Cervical cancer is a disease that can be completely preventable in case of timely detection and treatment of prenatal conditions and can be well managed in early stages of the disease.
Cervical cancer is characterized by the following symptoms:
- blood transfusion after sexual intercourse
- non-menstrual bleeding from the genital tract
More than 80% of new cases are diagnosed in women who live in economically disadvantaged conditions.
Cervical cancer grows locally and spreads to paracervical and pelvic tissues, regional lymph nodes, and only later forms metastases to distant structures. The most common histologists in the cervix are flatulence and glandular cancers.
Microinvasive cervical cancerStages
IA1 and IA2 can be determined only from the data obtained during conization, if there are negative lines of cut, as well as trachektomy or hysterectomy material.
In the case of IA1, the recommended treatment is total abdominal or vaginal hysterectomy.
If vaginal intraepithelial neoplasia is detected at the same time, the corresponding vaginal border should also be checked during surgery.
If the patient wants to maintain reproductive function, conisation of the cervix is allowed, followed by an oncological examination after 4 and 10 months. In the future, oncocytological examination can be repeated once a year, if the previous two oncocytopoies are in normal rage.
In the case of stage IA2, there is an increased risk for lymph node metastases, therefore lymphadenectomy should be included in the treatment protocol. The recommended treatment is modified radical hysterectomy (type 2) and pelvic lymphadenectomy. If there is no involvement of the lymphocytic space, the question of a simple hysterectomy with pelvic lymphadenectomy can be considered.
If the patient wants to maintain the reproductive function, the following options are acceptable:
Large cystic cone with laparascopic pelvic lymphadenectomy, or
radical tracheotomy with laparascopic pelvic lymphadenecotomy
Invasive Cervical Cancer
The choice of treatment method will depend on the available resources, the involved oncologist, the patient's age and overall health status. It is desirable that the question of treatment tactics is taken in the form of multidisciplinary discussions and the patient should be informed about possible treatments including their toxicity and the expected results.
Complications are more common when surgical treatment is combined with radiotherapy.
In order to reduce the risk of possible complications, treatment should be planned in such a way to avoid the need for both methods of the treatment.
Standard treatment in the case of IB1 / IIA1 is a modified radical hysterectomy or radical abdominal hysterectomy (2nd and 3rd grade by Piver-Rutledge class), which includes pelvic lymphadenectomy.
Younger patients may retain ovaries and may carry out transplantation outside the pelvis if it is suspected that a patient will need radiation therapy in the postoperative phase.
In some cases, radical hysterectomy can be performed transvaginally in combination with laparotypic pelvic lymphadenectomy.
The risk of recurrence following a radical operation is higher for patients with positive lymph nodes, and in cases where the tumor is detected in a parameter or surgical line. In these cases, better results are obtained if the patient had chemotherapy at the same time as radiotherapy after surgery.
Similarly, the risk of relapse is increased also in cases where there is no involvement of the lymph nodes but a primary tumor or tumor in the lymph node, or tumor intrusion in the cervical stroma external third.
Total adjuvant pelvic space reduces the possibility of local relapse and extends the disease-free interval as compared to non-adjuvanted radiotherapy patients. Radiation therapy is particularly well suited for patients with adenocarcinoma or adenoscopes morphology tumors.
Primary treatment options:
- Primary radiation chemotherapy;
- Primary radical hysterectomy and bilateral pelvic lymphadenectomy, usually followed by adjunctive therapy;
- Neoadjuvant chemotherapy (three platinum-based chemotherapy treatments) with sequential radical hysterectomy and pelvic lymphadenectomy ± adjunctive therapy or chemoradiotherapy
Cervical cancer during pregnancy
Generally, cervical cancer treatment during pregnancy is subject to general cervical cancer treatment principles. In case of pregnancy, care must be taken to minimize cervical conizza as there is a higher risk of bleeding, spontaneous abortion and premature birth. The treatment tactics should be decided by the involvement of both obstetricians and neonatologists in the discussion. Treatment plans can only be approved after a joint discussion with the patient and her husband, their wishes must be respected.
For pregnant women with suspected microinvasive cervical cancer, the wait-and-see treatment tactics do not play a decisive role in the future prediction of maternal health, but such tactics can significantly improve the viability of the fetus.
A patient with confirmed stage IA1 during cervical conization and with a clear retinal line can be observed until the end of pregnancy and vaginal delivery is allowed for those patients. There is currently no evidence that vaginal birth affects the outcome of a patient with microinvasive cancer. A woman with a tumor at IA2 or at a higher stage of the treatment is individualized and depends on the stage of the illness and the time of pregnancy. To prevent the spreading of disease is indicated MR.
If the diagnosis is determined by the 20th week of pregnancy, the illness can be treated without any waiting. In such patients, can start radical hysterectomy and pelvic lymphadenectomy when the fetus remains in the womb. Spontaneous abortion is usually expected during treatment with patients undergoing radiation chemotherapy as the basic treatment.
For women who are diagnosed with the disease after the 28th week of pregnancy, it is recommended to postpone the treatment until the fetus is mature. If the disease is detected between the weeks 20 and 28, the tactic of waiting is acceptable in the IA2 and IB1 stages without any significant effect on the disease prognosis. In the case of later stages, delay in treatment has shown to worsen the prognosis of treatment.
In addition to the above, there is so far no direct definition that determines whether tolerable tactics are acceptable.
The routine of daily waiting tactics should be determined by the clinical stage of the disease and tumor morphology, the time of pregnancy at the time of diagnosis and the wishes of the parents regarding the expectant baby.
If a delayed treatment tactic is planned for a patient with a locally advanced tumor, the question of prescribing neoadjuvant chemotherapy to prevent tumor progression should be considered. Clinical observation of the patient is essential for non-adjuvant chemotherapy. Pregnancy should be resolved no later than the 34th week of pregnancy.
Unless the tumor is excited during cones, the recommended method of resolving pregnancy is a plan for cesarean surgery, although individual studies indicate that vaginal delivery does not reduce the disease's prognosis.
