The study of the epidemiology of malignant tumors of the uterus in our country is carried out systematically and purposefully thanks to the organization of the All-Union Center for the Study of the Epidemiology of Female Genital Cancer. The degree of risk of cervical cancer varies among women of different ages: at the age of 0-29 years, one case of the disease occurs in 110,000 women, in 30-39 years – in 4400, in 40-49 years-in 1200, in 50-59 years-in 1300, in 60-69 years-in 3500, in 70 years – in 4000 women. It was found that married women are more likely to develop cervical cancer than unmarried women. In women who have given birth, the tumor is more common than in those who have not given birth. Cervical cancer occurs relatively often in women who have many sexual partners. Cervical cancer rarely affects women who have been married to men who take measures to prevent the accumulation of smegma. In Muslim women and Jewish women, whose husbands were subjected to the rite of circumcision of the foreskin, a cancerous tumor affects the cervix relatively rarely. The results of the study conducted by L. I. Charkviani and V. D. Todua indicate that smegma has carcinogenic properties. The role of viral infection in the occurrence of cervical cancer requires further study. It is assumed that the Herpes-2 virus has a certain significance in carcinogenesis. This is evidenced by epidemiological, serological, and biochemical studies. Herpes of this type is less common in men who have been circumcised than in men with preserved foreskin. 9 % of women with cervical cancer have a history of having previously suffered syphilis or a positive Wasserman reaction, while in the control group such women make up 2 %. In the occurrence of cervical cancer, the time of the beginning of sexual life is important: the earlier it begins, the greater the possibility of developing a tumor of this localization. The cause of cervical cancer has not been sufficiently clarified. It is known that a number of disorders in the woman’s body contribute to the development of a tumor of this localization. These include injuries to the cervix during labor, inflammatory diseases of the genitals and hormonal disorders (primarily in the form of an increased content of estrogens). It is known that under the influence of estrogenic hormones in a woman’s body, including in the cervix, proliferation processes are stimulated, cell differentiation is accelerated. With intensive division of epithelial cells, the possibility of persistent changes in hereditary structures (mutations) increases in them. With the weakening of the body’s defenses, mutant cells cannot be destroyed and become the source of the appearance of similar cells of a pathological structure. The occurrence of precancerous conditions of the cervix may also be due to the influence of unfavorable production factors on the woman’s body. Thus, the frequency of detection of this pathology is increased in women working in the oil refining, mining and tobacco industries. It is possible that the peculiarities of the state of the sexual apparatus of a woman’s sexual partner also have a certain influence on the occurrence of cervical cancer. Currently, it is considered that the occurrence of cervical cancer is a complex, sometimes long multi-stage process with the inclusion of precancerous conditions as an important component in it. With severe clinical cervical cancer, there are three symptoms inherent in gynecological diseases: pain, bleeding and whiteness. White spots are localized in the sacrum, lower back, rectum and lower abdomen. In advanced cervical cancer with damage to the parametral fiber of the pelvic lymph nodes, pain can radiate to the hip. Bleeding from the genital tract has a different character. Very characteristic are the so-called contact bleeding that occurs during sexual intercourse, defecation, lifting of gravity, vaginal examination.
The occurrence of bleeding is caused by the rupture of easily injured small vessels of the tumor. Pain in patients with cervical cancer can be serous, bloody, with or without an unpleasant smell. The origin of the whites is associated with the opening of the lymphatic vessels during the collapse of the tumor. When cervical cancer passes to the bladder, frequent urges and frequent urination appear. Due to the violation of contractile activity, the bladder is not completely emptied, which is the cause of persistent cystitis. Compression of the ureter leads to the formation of hydro– and pyonephrosis, and then uremia may occur. When a rectal tumor is affected, constipation occurs, mucus and blood appear in the feces, then a fistula forms between the vagina and the intestine.
I want to say that the preventive examination of women in the examination rooms of polyclinics, industrial enterprises, collective farms, state farms, as well as individual examinations in women’s clinics play a major role in identifying the initial forms of cervical cancer. During examinations, a cytological examination of the cervix by its surface scraping must be carried out without fail. If a gynecological examination reveals a pathology of the cervix visible to the naked eye or if atypical cells are detected during cytological examination of smears from its surface and from the cervical canal, the patient should be subjected to an in-depth comprehensive examination. With a targeted comprehensive examination, cervical cancer can be diagnosed in almost 100 % of cases. Examination of patients should begin with collecting anamnesis. Special attention should be paid to the reproductive function, finding out the time of the beginning of sexual life, the number of pregnancies, births and abortions, the peculiarities of their course. It is necessary to establish what gynecological diseases the woman suffered from and what treatment was carried out at the same time. Of great importance is the presence in the past of diseases of the cervix (“erosions”). In an interview with the patient, it is necessary to clarify the features of the onset and course of the disease that forced her to consult a doctor. It is also necessary to find out the duration of the disease and the nature of the symptoms (discharge from the genital tract, menstrual function disorders, their frequency, the dependence of their intensity on the behavior of patients). Examination of the cervix in mirrors. The examination should begin with an examination of the cervix in mirrors. To prevent injury to the organ affected by the pathological process, the cervix should be exposed using a spoon-shaped mirror and a lift. A cancerous tumor can have a different appearance. Thus, in the exophytic form of the tumor, lumpy formations of a reddish color are found, often with areas of necrosis that have a gray color. If you touch the tumor with a tool or even a gauze ball, bleeding may occur. When choosing a biopsy site, the Schiller test is quite effective. It is based on the ability of the multilayer squamous epithelium of the neck to perceive iodine staining when it is combined with the glycogen of the cytoplasm of cells. The areas of the vaginal part of the cervix, covered with a normal multilayer flat epithelium, acquire a dark brown color. Areas devoid of this cover, lined with prismatic epithelium, and tumor tissue retain a pale color with a sharply defined border. Therefore, the Schiller test is not specific for the diagnosis of cervical cancer. It only allows you to differentiate between normal and pathologically altered areas of the vaginal part of the cervix. Colposcopy has an important diagnostic value in the recognition of cervical cancer. Colpomicroscopic examination allows us to establish the polymorphism of cells and their nuclei with a disorderly arrangement of cellular elements. The boundaries of the cells are completely indistinguishable. With cervical cancer, such a study is almost impossible due to bleeding tissues and necrotic processes. Cytologically, when examining smears from the surface of a cancerous tumor, a large number of atypical cells are detected. The histological examination of the cervix is of crucial importance in the recognition of cervical cancer. The results of the pathomorphological examination of tissues largely depend on the correctness of the material taken. If the material is obtained not from the tumor itself, but from the areas located next to it, it is impossible to establish a correct morphological diagnosis. The accuracy of histological diagnostics also depends on the technique of obtaining the material for the study. The biopsy should be performed purposefully. In addition to the diagnostic value, a biopsy is important for determining the prognosis of the disease by detecting reactive changes in the underlying tissue and morphological signs of a tumor.
In the prevention of cervical cancer, which is the so-called visual form, preventive examinations of women are of great importance. In cities, preventive examinations of the female population at enterprises, in women’s clinics and examination rooms are carried out by doctors. At the same time, it is mandatory to conduct a study of the cervix in mirrors, a cytological study of the epithelium of the vaginal part of the cervix and its canal, and, according to indications, a colposcopy. For preventive examinations, experienced obstetricians and gynecologists should be allocated. In rural areas, at the first stage, the examination is carried out by district midwives and midwives of examination rooms. At the same time, the cervix is examined in mirrors and at the same time, material is taken for cytological examination. If the examination reveals a pathology of the cervix or cytological examination shows signs of atypicity, the woman should be sent to a gynecological or oncological institution, where there is a possibility of in-depth medical research with the use of additional diagnostic methods and necessary treatment. Detection and elimination of precancerous conditions of the cervix are a reliable prevention of cervical cancer. A significant role in the prevention of cervical pathology is played by activities carried out in obstetric hospitals. If the cervix is damaged during childbirth, its integrity should be restored by carefully sewing up the wound. The skillfully conducted anti-cancer propaganda is of great importance in the prevention of malignant tumors of the female genital organs, especially cervical cancer. It should cover the broad masses of the female population both in the city and in rural areas. Its purpose is to provide regular preventive examinations in women’s clinics, examination rooms, industrial enterprises, state farms and collective farms. With properly conducted sanitary and educational work, the risk of carcinophobia in the population is insignificant.