Screening for precancerous and cancerous diseases of the genital organs in peri-and post menopause

Breast Cancer

Breast cancer is the most common type of cancer among women and, perhaps, causes the greatest concern. About 25,000 new cases of this disease are diagnosed each year, and every year about 15,000 women die from it – more than from any other cancer. This is the most common single cause of death among all women aged 35 to 54 years. It is estimated that the probability of getting breast cancer is 1:12, and in some groups of women, as shown later, it increases significantly. The probability of developing breast cancer increases significantly with age. It is very rare in women under the age of 20, but since the age of 35, the incidence increases dramatically, and among women aged 85 and over, it is 300 per 100,000.

Self-examination of the breast: it is necessary to probe the surface of the entire breast and axilla with the tips of the fingers, and it will be alerted if it notices anything unusual.

  • It is important to pay attention to the following signs:
  • swelling or induration in the mammary gland,
  • change in the shape of the breast,
  • wrinkling or retraction of the skin of the breast,
  • peeling of the skin of the breast,
  • selection from the nipple,
  • the appearance of a seal or swelling on the nipple,
  • suction nipple,
  • swelling of the shoulder or space in the armpit,
  • unusual pain or discomfort in the breast.

Mammography is a method of examining the mammary glands with X-rays. Since breast tissue is very dense, a woman younger than 35 years of age, mammography does not give successful results in detecting cancers in this age group. However, it is very effective in examining older women. Since 1988, a national screening program has been operating in the UK, in which all women between the ages of 50 and 64 are invited to undergo a mammogram once every 3 years. It is estimated that by the year 2000, the number of deaths from breast cancer among women in this category will decrease by 25%.

Mammograms from 50 to 64 years old are offered to undergo a mammogram once in 3 years, from 65 years annually.

If a genetic susceptibility to the development of breast or ovarian tumors is suspected, a genetic examination is carried out for the presence/absence of mutations of the BRCA1 or BRCA2 genes.

If there are relatives in the family (mother, sister) with breast cancer, it is necessary to conduct a genetic analysis for the presence or absence of mutations of the BСA-1 and BСA-2-genes genes (Breast / Ovarian Cancer)

Cervical Cancer

Cervical cancer is the second most common cause of death from cancer and mortality of women worldwide. The best way to detect cervical cancer is a regular Papanicolaou test, or Pap smear, a microscopic examination of cells taken from the cervix.

Risk factors for cervical cancer:

  • Multiple sexual partners
  • Early sexual debut
  • Viral infections such as HPV, human immunodeficiency virus (HIV), or herpes simplex virus (HSV)
  • Weakened immune system
  • Presence of genital cancer
  • Smoking

Screening for cervical cancer is recommended for women from 21 years of age regarding the onset of sexual activity. Up to 30 years every 2 years, after 30 years every 3 years. After 30 years combined with the analysis on HPV. Screening ends at 65-70 years after receiving 3 negative results in recent years.

Only a specialist doctor is able to correctly interpret smear results. According to Bethesda, Papanicolaou smear samples that do not have abnormal cells are interpreted as “a negative result of an intraepithelial or malignant lesion” (that is, women who do not have cancer).

ASC (atypical squamous cells): squamous cells are thin, flat cells that form the surface of the cervix. The Bethesda system divides this category into the following 2 groups:

ASC-US (atypical squamous cells of uncertain significance): squamous cells do not seem completely normal, but doctors are not sure what the changes mean cancer. Sometimes these changes are associated with HPV infection. ACS-US are considered as mild anomalies.

ASC-H (atypical squamous cells, squamous intraepithelial lesions cannot be ruled out): the cells are not normal, but doctors are not sure that the changes mean cancer. ASC-H often means a precancerous condition.

AGC (atypical glandular cells): the glandular cells are gland-producing cells found in the endocervical canal (in the center of the cervix) or in the lining of the uterus. Glandular cells are not normal, but doctors are not sure what cellular changes mean.

AIS (endocervical adenocarcinoma): precancerous cells in the glandular tissue.

LSIL (mild squamous intraepithelial lesions): Low-grade means that there are some early changes in cell size and shape. The word lesion refers to the area of abnormal tissue. Intraepithelial refers to a layer of cells that form the surface of the cervix. LSILs are considered minor deviations due to HPV infection.

HSIL (pronounced squamous intraepithelial lesions): Pronounced means that there are more noticeable changes in the size and shape of the abnormal (precancerous) cells, that is, the cells are very different from normal cells. HSILs are characterized by more severe abnormalities and have a higher likelihood of cancer progression.

If there are abnormal cells in the cervix, a biopsy should be performed. If the result of a woman’s smear is abnormal, colposcopy and biopsy should be performed immediately. A biopsy is the only way to determine a precancerous condition, cancer or its absence.

If the result of a biopsy is intraepithelial neoplasia or cancer, treatment should be started immediately. In the early stages of surgical cryosurgery, radio wave surgery apparatus Surgitron.

Endometrial Cancer

Recently, a tendency to an increase in the incidence of uterine cancer is noted, which can be explained by an increase in the average life expectancy and an increase in the incidence of such “civilization diseases” such as anovulation, chronic hyperestrogenism, infertility, myoma and endometriosis. Combining them with impaired endocrine function and metabolism (obesity, diabetes, hyperinsulinemia, hyperlipidemia) leads to the development of a syndrome of disorders in the reproductive, metabolic and adaptive systems of the body.

According to the WHO International Histological Classification, the following morphological forms of endometrial cancer are distinguished:

  • adenocarcinoma;
  • clear cell (mesonephroid) adenocarcinoma;
  • squamous cell carcinoma;
  • glandular cell carcinoma;
  • serous cancer;
  • mucinous cancer;
  • undifferentiated cancer.

In the form of growth of the primary tumor emit:

  • Cancer with predominantly exophytic growth;
  • Cancer with predominantly endophytic growth;
  • Cancer with endozofitnym (mixed) growth.

The risk factors for endometrial cancer include:

  • endocrine and metabolic disorders (eg, obesity, diabetes, hypertension);
  • hormonal-dependent dysfunctions of the female genital organs (anovulation, hyperestrogenism, infertility);
  • hormonally active tumors of the ovaries (granulosa cell tumor and Brenner tumor in 20% of cases are accompanied by endometrial cancer);
  • genetic predisposition;
  • lack of sexuality, pregnancies, childbirth;
  • late onset of menarche, menopause (over the age of 55);
  • hormone therapy (tamoxifen).

In the early stages, the disease is asymptomatic. The main clinical symptoms of uterine body cancer are bloody discharge from the genital tract, watery leucorrhea and pain.

The most frequently observed symptom, atypical uterine bleeding, is non-pathogenomonic for endometrial cancer, since it is characteristic of many gynecological diseases, especially in women of reproductive and perimenopausal periods. Bleeding is a “classic” symptom only in postmenopausal women.

The appearance of abundant serous whites in elderly women without associated inflammatory diseases of the uterus, vagina, cervix is characteristic of cancer of the body of the uterus. The development of the disease may be accompanied by an abundant watery discharge (leukorrhea), characteristic of RMT.

Pain – a late symptom of the disease. Most often localized in the lower abdomen and lumbosacral region, are cramping or permanent. A significant proportion of patients go to the doctor late, i.e. when there are already signs of the spread of the tumor process (dysfunction of the bladder, intestines).

Vulvar Cancer

Vulvar cancer is more common in women aged 65-75 years (mean age 68 years). However, vulvar cancer can also occur at a young age. Vulvar cancer accounts for up to 5% of all malignant tumors of the female genital organs.

To the external genitals (vulva) include pubis; large and small labia; clitoris; hymen (or its remnants); the vestibule of the vagina, as well as two (right and left) large (Bartholin) glands and bulb (horseshoe venous plexus, covering the urethra and extending in the thickness of the small and large labia.

Risk factors for vulvar cancer:

1.Age

2.HPV infection. There are more than 70 types of HPV; Various types of viruses cause papillomas or epithelium dysplasia on the palms and soles, lips and tongue, penis, cervix, vulva, vagina, and anal canal. These viruses are sexually transmitted.

3.Human immunodeficiency virus (HIV) infection.

4.Non-tumor dystrophic diseases of the vulva

5.Dysplasia of the epithelium of the vulva.

6.Frequent change of sexual partners.

7.Smoking.

 

Symptoms of vulvar cancer

In patients with dysplasia and vulvar cancer in situ, itching may be the only complaint. With the further progression of the malignant process, patients complain of the presence of a tumor, usually in the form of a wart, cauliflower, or an ulcer that does not heal. Later, pain, bleeding or purulent discharge, painful urination, an increase in the inguinal lymph nodes due to their metastatic lesion.

Cancer of the vulva can develop on the background of dystrophic non-neoplastic diseases. Sclerosing lichen (Krauros) leads to thinning of the subcutaneous tissue of the vulva. The skin becomes pale with a yellowish tinge, shiny, “parchment”, cracks appear, the entrance to the vagina is narrowed. Foci of leukoplakia can appear not only in the vulva, but also in the vagina and on the cervix. They are flat or rise above the surface of the skin or mucous membrane, single or multiple, not removed with cotton balls, have the appearance of films or plaques of white color with a nacreous shade. Kraouroz and leukoplakia, as well as their combination (dystrophic changes of the mixed type) are accompanied by paroxysmal itching, often unbearable, the appearance of cracks, pain during intercourse.

The choice of treatment for vulvar cancer is influenced by the patient’s age and general condition, the stage and location of the tumor, the histological structure and degree of differentiation (low, moderate or high malignancy) of the neoplasm, the depth of invasion (spread of the tumor into the underlying tissues), the presence or absence of metastases in inguinal and pelvic lymph nodes, etc. The main treatment for vulvar cancer remains surgical.

 

Ovarian Cancer

Ovarian cancer in the early stages of development is usually asymptomatic.

Complaints that bother patients are not specific. This, as a rule, unpleasant sensations in the abdomen, possibly, its increase, feeling of fullness, bloating, dyspepsia. Patients who have not yet reached menopause, may complain of irregular menstruation. When the tumor masses of the bladder or rectum are pressed, complaints of frequent urination and / or constipation may appear. In the later stages, the main complaints are associated with an increase in the abdomen in the volume due to the presence of ascites (fluid in the abdominal cavity) or an abdominal mass.

As a diagnostic method, the method of transvaginal ultrasound and the determination of the CA 125 marker in blood serum are used. Normal serum levels up to 35 IU / ml. In most cases of ovarian cancer, its concentration increases by 5 or more times. Serum CA 125 concentration may also increase in case of various non-neoplastic diseases: inflammatory changes in the abdominal cavity, small pelvis, menstruation, benign tumors of the female reproductive system (ovarian cysts). However, in most of these cases, the concentration of CA 125 in serum does not exceed 100 IU / ml. Additional research methods such as magnetic resonance imaging (MRI)

Treatment of ovarian cancer and the amount of surgery, chemotherapy depends on the stage of the disease.