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Cervical cancer (cervical cancer) or cervical cancer is an oncological pathology affecting the lining of the cervix.
Varieties of RSM
According to histological signs, two types of RSM are distinguished:
- squamous cell carcinoma (occurring in 70-80% of cases) and
- adenocarcionam (diagnosed in 10-20% of women).
In isolated cases, rare forms of oncology are detected in patients, for example, neuroendocrine cervical cancer or mucin-producing cancer. Despite the fact that these cancers are detected extremely rarely, they pose the greatest danger to health, as they are characterized by a high degree of aggressiveness.
Symptoms
The presence of a pathological process in the body can be suspected according to the following symptoms: with cervical cancer, bloody discharge is observed between menstruation (after sexual contact or spontaneous), heavy bleeding, the appearance of specific daily vaginal discharge accompanied by a putrid smell is possible.
Mortality
As of 2022, in most cases, cervical cancer is diagnosed at stages 1-2, but in 40% of women the disease is detected at stages 3-4, while the five-year survival rate of patients with stage 1 oncology is 87%, with stage 3 - 43%, and with 4 - 7%.
Spread of the disease
In Russia
2021
As of 2021, about 44,000 women die from cancer of the reproductive system in Russia every year.
In total, in 2021, more than 15 thousand cases of the disease were detected in Russia - in about 14 per 100 thousand women of different ages.[1]
countries CIS In Russia, the incidence rates of cervical cancer uterus are still kept at a high level, this is also due to the lack of awareness of the country's residents about the methods of prevention and screening, noted in the Fund medical for Decisions "Not in Vain."
2018
Cervical cancer (cervical cancer) ranks second in incidence among women from 30 to 59 years old in Russia. According to the statistics of the Ministry of Health of the Russian Federation, 17,766 cases of cervical cancer were detected in 2018, which is 22.3% more than in 2008 (13,807 cases), [2]
The average age of patients with cervical cancer (cervical cancer) in Russia is 52 years. In 2018, RSM became the main cause of mortality in Russia in women in the age group of 30-34 years. The mortality rate during the first year from the moment of diagnosis is more than 20%, i.e. almost every fifth sick woman dies from RSM during the first year. Professor Yulia Payanidi, an obstetrician-gynecologist and oncologist of the highest qualification category of the N.N. Blokhin National Medical Research Center of Oncology, spoke about this at an interregional interdisciplinary scientific and practical conference in 2021.
"The incidence of cervical cancer in Russia is one of the highest in Europe, in 2019 more than 17 thousand new cases of this disease were detected. There is an increase in the number of cases aged 20 to 40 years, every third patient is diagnosed with the disease in the advanced stage, "said Galina Nikolaevna Minkina, Professor of the FSBEI HE" Moscow State Medical and Dental University named after A.I. Evdokimova "Department of Obstetrics and Gynecology of the Faculty of Medicine, Doctor of Medical Sciences, gynecologist of the highest category.
In the world
2021
Cervical cancer ranks first in the world in frequency among malignant gynecological diseases and fourth among all tumors in women.[3]
2020
Every year, 12.7 million patients with newly diagnosed malignancies are registered in the world, and 1.2 million of them are diseases of the reproductive system. According to WHO, more than 529.4 thousand newly ill cervical cancer are detected in the world annually and 274.9 thousand die from this disease.
In 2020, 59,600 women died of cervical cancer in China alone, according to the World Health Organization (WHO). During the same period, 109,741 new cases of the disease were detected in the country.
As of 2020, cervical cancer ranks 2nd most common among all cancers of the reproductive system, second only to breast cancer. Every year around the world, cervical cancer causes the death of more than 300 thousand women.
It is also the fourth most common cancer among women worldwide. In the absence of additional measures to tackle cervical cancer, the annual number of new cases between 2018 and 2030 is expected to rise from 570,000 to 700,000 and the annual number of deaths from 311,000 to 400,000. In addition, in low- and middle-income countries, morbidity is almost twice that, and mortality is three times that of high-income countries.
Causes of the disease
The main trigger for the development of cervical cancer in 2022 is considered to be the human papillomavirus (HPV). HPV serotypes 16 and 18 have the greatest degree of oncogenic risk, they are found in 95% of patients with cervical cancer.
Another provoking factor in the development of cervical cancer is other sexually transmitted infections, such as chlamydia, genital herpes, and HIV.
In addition, genetic predisposition, age over 40, early onset of sexual life (up to 16 years), frequent change of sexual partners, numerous births, frequent abortions, neglect of barrier contraception, oral contraceptives or immune suppressive therapy (in the treatment of cancer and autoimmune diseases), smoking, including increase the risks of cervical cancer.
Association of disease with papillomaviruses and tobacco smoking
From 50 to 80% of women with diagnosed cancer are infected with the human papillomavirus. This is one of the oldest viruses, more than 200 varieties of it are known.
The human papillomavirus bypasses the immune system and participates in the carcinogenesis of a number of organs of the female reproductive system. The highest susceptibility to papylomovirus infection in squamous epithelium-coated organs.
 | "The presence of human papillomavirus alone for high oncogenic risk is not enough. It is also necessary to have risk factors - a sedentary lifestyle, poor nutrition, bad habits, among which smoking is especially distinguished, "said Yulia Payanidi, professor at the Department of Obstetrics and Gynecology of the Russian National Medical University named after Pirogov of the Ministry of Health of Russia |  |
Smoking, she said, is one of the key risk factors that can "push" papillomavirus to start expressing cells that cause malignancies. In addition, in 34% of observations in women who smoke, cervical cancer was combined with lung cancer.
| | "Smoking causes cancer not only in the respiratory system, tobacco smoke affects the metabolic activation of carcinogens throughout the body. Tobacco smoke contains benzapyrene, which accumulates in the colon. Smoking can also cause carcinogenesis in organs not exposed to tobacco smoke, so carcinogens can also be found in the cervix. At the same time, it is important to understand that nicotine, as a plant alkaloid, is not a carcinogen, "said Julia Payanidi. | |
According to the professor, patients who continue to smoke during the period of radiation therapy are 3 times more likely to have complications in the small intestine. Smoking also negatively affects the pharmacokinetics of chemotherapy, reducing its effectiveness. Smoke components can cause complications during operations. However, 80% of cancer patients continue to smoke even after diagnosis.
Disease prevention: vaccination and screening
Source: wiki.nenaprasno.ru
Since cervical cancer is one of the forms of neoplasms that can be detected in the early stages, one of the preventive measures may be population screening. The most effective for 2020 is the screening of women from 25 to 65 years old annually. As well as vaccination against human papillomavirus (HPV) before the beginning of sexual life. In Iceland, for example, thanks to such measures for 40 years, the mortality rate from cancer of the reproductive system decreased by 80%, in Finland by 50%. With the existing HPV vaccination programme, Australia has become one of the first countries to be able to eliminate cervical cancer. In just 10 years of the program, the incidence of cervical cancer has decreased 22 times - from 22.7% to 1.5%.
In 2020, WHO approved a global strategy to reduce the incidence of HPV. It is a set of measures, starting with primary prevention in girls 9-13 years old, secondary prevention in women over 30 years old, screening, direct cancer treatment and rehabilitation.
HPV vaccination was included in the national immunization program of 110 countries in 2020, but Russia was not included in the list of these countries. Data from long-term studies involving women from different countries aged 16-26 years showed that vaccination provides sustained protection against high grade cervical dysplasia associated with HPV type 16, type 18 for more than 12 years with a trend towards continued protection for 14 years after vaccination. Data from another study involving women 24-45 years old showed that the vaccine was effective for 10 years and elicited a sustained immune response since the first dose.
2023: Digital portable colposcope for diagnosis of cervical cancer created in Samara
In mid-May 2023, the Samara State Medical University (SamSMU) announced the creation of a digital portable colposcope for the diagnosis of cervical cancer. According to the developers, the device will expand the coverage of cancer screening for women and detect the disease at an early stage. Read more here.
2020
Mortality from cervical cancer in Russia has doubled in 30 years
The incidence of cervical cancer in Russia has increased more than 5 times from 1990 to 2020, and mortality has doubled. At the end of June 2022, Medvestnik writes about this with reference to Natalia Babayeva, an oncogynecologist at the National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Kulakov. According to the publication, in 2020, cervical cancer was detected in 3.4 thousand Russian women, 699 of them died. The average number of cases in the country is 13.6 per 100 thousand population, mortality is 4.8, Babayeva said.
In her opinion, this may be due to the fact that in the Russian Federation there is no national screening program and a clear algorithm for examining women. But there are 30 regional programs that are "opportunistic" and do not provide the necessary patient outreach. In total, less than 70% of residents of the regions undergo examinations. In addition, there are shortages of gynecologists and cytologists.
Шаблон:Quote 'Each region forms a program at its own discretion. Most do not have a scheme for routing, examining and treating patients, centralizing and automated accounting, monitoring further examination, the doctor said. During the audits, the center's experts revealed in many regions a shortage of obstetricians-gynecologists and cytologists, meager funding for screening programs, including at compulsory medical insurance rates, as well as the lack of modern equipment for mammography. In addition, Babayeva noted, many women's consultations occupy small areas, which complicates research.
Cervical cancer is an invasive process that usually begins at the transition of a multilayer flat epithelium into a single-layer cylindrical epithelium and is represented by either a multilayer flat or glandular epithelium. Cervical cancer is one of the leading causes of death from cancer, despite a 50% reduction in the incidence of the disease over the past 30 years by 2022.[4]
Oncologists of the center "Medical City" cured a patient with the fourth stage of cervical cancer
On October 14, 2020, the Department of Health of the Tyumen Region announced the cure of a patient who was diagnosed with stage four cervical cancer. Oncologists of the regional multidisciplinary center "Medical City" performed a patient with intra-arterial chemotherapy. Read more here.
The Ministry of Health of the Russian Federation introduces standards for the provision of medical care for cancer of the uterus
As it became known in October 2020, the Ministry of Health of the Russian Federation introduces standards for the provision of medical care for cancer of the uterus.
According to the new standards, the average duration of treatment for stage I cervical cancer will be 145 days, and endometrial cancer at the same stage - 365.
The draft standards contain lists of drugs registered in Russia indicating the average daily and course doses, options for medical nutrition.
It is specified that the appointment and use of drugs, medical devices and medical nutrition that are not included in the standard is possible for medical reasons in accordance with the decision of the medical commission.
The fact that the procedure for providing assistance to patients with cancer will change in Russia was announced earlier in October 2020 by the head of the Ministry of Health Mikhail Murashko.
| | The new procedure for the provision of medical care is licensing requirements, which, first of all, provide not the recommended, but the mandatory format of structural divisions, equipping [them] with equipment, the use of certain medical technologies for this type of institution, the minister said. | |
According to him, the procedure will also include a set of measures for information support and the use of various information products, data centers.
The fight against cancer is one of the priorities of the national project "Health." In six years, it is planned to reduce mortality from cancer to 185 cases per 100 thousand population. To achieve this goal, it is planned to allocate almost 1 trillion rubles. Most of these funds will be used to provide Russians with modern medicines in accordance with international clinical recommendations and treatment protocols.[5]
2019
Ultrasound and biopsy. Named the most effective way to predict metastases in patients with endometrial cancer
In late December 2019, researchers found that the use of ultrasound in combination with endometrial biopsy and evaluation of clinical manifestations allows physicians to reliably predict the risk of lymph node metastases in patients with endometrial cancer before surgery.
A prospective multicenter study compared three methods of assessing metastases: endometrial biopsy alone, ultrasound biopsy, and ultrasound biopsy and risk score. A research team led by Dr. Linda Eriksson of Karolinska University Hospital in Stockholm found that the technique using all three assessment methods was the most sensitive and specific.
| | Our model can be used to predict the effectiveness of a sentinel node lymphadenectomy or biopsy based on individual risk of metastases, the researchers explained. | |
The fact is that lymphadenectomy is often necessary during surgical intervention, but does not have advantages in survival at an early stage of endometrial cancer and is not recommended in cases of low risk of metastases. Using transvaginal ultrasound together with preoperative biopsy and risk factor assessment will help assess the need for lymphadenectomy.
Previous studies have relied on small retrospective samples, where MRI was used to create the prediction model. However, transvaginal ultrasound has proven to provide accuracy similar to MRI and is preferred in terms of availability, tolerability and cost and time.
The researchers suggest the new model could be integrated into ultrasound machines or applications that automatically calculate the risk of metastases to lymph nodes. In addition, the use of a risk prediction model may help in estimating the expected time of surgery and the need for a qualified surgeon.[6]
Clinics start using Microsoft's artificial intelligence to quickly diagnose cervical cancer
In November 2019, it became known that Indian clinics began to use artificial intelligence Microsoft for rapid diagnosis cancer of the cervix. This is a joint project of the company with - SRL Diagnostics the country's largest network of diagnostic centers engaged in pathological and radiological research. More. here
See also
Notes
- ↑ Malignant neoplasms in Russia in 2021
- ↑ the Ministry of Health of the Russian Federation, clinical recommendations for the disease "Cervical Cancer," 2020.
- ↑ Global Cancer Statistics 2020
- ↑ Mortality from cervical cancer in Russia has doubled in 30 years
- ↑ npa = 109208 On approval of standards of medical care for adults in cervical cancer
- ↑ Model predicts metastases in endometrial cancer patients
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