What is downstaging in the CA cervix
Cervical Cancer: Symptoms & Vaccination
Last Updated on: 26th June 2020, 02:49 pm
cervical cancer (also Cervical cancer) is the only form of cancer against which it is there is a vaccination. But even women who have not been vaccinated in time can protect themselves by regularly taking the for early detection important Pap smear have it carried out. We have researched what symptoms Cervical cancer triggers what signs you your Gynecologist should seek out, and how that Chances of recovery look for cervical cancer.
Table of Contents
Cervical Cancer - What Is It?
Cervical cancer, too Cervical cancer, Cervical cancer or Collum carcinoma called, is onemalignant cell growththe mucous membrane in the cervix. In most cases it is triggered by an infection with the so-called HP viruses (HumaneP.apilloma (a)V.iren). The Average age for women with cervical cancer is included 54 years. Cancer of the cervix is therefore more common than average to menopause.
Where does cervical cancer arise?
Cervical cancer develops superficial cells of the cervix (Cervix). This is the part of the uterus that protrudes into the vagina with the external cervix and that "lowers" a little every month in preparation for your period. In advanced stages, the cancer can even be found on the cervix feelbecause the cervix, which is usually a smooth surface and in most women can be completely covered with the fingertip, yourself changed.
Cervical Cancer - How Do You Get It?
The most common cause of cervical cancer ischronic infection With human papilloma (a) viruses, also called HPV for short. Of the approx. 120 known HP virus strains, around 30 can attack the urinary and reproductive organs of humans. Here one subdivides again into High-risk and low-risk viruses. The majority of all cases of cervical cancer go on High risk viruses, above all HPV 16 and 18, more rarely 31, 33, 45, 51, 52 and 56 back. Low-risk viruses such as HPV 6 and HPV 11, on the other hand, trigger genital warts (condylomas).
Who transmits cervical cancer?
Human papilloma (a) viruses, the main cause of cervical cancer, are exclusively caused by direct body contact, usually sexual intercourse. You get over smallest skin or mucous membrane injuries into the body and can be transmitted even if the couple is using a condom. Both women and men can be carriers if they are infected with HPV themselves. The infections mostly happen between the 20 and 25 years of age.
The infection mustdoes not necessarily lead to cervical cancer to lead. Because the immune system often manages to fight the viruses so that they can no longer be detected after a year. During this time, however, the viruses can already Trigger cell changesthat can be detected by a cancer smear.
Cervical Cancer - How Fast Is It Growing?
The development of cervical cancer often takes a long time. Whereby the tissue usually characteristic precancerous stages, so-called cervical intraepithelial neoplasia (CIN). Often times pass between the infection causing the disease or the preliminary stages and the development of the tumor up to ten years.
Cervical Cancer - Who Is At Risk?
Cancer of the cervix can only affect people with female anatomy develop. The Main trigger for cervical cancer is one HPV infection, but there are also other factors that increase the risk of the disease. For example, studies have shown that women who have had other sexually transmitted diseases such as B. Chlamydia, genital herpes, have an increased risk of developing cervical cancer. Other Risk factors are:
- frequently changing sexual partners
- early sexual activity above average
- an above-average number of pregnancies
- Taking the pill for a very long time
- Taking ofImmunosuppressants(Suppression of the immune system)
- Immunodeficiency (e.g. a HIV-Infection)
- inadequate hygiene in the genital area
Cervical cancer vaccination
The earlier the cancer-causing cell changes in the cervix are recognized, the better the chances of recovery. But it doesn't have to get that far: In Austria there are currently three vaccines against HP virus, the leading cause of cervical cancer, are available.
For girls and boys between nine and eleven years is vaccination free, between twelve and fifteen it can be made up for at a small cost, which varies from state to state. By the way, immunization against the cancer-causing viruses must be carried out not necessarily happen before the first sexual contact.
Who vaccinates against cervical cancer? Vienna
Women and men who were not vaccinated against human papillomavirus in childhood can do so too catch up in adulthood. It is best for women to see a gynecologist and men to see a general practitioner (family doctor). But be careful: not all general practitioners offer immunization. The followingGynecologists and general practitioners in Vienna offer the vaccination against cervical cancer:
Cervical Cancer Symptoms
The tricky thing about cervical cancer is that it is in the early stages of the disease no or just a lot unspecific symptoms caused. The precursors of cervical cancer, so-calledcervical intraepithelial neoplasia (CIN), often in very young women. For this reason, you should conscientiously follow the check-ups at your gynecologist, including cancer screening (PAP smear).
Develop symptoms typical of cervical cancer, such as vaginal bleeding outside of your period, discharge that smells unpleasant, and / orPain in theLower abdomen or at theLumbar spine, the disease is often at an advanced stage.
Where Does Cervical Cancer Spread?
In the first stage, the tumor is limited to the uterus. From the second stage, the cancer can spread into the vagina and up to the pelvic wall, and later spread to the ureter, bladder and rectum. TheTumor classification alias Staging usually happens after TNM system. T stands for the extent of the tumor (T1 to T4), N for lymph node involvement (N0 to N3) and M. for metastases (M0 or M1). For gynecological tumors there is also the so-called FIGO classification (International Federation of Gynecology and Obstetrics), which practically corresponds to the TNM classification.
|I.||The tumor is limited to the uterus.|
|II||The cancer grows into the surrounding connective tissue, but not up to the pelvic wall. And / or into the vagina, but not into the lower third of the vagina.|
|III||The tumor spreads to the pelvic wall and / or the lower third of the vagina. Or constricts a ureter.|
|IV||The cancer spreads to the bladder or rectum or extends beyond the confines of the pelvis. Or it forms metastases in other organs.|
A metastasis from cervical cancer on the Lymphatic path occurs quite early and mainly in the pelvic connective tissue and the pelvic lymph nodes. Later, the tumor also spreads cancer cells over the Bloodstream mainly in the Liver, lungs and ins skeleton.
Cervical Cancer - How Do You Know?
When it comes to cervical cancer, don't rely on your feelings, because in the early stages, this type of cancer is pretty much the cause no symptoms. The only way to detect cervical cancer before it's too late is by regular cancer smears, also PAP test called. During this examination, the gynecologist removes the vagina after painless stretching through a specula (hand mirror) with a small brush, spatula or cotton swab superficial cells from the cervix and cervix. They are examined in the laboratory to detect any deviations from the normal cell picture.
A distinction is made depending on the severity light (CIN I) and moderate (CIN II) dysplasiawhich in the vast majority of cases regress by themselves as well as severe dysplasia (CIN III)that lead to invasive cancer in 70 percent of all cases.
If the PAP smear shows abnormalities, it can be useful to check, if one Infection with human papillomavirus is present. The combination of virus detection, gynecological findings and PAP smear results helps to assess the risk of cervical cancer on an individual basis.
Cervical cancer PAP 1 to PAP 5
The at Cancer smear removed Cells will be depending on your Appearance in groups classified asPAP 0 to Vdesignated. The appearance of the cells reveals whether or how much they have changed towards cervical cancer. The further diagnostic and therapeutic procedure depends on the determined group.
|PAP||Finding||Consequence / treatment|
|0||can not be assessed||Repeat in 2 weeks|
|I.||no abnormalities, normal according to age||Repeat the check in a year|
|II||harmless inflammatory changes||Check-up in six months to a year|
|III||stronger inflammatory / degenerative changes||Repeat smear, HPV test, colposcopy, possibly biopsy|
|III D||Dysplasia: slight to moderate changes||Repeat smear, colposcopy, possibly biopsy|
|III G||abnormal gland cells||Colposcopy, curettage, vaginal ultrasound, biopsy|
|IV a||moderate / severe neoplasia or carcinoma in situ||Colposcopy with biopsy, conization|
|IV b||severe neoplasms, possibly invasive carcinoma||Colposcopy with biopsy, conization|
|V.||cervical cancer||Immediately colposcopy, biopsy or curettage|
A conspicuous cancer smear is not always a cause for panic. He can go through a infection should have come about, which would have heard treated before the evaluation of the smear. It can also be used when performing the smear or in the laboratory error happened. Or it is slight cell changes such as cervical intraepithelial neoplasms.
Suspected cervical cancer - what happens next?
If precancerous or cervical cancer is suspected, the cervical cells still need to be used to confirm the diagnosis Under the microscope be assessed histologically (tissue). For this purpose, a small, special pair of pliers is used biopsy (Taking a tissue sample) at the suspicious point. The findings reveal the severity of a preliminary stage or what type of cervical cancer is present.
If a targeted biopsy is not possible, e.g. because the changes are in the invisible part of the cervical canal, a so-called diagnostic conization respectively. This is the term used to describe the cutting out of a conical piece from the cervix for the purpose of histological assessment. She will mostly be with a curettage (Scraping) of the cervix combined.
Diagnosis of cervical cancer
If the diagnosis is cervical cancer, the first thing to do is to determine at what stage the cancer is located. Because the Form of therapy depends on how big the tumor is, how far it has spread and whether it has already spread cancer cells to lymph nodes and / or other organs. For this so-calledStagingare further investigations required such as
- a transvaginal ultrasound.
- a Computed tomography (CT) of the chest and abdomen.
- a magnetic resonance imagingof the pelvis to assess the size of the tumor and its relationship to neighboring organs.
- an ultrasound scan of the kidneys and liver
- a chest x-ray.
- a Blow- or. Colonoscopy to clarify whether the cervical carcinoma has grown into the bladder or rectum.
- a determination of so-called Tumor markers such as tumor antigen SCC (squamous cell carcinoma antigen, squamous cell carcinoma antigen), CEA (carcinoembryonic antigen), CA 125 (cancer antigen 125) or NSE (neuron-specific enolase).
- Blood tests to assess the general state of health and organ functions (e.g. kidney values).
Cervical Cancer - Where Does Pain?
Pain usually only causes cervical cancer in the later stagesif the tumor is very large and / or has already affected neighboring structures and / or organs. Typical of cervical cancer are vaginal bleeding and / or spotting that independently from the menstrual period or during menopause e.g. B. occur after sexual intercourse, cycling or hard bowel movements. Other symptoms of advanced cervical cancer include:
- slimier, purulent or malodorous discharge out of the vagina
- Pain in the Lower abdomen or at the Lumbar spine in advanced cervical cancer
- Changes in urine or stool, constipation or pain when urinating and very advanced bowel movements when the cervical cancer invades surrounding organs
- an unexplained weight loss
- Leg swelling noticeable on one or both sides
Cervical Cancer - What Is Done?
The choice of therapy for cervical cancer depends on the Disease stage, the age and other health status of the patient and, if possible, also takes into account whether a Desire to have children consists. In the early stages, experts recommend one surgery, a combination of in advanced cervical cancer Radiation and chemotherapy.
Operate on cervical cancer
The operation is all in one for cervical cancer early stage the best option, because in most cases it is a complete removal of the entire tumor tissue can be reached. Which method is used depends primarily on the spread of the tumor.
If the detected neoplasms are already in a more advanced stage and / or they do not regress, a Conization carried out. Likewise with smaller tumors. The gynecologist removes a conical part of the cervix. With a hem made of healthy fabric for safety. In addition, there is a curettage the cervix to make sure cancer cells are not left in the cervix.
If a conization is not sufficient to remove the entire tumor tissue, a so-called Trachelectomy to debate. The gynecologist removes a large part of the cervix, but leaves the body of the uterus and the top 5 mm of the cervix.
Hysterectomy for cervical cancer
For larger tumors that already have the entire uterus affected the organ usually has to be completely surgically removed. If the carcinoma is far-reaching, a so-called radical hysterectomy (Wertheim-Meigs operation), in which additional parts of the vagina or the retaining straps of the uterus are also less common Ovaries and fallopian tubes removed become.
Cervical cancer chemotherapy
Chemotherapy hardly plays a role as the sole treatment for cervical cancer, but it is becoming Therapy of relapses (Relapses) used. Especially when Metastases are present, because the cytostatics used to do this reach cancer cells throughout the body. However, since they act on all rapidly dividing cells, they damage not only tumor cells, but also healthy tissue.
Even if the cervical cancer advanced and inoperable chemotherapy can be used to shrink the tumor. This Downstaging can improve conditions before surgery.
Radiation therapy for cervical cancer
Radiation therapy is used when a Operation not possible or not useful is (e.g. due to poor health). Radiation therapy is used to slow down tumor growth, prevent further spread and improve quality of life. You can reduce pain or vaginal bleeding with radiation.
In addition, the so-called adjuvant radiation therapy is carried out following an operationto get one long-term treatment successto achieve a cure, at best, by destroying cancer cells. The high-energy (ionizing) rays damage the nucleus of the cells so that they no longer divide, i. H. cannot reproduce.
In advanced stages, cervical cancer can also be treated with radiation therapy alone. The larger tumors that spread to adjacent tissue receive a combination of external radiation (Teletherapy) and indoor irradiation (Brachytherapy) by means of a radiation source inserted into the vagina.
Pregnancy despite cervical cancer?
Interventions such as conization or trachelectomy usually do not limit the possibility of having children. However that is Risk of premature birth elevated. However, if the entire uterus had to be removed, pregnancy is of course no longer possible.
Radiation and chemotherapy also has an effect on fertility, because the treatments attack healthy cells as well as tumor tissue. For example, you can use the Functionality of the ovariesaffect. The resulting lack of hormones can trigger premature menopausal symptoms such as hot flashes or sleep disorders in younger women.
Artificial insemination after therapy
Women diagnosed with cervical cancer who do not need a hysterectomy have the option of opting for it before start chemotherapy and / or radiation therapy remove healthy egg cells and let them freeze (cryopreserve). Artificial insemination then takes place after the (successful) treatment.
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