Cervical cancer recurrence is the resumption of the oncological process in the primary focus area after the completion of radical treatment and subsequent well–being. It is manifested by pulling pains in the lower back, perineum and sacrum area, watery or succulent discharge, urination disorders, edema, weakness, apathy, exhaustion and appetite disorders. Sometimes it is asymptomatic and is detected during a routine examination. The diagnosis is made taking into account anamnesis, complaints, gynecological examination data, angiography, lymphography, cytological examination, biopsy and other studies. Treatment – surgery, radio and chemotherapy.
Information
Cervical cancer recurrence is the re–development of a malignant tumor some time after radical treatment of the neoplasm. Relapses are understood only as oncological lesions that occur after a period of well-being lasting from six months or more. In the absence of such a period, they talk about the progression of the oncological process. The probability of cervical cancer recurrence after combined treatment (surgery and radiotherapy) is approximately 30%, most tumors are diagnosed within 2 years after completion of therapy. Recurrent neoplasms are characterized by a more aggressive course. The treatment is carried out by specialists in the field of oncology and gynecology.
Causes
In 70% of cases, a cervical cancer recurrence occurs in the pelvic region. Lymph nodes and ligaments of the uterus are most often affected. Local tumors are diagnosed in only 6-12% of cases and are usually detected in patients suffering from endophytic forms of cancer. The cause of the development of neoplasms are malignant cells remaining in the pelvic cavity after surgery and radiotherapy due to the rapid growth of the tumor or too non-radical treatment due to underestimation of the severity and rate of progression of the disease.
Symptoms
Recognition of recurrent lesions is often associated with significant difficulties, especially at the initial stage. The causes of difficulties are asymptomatic or low-symptomatic course, as well as difficulties in interpreting the manifestations of the oncological process against the background of postoperative scars and sclerotic changes caused by previous radiotherapy. The first symptoms of a cervical cancer recurrence are usually apathy, unmotivated fatigue, appetite disorders and dyspeptic disorders.
After a while, there are pains in the abdomen, perineum, sacrum and lower back. The intensity of the pain syndrome can vary significantly. Pains, as a rule, pulling, increase at night. While maintaining the patency of the cervical canal, sucrovichnye, watery or purulent whites are noted. When the canal is overgrown, there are no whites, fluid accumulates, the uterus increases. Edema and urination disorders are possible. Some patients with recurrent cervical cancer develop hydronephrosis. With distant metastasis, the functions of the affected organs are disrupted.
During the gynecological examination, an ulcer with compacted edges is found in the neck area. With the growth of the tumor, the neck expands, becomes lumpy. When the canal or the upper parts of the vagina are overgrown, an elastic formation is palpated above the neck. With the progression of cervical cancer recurrence, the general signs of oncological damage become more pronounced. The patient suffers from disability, fatigue and depressive disorder. Exhaustion and hyperthermia are detected.
Diagnostics
The diagnosis is made on the basis of anamnesis, complaints, gynecological examination data and additional studies. A fairly effective way of early diagnosis of relapses is to determine the level of the cancer marker of squamous cell carcinoma SCC. An increase in the level of the tumor marker at the preclinical stage is noted in 60-70% of patients and can serve as a basis for an extended examination. When examining patients with clinical forms of cervical cancer recurrence, an ulcer is found in the affected area. During bimanual examination, infiltrates can be palpated in the surrounding tissue. Excretory urography is performed to detect renal dysfunction.
To detect vascular networks in the tumor growth zone, percutaneous transfemoral angiography is performed, indicating the presence of new randomly located vessels with characteristic “panicles” at the end. To confirm the cervical cancer recurrence with metastases to regional lymph nodes, direct lymphography is prescribed. The affected nodes are enlarged, with uneven contours, the passage of contrast is slowed down. Ultrasound of the female genital organs, CT and MRI of the abdominal cavity are also used during the examination. If a metastatic lesion of distant organs is suspected, CT and MRI of the brain, ultrasound of the liver, skeletal scintigraphy and other studies are prescribed. The final diagnosis is made taking into account the data of cervical biopsy or cytological examination of cervical scraping.
Treatment
Radical surgical intervention is possible in the absence of hematogenous metastases and extensive infiltrates. Patients undergo a pangisterectomy – removal of the uterus (hysterectomy) with adnexectomy. With single lymphogenic metastases, lymphadenectomy is performed. After surgery, radiotherapy and chemotherapy are performed. The best option is considered to be a combination of intracavitary and remote gamma therapy. Sometimes transvaginal radiotherapy and short-range intra-vaginal radiotherapy are additionally prescribed.
In case of cervical cancer recurrence with spread to the pelvic tissue and multiple lymphogenic metastases, radiotherapy and drug therapy are used. With relapses in the vagina, surgery is usually not indicated. Patients undergo combined radiation therapy. With single nodes in the liver and brain in young, somatically preserved patients, surgical removal of metastatic tumors is possible. With multiple distant metastases, chemotherapy, radiotherapy and symptomatic therapy are prescribed.
Prognosis and prevention
The prognosis is unfavorable in most cases. The best results are observed with local relapses that do not extend beyond the uterus and vaginal arch. The average five-year survival rate after surgery in combination with radio and chemotherapy in such cases is 27.4%. In the presence of lymphogenic and distant metastases, 10-15% of patients manage to live a year from the moment of diagnosis.
The importance of early detection of cervical cancer recurrence causes the need for thoughtful preventive measures. During the first year, the examination is carried out once every 4 months, during the next two years – once every 6 months. The examination includes examination in mirrors, rectovaginal examination, general and biochemical blood analysis, cytological examination of vaginal fluid, excretory urography, chest X-ray, ultrasound of female genital organs, CT of abdominal organs and dynamic kidney scintigraphy (if appropriate equipment is available). In doubtful cases, a puncture biopsy of the cervix is performed.