Transcript Background and pre-cancer disease. cervical cancer and uterine body

Babadjanova G.S.
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The neck are covered multilayer squamose
epithelium which emanates from urogenital sine,
of which the privates - the vulva and the vagina
also are organized. This is why in pathogenesis of
these areas some community in difference from
oncological the ovarian disease is available, the
uteruses where the great significance has the
hormone disbalance in the body. In pathogenesis
play the factors: behavior pattern of woman (in
risk group enters the women which early become
sexually active - up to 16 years, since up to 16
years the stratified epithelium extremely thins,
easily vulnerable, and the early traumatization
can result in development of oncological process
).
 Early
primary pregnancy and early first
genera (up to 16 years ) is also epithelium
traumatization of uterine cervix.
 Frequent change of sexual partners (speak
about carcinogenic effect of sperm on
epithelium of uterine cervix - in sperm is two
protein - Heston and the protamine, which is
assigned to carcinogenic effect ).
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- the viruses - the herpes virus of second serotype ( first type
does not matter ); the human papillomavirus - occupies the first
place (10, 16, 18 genotypes ) - contamination occur only genital
tract - causes the development by the condylomas, verruca at
the surface of uterine cervix, which inappreciably (on the view
are not discovered ), well is seen when endoscopic examination colposcopy ); when serological study can be found the specific
cells, characteristics for defeat only human papillomavirus changed cell of stratified epithelium - cell gain the air form
(koylotsity, air cell ) - About nucleus is organized the air rim.
When electron microscopy the special encompassings by nucleus
find out, that pathognomonic. The immunochemical method is
also found out these viruses - the immunoperoxidase method - in
cytoplasm and nucleus the special inclusions find out, that
emerge only when defeat of multilayer squamose epithelium. By
means of monoclonal antibodies and molecular biological means
can be found viruses. Definition of antibody titer in blood did not
actual. The viral theory actual because at 80-90% sick find out
defeat by the viral infection. Cytomegalovirus in combination
with herpes virus of second type.
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Cervix cancer this not only a medical problem, but as
well social. Since there are the women group at
which the risk of development cancers of uterine
cervix achieve 90%.
Classification disease of uterine cervix.
Clinicopathologic classification.
Background processes of uterine cervix: erosions,
pseudoerosion, leucoplakia, polyps, condyloma.
Pre-cancer process - dysplasia.
Cancer stage zero - carcinoma in situ.
Microinvasion cancer.
Invasive carcinoma.
The background process not necessarily precedes
neck cancer.
Background processes.
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Occur the hyperplasia processes of epithelium cells,
that of new glandular structures, and following
proliferation and the tumour process gives rise.
The true erosion is the epithelium injury (the
epithelium absence on some site ), and it as any
fabric always apt to regeneration, and there is within
a few day. In future the erosion refreshes, or to coats
by the multilayer squamose epithelium, or to coats
by the cylindrical epithelium, which inherent for
cervical canal. If the erosion being not ectocervix will
be capped cylindrical epithelium then is organized
псевдоэрозия - this areas of cervical mucosa, which
is covered by the irregular epithelium, not those
which should be there. Are being founded condition
for processes of proliferation.
Leucoplakia. Appears in sight of white spot on
uterine cervix, the site of redundant
cornification.
 Eroded ectropion. Due to of labor, abortions can
be the side cervical rupture, and then occurs the
channel eversion of neck, that is misplaced by
the fabric, i. e. fabric submitted to unusual her
the Wednesday, and consequently will take place
proliferation.
 Condyloma, verruca. Nature their viruses.
 The polyps, as a rule of cervical canal, is
sometimes various sizes, as a rule on foot. The
basis their connective tissue, and are covered
they as a rule by the glandular epithelium. Can
be the glandular-fibrous polyps.
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 inspection
in mirrors, endoscopy
(colposcopy), cytologic examination.
 Pre-cancer process - dysplasia. The dysplasia
is sometimes easy, moderate, heavy. Offer
the term - the cervical intraepithelial
neoplasia. The dysplasia is the atypia of
cover epithelium of uterine cervix, in
violation its lamination, but during is not
involving the germinal epithelium and the
stroma. Outside as a rule of pathology not to
find, only if there is the conformity with
backgrounds by processes.
 The
moderate dysplasia are affected all
stratum, but to a greater extent, can be
found changed cells, the cells аtipizm of
lower cells - the nucleus hyperchromatosis is
available, in them varys the nuclearcytoplasmic relation. This is determined only
when cytologic and hystological research. So
that the cervical dysplasia shall be
established on a foundation of histological
and cytologic examination. If the dysplasia
group with colpitis, then dysplasia cause may
be the inflammation, cured the colpitis may
withdraw and the dysplasia.
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Cancer stage zero.
Carcinoma in situ. Sometimes it is very difficult to
hold the facet between heavy dysplasia and cancer
stage zero because when last by the prolapsed
bedding, the violation of cytoarchitectonics - the
change of nuclear-cytoplasmic correlation are taking
place. The cancer stage zero differentiate those that
it does not врастает in строму and is not introduced
in the muscular layer. Respectively no metastases.
May not to be clinical symptoms, but if there is then
this contact bloody issues. These bleeding arise after
physical load, sexual connections, inspection. In the
area of external shed meet two different epithelium
- cervical and multilayer flat, there of most
frequently the cancer stage zero is developing. This
is why when take cytologic are trying to achieve this
areas.
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Microinvasion cancer.
Corresponds 1а of disease stage. There is the
invasion, there is the infiltrative growth, the
basement membrane has been impressed, but the
invasion is limited three by millimeters. Separated
this form this is why that if is affected 3 MM of
muscular layer, then this more or less compensated
the process, with less aggressive current, with
smaller percentage of metastases development. The
diagnosis shall be established only after histological
conclusion, the cytologic examination not is crucial.
So is the invasion, then in clinical picture may appear
except spontaneous bleeding, can be pain, of whites.
Whites is linked to damage of lymphatic vessels,
under which go early metastazing. Watery бели is
lymphorrhea.
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Invasive carcinoma.
There is the invasion in строму more 3 MM. Clinic:
pain, whites, bleeding. If go expressed the
infiltrative growth, then can be violation on the part
of neighbouring bodies - the acraturesis, pain, the
defecation violation, can be hydronephrosis
phenomena.
The cervix cancer may be endophytic, exophytic and
mixed mode of growth. When exophytic form,
already on the view in mirrors can be seen growth of
uterine cervix, in sight of cauliflower - shapeless the
education, the ruddy, when the Touch easily are
bleeding. Is found in 50-55%. The endophytic form in
sight of ulcer, crater, with purulent territories, at the
bottom can be necrotic mass, is found in 35%. Mixed
form.
When exophytic form the metastases are found
in smaller percentage of cases (13% ), and when
endophytic of more often (35%). On minute
structure differentiate :
 Mixed form - more aggressive current.
 Flat cell cornified the cancer.
 Flat cell not keratinizing cancer.
 Adenocarcinoma.
 Adenosquamous carcinomas.
 undifferentiated swelling.
 Most heavy adenocarcinoma and
undifferentiated swellings.
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Diagnostics.
In order to correctly make a diagnosis, separate 2 stage
examination:
In the first stage go the detection - the screening. At the
second stage - deepened the diagnostics.
For primary screening the cytologic examination is being
used. The smears take from cervical canal, from
endocervix, from the surface of neck - ectocervix.
The double touch will help the process stagement, the
place the going to parametrial cellulose has whether.
Colposcopy - inspection of uterine cervix. Simple
colposcopy - 15 multiple increases, inspection of uterine
cervix. Extended the colposcopy, - for best identification
process by the vinegar, methylene blue. MicroColposcopy.
 Schiller
trial. To identify distribution hotbed.
process the mucous uterine cervixes, and the
cells of germinal epithelium keep the
glycogen, which is reactive with iodine and
gives the brown overtone. Normal mucous if
treated with will be colored in the brown
colour. When integrity violation then cell do
not stained in the brown colour.
 For stagement redetermination use the
aiming biopsy, which gives the material for
hystological research. Before used the
lymphography - presence definition of
metastases in the lymphatic nodes.
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Abrasion of cervical canal and uterus.
Ultrasound with vaginal probe.
CT and NMRI.
Classification cancers of uterine cervix (1985 ).
Precipitation of process stage it is necessary for choice of tactics of treatment.
0 stage - cancer stage zero.
1А stage - microinvasion cancer. Invasion up to 3 MM. Swelling diameter not more 1
refer to.
1B the stage - the swelling is limited only by uterine cervix, but the invasion is
limited by the uterine cervix.
2А the stage - the cancer infiltrates top vagina third, or on uterine body.
2B the stage - the process shift to parametrial cellulose, not gets to uterus walls.
3А stage - extension to lower third of vagina, on body and appendages.
3B the stage - with parametrial the process gets to Taz walls. Appear in the regional
lymph nodes. Then if the metastases have developed in the lymphatic nodes then
this 3 stages. The hydronephrosis - growth in the urine path may be.
4А stage - defeat neighbouring bodies.
4B stage - distant metastasis.
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Regional metastases.
Blood supply of uterine cervix. The uterine artery go
from internal iliac artery. At the level of internal
shed the uterine artery divides into rising and
descending branches. Primary metastasis will units
defeat ranging on internal and external iliac arteries,
in obturator pit. Units - internal, external iliac and
obturator.
Classification of TNM.
Treatment.
Background treatment of process.
Basic treatment is the destruction method. Before
treated by the buckthorn oil that wrong, since
inspires the irregular regeneration. If the conformity
with inflammatory process then add antibiotics.
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Destruction by the electric current diathermocoagulation. At the site action the ulcer is
developing, which to coats normal epithelium. Letdowns: the painful procedure, often the Stroop drops
out on 7-10 days and appears the bleeding; the
cicatrice is organized, under which can walk the
break in labors; no material for hystological research,
then before procedure it is necessary to make the
biopsy.
Action by the cold - cryodestruction. - 30 degrees in
zone of erosion. The Stroop of more mellowy, the
bleeding is sometimes rarer, the cicatrice of less
expressed, without serious consequences.
Laser destruction - most optimum action evaporation of irregular epithelium. Without serious
consequences, bleeding never is sometimes, are not
organized rumen change of uterine cervix.
Chemical degradation.
 Conization:
 Electric conization
 Cutter conization.
 Conization is exercising when the background
process is combined with deformation of uterine
cervix. For instance when eroded ectropion. The
external shed - the site from where go take away
most frequently swelling. Is being done when
heavy dysplasia, cancer stage zero. Moderate
and easy the dysplasia can be healed by the
laser exposure.
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Invasion and the microinvasion cancer are being
treated:
 Combined method: surgical + beam.
 Complex method - use of all types of action surgical method, beam, chemotherapy.
 When stage one use the surgical method - the
Вергейма operation (1911 ) - the uterine
extirpation with appendages, disposal of top
third of vagina, the pelvic lymphadenectomy. If
the process 2-3 stage then use the combined
method. Radiation therapy - distant, internal.
Chemotherapy on 3-4 stage.
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