can become “clogged”, which also affects the availability of evaluation of the obtained cells.
  • As a result, a PCR smear will show whether there is a human papillomavirus or not - that's all. That is, it cannot be used to judge the amount of this virus, and this matters.

Modern possibilities for assessing the condition of the cervix

Liquid Cytology

The essence of the method lies in the fact that the material is taken from the cervix using a special brush, which, due to its design, allows you to capture cells from the entire surface and cervical canal.

Next, the brush is immersed in a special container with a solution. This container is sent to the laboratory. All cells from this brush end up in a solution that is loaded into the apparatus. The material is processed in it, and after the cells are applied in a thin and uniform layer on the glass, which, after staining, is evaluated by a cytologist.

This approach allows us to consider all the cells obtained during the sampling of the material and fully evaluate them. This significantly increases the likelihood of accurate diagnosis of the state of cervical cells and not to miss their malignant transformation.

This method has two more important advantages:

  • Recall that the cells after sampling are in a special solution, where they can be stored for up to six months. Using this solution, you can also analyze for the presence of human papillomavirus by a quantitative method (Digene-test) - that is, to identify not only the presence of this virus, but also to find out its amount, and this is important when interpreting the results of cytological analysis and affects further tactics.
  • From the resulting solution with cells, one more important analysis can be done - the determination of a specific P16ink4a protein. The determination of this protein makes it possible to clarify the situation when detecting altered cells of the cervix. The detection of this protein indicates that the cell has serious damage, and there is a high probability of its malignant transformation. The absence of this protein indicates that the defect in the cells is not dangerous and the probability of malignant transformation is minimal.

Thus, three analyzes can be made from one material sampling and for this it is not necessary to come to the clinic several times and make an additional sampling. That is, if an analysis is taken from you only for liquid cytology and “bad” cells are detected, additional studies (determination of the amount of human papillomavirus and analysis for a specific protein) can be performed from the material already received, simply by additionally ordering these tests in the laboratory.

This triple test allows you to analyze the cells of the cervix with the highest possible accuracy at the moment and decide what to do next.

Such a test should be carried out not only for women who have already had changes in the cervix or who have been diagnosed with oncogenic types of human papillomavirus. This test should be performed prophylactically once a year, in which case you can be sure that you do not miss possible changes in the cervix.

In our clinic, such an analysis of cervical cells will be performed.

Prices:

  • Liquid cytology - 2500 rubles
  • Digene-test (quantitative determination of HPV) - 2500 rubles
  • Analysis for the presence of P16ink4a protein - 2000 rubles

Cervical cancer (cervical cancer) is a disease characterized by the appearance of a malignant neoplasm on the cervical tissue. In terms of prevalence, cervical tumors occupy one of the first places among oncological diseases in gynecology. That is why the early diagnosis of cervical cancer is an important issue for both professional oncologists and for every woman.

Stages of the tumor process

There are five stages of the process:

  1. Zero stage. The rate of distribution of atypical cells is approximately equal to the rate of their destruction.
  2. First stage. At this stage, the cancer penetrates into the stroma (skeleton) of the cervix. At the zero and first stages of the process, the detected cervical cancer can be cured by removing a small affected tissue area and concomitant conservative therapy.
  3. Second stage. At the second stage, the tumor process passes to the uterus, the surrounding tissue (parametrical cancer) or the vagina (usually 2/3 of the organ is affected).
  4. Third stage. The third stage is characterized by the continuation of the development of uterine, parametric or vaginal cancer: the lymph nodes and tissues of the small pelvis (including the kidneys) or the entire vagina are affected.
  5. Fourth stage. At the last stage, a malignant neoplasm grows into different parts of the intestine, the genitourinary system, metastases (secondary foci of the disease) spread throughout the body.

Stage zero cancer, also called carcinoma in situ, is characterized by the presence of abnormal cells on the surface of the epithelium that covers the cervix. Diagnosis of intraepithelial cancer mainly consists of color chemical tests, in which the pathologically altered tissue is stained differently than normal, and histological analysis of the surface fragment.

After penetration of atypical cells beyond the basement membrane, invasive cancer develops. Even in the early stages of the cancer process, the tumor is very sensitive to mechanical damage, therefore, when examined on mirrors, the cervix bleeds when touched. It is possible to detect the presence of cervical cancer at stage 0-1 only with regular visits to the gynecologist.

With an increase in the size of the tumor, the risk of its metastasis and germination in the surrounding tissues increases, therefore, it is necessary to diagnose the most likely sites of localization of secondary foci of cancer (lungs, liver, peritoneum), as well as a complete examination of the intestines and small pelvis.

Symptoms of cervical cancer

The list of symptoms of a cancerous process depends on the stage of its development. In the initial stages, the disease can proceed unnoticed or with rare non-specific manifestations. The main signs of cervical cancer include:

  • pinkish or brown discharge outside of menstruation, incl. after menopause;
  • minor bleeding during and after sexual contact due to damage to the tumor;
  • discomfort and pain during intercourse;
  • an increase in the duration, profusion and soreness of menstruation;
  • inflammatory processes in the mucous membrane of the vagina and uterine neck;
  • frequent urination (as a result of inflammation);
  • subfebrile condition;
  • watery or purulent discharge;
  • swelling of the lymph nodes.

The last two symptoms mainly appear not earlier than the 2nd stage of the process. The appearance of atypical secretions is associated with the decay process: a clear liquid is a sign of the disintegration of the lymphatic vessels adjacent to the layer of the affected epithelium, and purulent ones are a sign of the decomposition of the tumor tissue itself.

General signs of the presence of pathology in the body, as a rule, appear at later stages. These include loss of appetite, physical and nervous exhaustion (asthenia), weakness, hyperthermia. These symptoms are the result of intoxication of the patient's body with decay products of the cervical neoplasm.

In addition to these signs, in the later stages of cervical cancer, there are phenomena that accompany the growth of any tumor in the pelvic area:

  1. severe pain in the sacral, lumbar, anorectal or inguinal region (is the result of tumor growth to the nerve endings near the sacrum);
  2. difficulty urinating (observed with damage to the urinary system), blood in the urine;
  3. swelling (occurs due to squeezing of the lymph nodes);
  4. constipation (atony when the tumor spreads to the intestines) and blood in the stool.

Further growth of the neoplasm and metastasis to the liver, peritoneum and lungs provokes the appearance of new symptoms - constant pain in the abdomen, intense cough, and an increase in the size of the liver.

Methods for diagnosing cervical cancer

In the initial stages of cervical cancer, diagnosis is significantly complicated by the absence of obvious symptoms of the disease. Patients often do not show concern and do not pay due attention to their health, ignoring the need to undergo a gynecologist.

Cervical cancer is a rapidly developing disease, therefore, if any suspicious signs appear, it is necessary to visit a doctor as soon as possible and do not forget about regular preventive examinations.

The diagnostic process consists of several stages:

  • visual inspection.
  • Methods of hardware and instrumental diagnostics.
  • Laboratory research.

In the presence of a cervical tumor, during a visual examination, a certain nature of changes in the mucosa is noted: the endophytic form of cancer is manifested by ulcers of the external os of the cervix, and the stroma thickens and increases in size, and with an exophytic invasive cancer, scarlet bumpy formations and gray areas of necrosis are observed on the body of the cervix.

Examination is performed by the vaginal-abdominal (two-handed) method or with the help of gynecological mirrors.

To confirm the preliminary diagnosis and clarify the stage of development of the process, the doctor sends the patient to laboratory tests, hardware and instrumental diagnostics.

Instrumental diagnosis of cervical cancer

A fiberoptic probe called a hysteroscope is used to examine the vagina and cervix. The instrument is inserted into the vagina under local or general anesthesia, and through the probe, the doctor brings other instruments to the cervix that are necessary for sampling or surgical treatment.

If the cervical tumor is recognized as inoperable, then there may be a need for additional research methods - rectoscopy and cystoscopy. Such diagnostics allows you to accurately determine the depth of germination of the neoplasm in the urinary system (in particular, the bladder and ureter) or intestines.

During cystoscopy, a catheter is inserted into the urethra. No additional preparation, apart from daily hygiene, is required for the procedure. Rectoscopy is preceded by an enema.

Hardware methods for the study of cervical tumors

The most accessible method for the primary study of cervical cancer is hardware diagnostics - ultrasound. If a tumor process in the uterine neck is suspected, a comprehensive examination of the pelvic organs is prescribed.

CC is noticeable with any research technique - transvaginal, transabdominal or rectal, however, traditionally for ultrasound in such cases, a thin intravaginal probe is used, because. this technique does not require additional training.

The shape of the cervix, resembling a barrel, uneven contours, deviation from the normal position in relation to the uterus, and other signs may indicate the presence of a tumor process even at its initial stages.

Despite the widespread use of ultrasound as a method of primary diagnosis of cervical cancer, the most accurate research method that provides complete information about the location, configuration and spread of the tumor to neighboring tissues is tomography.

Magnetic resonance imaging allows you to get pictures of the tumor, to assess the volume and degree of damage to the pelvic organs. These parameters are taken into account when choosing a combination of treatment methods and the intensity of chemotherapy.

Spiral computed tomography is an X-ray method of examination. Contrast CT is necessarily prescribed when planning an operation and suspecting the spread of an oncological process to the lymph nodes. The location, shape and size of the tumor in all sections are necessary to assess the operability of the neoplasm.

Instead of CT with contrast, PET (positron emission tomography) can be used. In this research method, the role of a contrast agent is performed by fluoroxyglucose, which consists of a positron-emitting (radioactive) isotope of fluorine-18 and a monosaccharide, which is actively absorbed by malignant tumors.

The PET scanner registers energy emissions during the annihilation of positrons with tissue electrons and, using these data, reconstructs the location of the tumor into a three-dimensional model.

In the later stages of cervical cancer, osteoscintigraphy (radionuclide bone diagnostics), ultrasound of the liver and abdominal cavity, and radiography of the lungs are mandatory. They allow you to accurately determine the presence or absence of tumor metastases in the relevant organs and systems.

Laboratory studies in the diagnosis of cervical cancer

Cancer screening is widely used in medical practice. A smear for laboratory analysis for atypical cells is taken directly during a gynecological examination and does not cause pain due to the absence of nerve endings on the cervix.

A deeper and more accurate method is the study of a smear taken during colposcopy. Before determining cervical cancer, the doctor performs not only a visual examination, but also a biomaterial sampling using a deeply inserted device - a colposcope.

If screening is desirable in the middle of the menstrual cycle, then the interval between menstruation and egg maturation (i.e. the first half of the cycle) is optimal for colposcopy.

With the help of instrumental methods, not only smears are taken for analysis, but also individual pieces of tissue for biopsy. This laboratory method allows you to accurately diagnose the degree of malignancy of the cervical neoplasm.

In addition to a colposcope and a manipulator, a radio wave knife, a curette, liquid nitrogen, and a loop instrument (rarely used due to the traumatic nature of the technique) can be used to take biomaterial.

Mandatory laboratory tests that are prescribed for suspected cervical cancer are also a blood test for the human papillomavirus and determining the level of concentration of a tumor marker associated with uterine tumors.

Before recognizing the presence of a virus, a biomaterial is taken. For women, the procedure involves inserting a soft brush into the vagina and scraping material from the surface of the cervix. The imprint of the tool is examined under a microscope for microorganisms, and the brush itself in a sealed container is sent to a virological laboratory for analysis for HPV.

Among tumor markers, the most specific and informative are squamous cell carcinoma antigen (SCC), tissue polypeptide (TPS), cancer embryonic antigen (CEA) and CYFRA-21-1.
The concentration rate of the main oncomarker used in cervical cancer - SCC - is 2.5 μg / l.

Exceeding this indicator in more than 80% of cases indicates the presence of an oncological process.

Analyzes of SCC and CEA concentration levels are also used to monitor the effectiveness of treatment, to determine metastases and recurrences of cervical tumors.

A professionally performed comprehensive diagnosis ensures an earlier start of therapy and thus increases the chances of survival for the patient. A complete cure for cervical cancer is possible with a careful attitude to one's health, regular check-ups and following the recommendations of the attending physician.

Cervical cancer is a malignant tumor that develops in the lower part of the cervix.

According to statistics, this disease ranks third among all cancers in terms of prevalence among the female population of the planet.

Etiology and clinical picture

As with other cancers, it is not possible to determine why cancer occurred. In absolutely equal conditions, one woman can develop cancer, while another does not. Perhaps the reason lies precisely in genetics and the individual characteristics of the body.

According to statistics, it was revealed that women with cervical cancer have always been carriers of the human papillomavirus or HPV for short.

After numerous tests and diagnostics were carried out, which included scraping, a blood smear for oncology and cancer cells, it was concluded that HPV became the main conditions for uterine cancer.

This virus is transmitted mainly through sexual intercourse during sex without a condom, however, it was also found in those girls who had not yet had sex.

But if a blood test and a smear for oncocytology were performed, and the transcript showed the presence of HPV in the body, this does not mean that cancer is present.

You should not be so afraid of this, because infections caused by papilloma in most cases can go away on their own without medical intervention.

The exception is one tenth of infected women, in whom papilloma slowly develops into dysplasia, which later becomes an oncological disease.

Here are some of the factors that can cause the development of cervical cancer:

If a woman has one or more of these factors, it is impossible to give a 100% guarantee that cancer will develop, but because of the significant risk, it will be better to take a blood test and a scraping or a smear for oncology and cancer cells.

This type of cancer at the initial stage goes mostly without symptoms and is not noticeable to the woman herself until the following signs appear:


Despite the presence of other symptoms, the main phenomenon indicating the appearance of such cancer in a woman is still the discharge of blood immediately after sex.

If this happens, you must immediately take tests, including scraping and a smear for oncology.

It is also necessary to decipher the blood test for cancer cells. Allocations do not necessarily indicate cancer, but it is necessary to check to maintain your female health.

How is this type of cancer diagnosed?

In the process of a simple examination by a gynecologist, cancer can go unnoticed. To make sure of the diagnosis, you need to take a smear or scraping for oncology.

In medicine, with the help of screening examinations, the number of late cases of diagnosis of this type of cancer has been significantly reduced. This type of examination includes the diagnosis of HPV, scraping and smear, or as it is also called the Pap test.

Scraping and smear analysis help to diagnose cervical cancer with high accuracy, which is why WHO strongly recommends doing a smear for oncocytology throughout your life.

A smear should not be done for those who have not reached the age of twenty-five; a smear analysis is performed from twenty-five to twenty-nine years once every three years.

From thirty to sixty-five years, a smear analysis for cytology and an analysis for HPV is performed once every five years. If the age has reached sixty-five, and all tests before that showed a negative result, a scraping or smear for oncology can no longer be performed, since the risk of cancer at this age is extremely low.

A smear test can be done at any hospital or clinic. This simple smear has saved many women's lives by revealing a precancerous condition of the uterus, which at this stage is very successfully treatable.

If the results of a smear or scraping show unwanted changes, the doctor prescribes another test for cervical cancer:


You need to understand that this marker does not always indicate uterine cancer. It may indicate cancer of the vulva, vagina, or esophagus.

But if the diagnosis is confirmed, this marker can be used to predict the disease. You can confirm the diagnosis by performing a scraping and analysis of a smear for oncology.

After the diagnosis is confirmed, the attending physician may prescribe additional types of tests, such as:


Despite the severity of the disease, today there is an opportunity to prevent it. To significantly reduce the risk of cervical cancer in the future, the fair sex needs protection from HPV, which is the main cause of this type of cancer.

To do this, in modern medicine there are several types of vaccinations that are aimed at instilling immunity from this disease so that in the future the papillomavirus cannot settle in the human body.

Diagnosis of cervical cancer is an important step before starting treatment, because the earlier the pathology is detected, the greater the likelihood of a positive outcome from therapy. The accuracy of diagnostic procedures largely depends on the availability of the organ for examination. Regarding the cervix, it gives access to a comprehensive examination of it.

The last twenty years have radically changed the methods of detecting the disease. Previously, the development of cervical cancer was assessed based on the history of the disease and a clear, pronounced clinical picture. Unfortunately, such manifestations occur already at advanced advanced stages, so such a passive diagnosis is considered ineffective for further treatment.

Currently, the main task of diagnostic procedures is to identify the disease in women who do not yet have any specific symptoms and consider themselves to be absolutely healthy. In this case, it is possible to detect a tumor at the first and even zero stage, when pathological changes are at the cellular level and are not visible to the naked eye. For this, a number of modern diagnostic methods are used to identify the initial stages of the tumor process.

History of pathology

The diagnosis of cervical cancer is established after a whole range of procedures, both instrumental and laboratory. In addition to them, the doctor collects an anamnesis of the disease. If the patient applied at an early stage, the symptomatology, as a rule, is absent or exists, but characterizes another, precancerous disease.

Characteristic changes that may appear at an early stage are unusual leucorrhea, often milky or brownish in color, sometimes with an admixture of blood. Also an important symptom in the anamnesis is bleeding outside the menstrual cycle. In 73% of cases, abnormal bleeding is a sign of cancer. In the remaining 17% - it can be dysplasia, erosion and other pathologies of the female genital organs.

A routine examination by a gynecologist with the help of mirrors is considered uninformative, since it is possible to identify a seal or ulcer on the epithelium of the walls of the cervix only in a running process.

Colposcopy and its types

Colposcopy of cervical cancer is considered an affordable and informative diagnostic method. The study allows:

  • identify and separate the modified epithelium from the healthy one;
  • outline the exact location of the pathological focus;
  • distinguish a benign tumor from a malignant neoplasm;
  • allows you to take a targeted smear for cervical cancer and a biopsy to improve the accuracy of cytological and histological analysis.

Colposcopy can be of two types:

  • simple, without the use of medications, serves to diagnose an indicative nature;
  • extended, it is characterized by the use of 2% Lugol's solution and 3% acetic acid. The advanced method allows you to get a clearer and more accurate picture.

An advanced procedure is chromocolposcopy. The method is characterized by the use of nuclear stains such as 0.1% hematoxylin or 1% goluidine blue. Cancer cells are distinguished by polyferative activity, as a result of which pathological tissues acquire a dark blue color.

Cytological examination

Cytological screening for cervical cancer is an important test at an early stage of the disease. The method allows to detect cancer cells at the very beginning of malignancy even before the onset of visual changes on the epithelium of the cervical walls.

Cytology of the cervix allows not only to determine the presence of a malignant process with an accuracy of 96%, but also to determine:

  • degree of differentiation;
  • histological form of the tumor;
  • stromal reaction.

Cytological examination is highly informative at preventive examinations and is able to detect not only the presence of oncology, but precancerous pathologies.

Histological and morphological examination

It is important in the accurate diagnosis and identification of the shape and composition of the tumor at different locations. A sample of pathological tissue can be taken in various ways, but the study is reduced to identifying the histological and morphological composition of the formation.

A histological analysis for cervical cancer is usually performed at the end after all the necessary procedures and is a clarifying examination.
It is important that it is carried out precisely, that is, exactly the pathological tissue is taken for analysis, because the result of the study depends on it.

tumor markers

A blood test for cervical cancer does not have a high information content at stages 3 and 4 of the disease. At an earlier stage, information content is reduced. In more than 90% of cases, squamous cell carcinoma is detected. For its diagnosis, it is used for cervical cancer - SCCA. This antigen is the most informative for assessing the effectiveness of treatment, prognosis and the possible occurrence of relapse.

The sensitivity of the SCCA tumor marker depends on the stage of the pathology:

  1. 1 - up to 47%;
  2. 2 - up to 67%;
  3. 3 - up to 83%;
  4. 4 - up to 84%.

With a recurrence of the pathology, the blood in cervical cancer with the SCCA tumor marker is positive in most cases up to 90% and is ahead of the appearance of symptoms in the progression of oncology.

Instrumental techniques

In addition to the studies described, instrumental methods are prescribed. Cervical cancer on ultrasound is uninformative, especially in the early stages of the disease. Ultrasound can detect a malignant process only if there is invasion on the walls of the cervix and pronounced signs of a tumor.
More informative instrumental methods are CT and MRI, in particular, the latter method provides the most extensive information. A layer-by-layer section of the cervical tissue allows you to clearly examine the pathological tissue, clarify its size and the exact location.

New Developments in Cancer Diagnostics

Histochemical examination of the epithelium of the cervix allows you to identify the disease even at a precancerous moment. Such examination allows to reveal metabolic changes in tissues. Also, one of the innovative and promising methods is mitotic research. Mitosis is the main method of cell reproduction. Therefore, the technique allows you to determine changes at the gene, molecular level. Since with the development of oncology there is a sharp violation of the metabolism of nucleoproteins, which occurs long before the appearance of morphological signs of malignancy. Thus, the procedure should help detect atypical cell division even in a precancerous state.

Conclusion

Modern diagnostic techniques make it possible to detect oncological lesions of the cervix at the earliest stages. The main task for all women is the systematic visits to the gynecologist and the passage of a cytological examination for prevention. If the cytological analysis aroused suspicion in the doctor, other more extensive studies will be prescribed. The described set of diagnostic procedures will allow you to identify the disease at the first or even zero stage and start emergency treatment. Women who discovered cancer in the first stage and followed all the doctor's recommendations for treating the disease overcame the disease in more than 90% of cases.