Metastases in uterine and cervical cancer

Main types of metastasis

Atypical cells in cervical cancer can move from their primary focus to distant tissues and organs in only two main ways. Based on this, experts consider 2 types of metastasis:

movement of a cancer cell along the lymphatic pathways;
damage to distant organs by atypia with the help of blood flow.

The first type is lymphogenous and is detected much more often, since, knowing about the characteristics of the lymph system in the area of the uterus, specialists purposefully examine the nearest lymph nodes. For example, the periuterine, internal iliac, as well as peri-cervical, external iliac and common iliac groups of lymph structures are most susceptible to cancer metastases.

In the second type - hematogenous metastasis - the movement of the mutated cell occurs through the flow of aortic blood. A secondary focus of metastases in uterine cancer can occur in the most distant organs. For example, in the structures of the liver, lungs or bones. Diagnosing them can be quite difficult, because it requires an extensive set of instrumental research procedures.

Metastases in cervical cancer: features, causes

Oncological processes are unfavorable not only in themselves, but also because they can rapidly develop and spread (especially in young patients).

Any oncological process over time gives metastases, which can provoke the development of an oncological process in an organ in which it did not exist before. Metastases from cervical cancer are no exception.

They are also actively formed and spread throughout the body, causing negative consequences. They are described in more detail in the material below.

Definition

In order to understand what metastases are, you need to know the very nature of the development of the oncological process and its pathogenesis. Cancer develops when active cell division of a particular tissue begins. As long as these cells are unchanged, that is, they do not differ in any way from the cells of the tissue from which they grow, the tumor formed by them is considered benign.

A malignant neoplasm is spoken of when atypical cells are found in the tumor. These are cells that are different from the original ones. They may differ in size, shape, as well as in structure, number of organelles, etc.

There may be more or fewer such cells, and sometimes the tumor may consist only of them.

In addition, the severity of the changes differs - according to this parameter they can be weakly, moderately or strongly differentiated (based on this feature, conclusions can often be drawn about the general aggressiveness of the process).

These cells are called metastases. If such an atypical component is separated from the formation and enters the blood or lymph flow, then it can travel through it to another organ and remain there. Such a component is generally suppressed by the immune system and does not begin to divide for this reason. However, if enough cells accumulate, they can divide successfully.

This process leads to the formation of a cluster of atypical cells, a tumor consisting of them. Thus, in an organ in which there were initially no atypical cells, the oncological process begins.

Moreover, the peculiarity is that in the human body such pathological cells are constantly formed, but their division is actively suppressed by the immune system. And if the immune system malfunctions under the influence of unknown factors, it loses the ability to suppress this process. For the same reason, the oncological process does not develop in all organs that receive metastases.

Kinds

Metastases from cervical cancer can be transmitted in different ways. Depending on this, two types of metastasis are distinguished - lymphatic and hematogenous.

Lymphatic metastasis is characterized by the fact that atypical components spread throughout the lymphatic system. In this case, lymph nodes are affected, mainly local ones, that is, located near the source of metastases. These are the pericervical, periuterine, obturator, internal and external iliac, as well as common iliac. Moreover, it is the ileal lymph nodes that are the first to suffer, but quite rarely the aortic and inguinal lymph nodes can be involved in the process;
Hematogenous metastasis is characterized by the spread of metastases with blood through the vessels. This is a rather unfavorable process, since oncological processes can develop in distant organs and systems because of it. In case of cervical cancer, such organs most often become bones, liver, and kidneys.

There is no direct relationship between the type of lesion and the direct selection of treatment. For both hematogenous and lymphatic spread, the process is treated with chemotherapy and radiation therapy.

Metastasis spreads through the lymphatic system. They enter the lymph and, along with it, are carried to other organs and systems.

To a lesser extent, blood is involved in their transfer (which is typical for cancer of the reproductive system).

Due to the significant involvement of lymph in the pathological process, atypical cells are found in it, and are also present in large numbers in the lymph nodes.

While with lymphatic transfer, metastases are found mainly in the nearest organs, with blood transfer they can be found in fairly distant organs. But in many ways, it depends on what stage of the disease occurs.

At first degree

At the first stage of development, uterine cancer is clearly localized in the uterus. It does not metastasize at all, even to nearby organs. This is due to the fact that there are not too many atypical cells, they are not clearly changed, and there is no tumor as such consisting of them yet. As a result, atypical cells cannot yet separate and spread.

In the second degree

At this stage, the number of atypical cells increases, and the process ceases to be strictly localized.

There is a release of a small number of atypical cells into the lymphatic system, which is why the organs of the reproductive system are affected - the body of the uterus, ovaries, fallopian tubes, local lymph nodes, etc.

At this stage, the process does not go beyond the reproductive system, although local lymph nodes may also be affected.

In the third degree

At this stage, the process loses its strict localization and goes beyond the reproductive system. Through the lymph flow, metastases can reach any pelvic organs - bladder, kidneys, ureters, etc. Sometimes the vagina can be affected, sometimes the abdominal wall can be affected. At this stage, metastases sometimes already enter the blood.

At the fourth degree

Metastases are found not only in the lymph, but also in the blood. They spread through blood vessels throughout the body. As a result, atypical cells can be found in the most distant organs - the stomach, liver, bones, lungs, etc. This is a rather negative option for the development of the process, since it is no longer possible to stop the spread of metastases.

Causes

There are no specific reasons for metastasis, since this process is natural for oncology. Atypical cells may break off and enter the blood and lymph.

It is impossible to somehow avoid this phenomenon or prevent it. Thus, the cause of metastasis is the cancer itself.

And the cause of cancer may be the human papilloma virus or other phenomena that have not been reliably established.

Symptoms

There are no symptoms of the actual spread of metastases. However, we can say with confidence that metastases are present if symptoms of the third stage of cervical cancer are observed:

Pain in the lower abdomen;
Bloody acyclic discharge;
Loss of appetite, weight loss;
Fatigue, increased fatigue, weakness, drowsiness, etc.

Symptoms are nonspecific and may indicate another disease. But if you find them, you should consult a doctor.

Treatment methods

Stage one cervical cancer can be treated surgically. Since there are no metastases yet, removing the tumor along with part of the organ helps to avoid further development of the process. At the second stage, metastases are already present, therefore, in addition to surgical intervention, local radiation therapy is used. During it, the pelvic organs are treated and the metastases are destroyed.

In the third and fourth stages, there is no point in performing the operation. Combination treatment is used, including chemotherapy and radiation therapy. This allows you to stop the development of the pathological process, and also leads to the cessation of the spread of metastases.

Source: https://vashamatka.ru/zabolevaniya/rak/metastazy-pri-rake-shejki-matki.html

Main location of metastases

With a malignant lesion of a healthy organ (uterus), a gradual impairment of its functional ability is observed. However, for a long time a woman may not even suspect that she already has such a dangerous disease with its complications as cervical cancer.

The experience of oncologists allows them to claim that most often in uterine cancer, its metastases are found in 6 subgroups of lymph nodes:

periuterine, pericervical (primary);
iliac external and internal, as well as obturator (intermediate);
peri-aortic, common iliac, inguinal (secondary).

The prognosis of a woman’s survival and ability to work is greatly influenced not only by the specific area in which the secondary tumor focus was diagnosed. The total number of metastases, the initial state of health of the cancer patient, as well as the susceptibility of her body to the ongoing treatment measures are important.

Metastases in cervical cancer

The hidden danger of all oncological diseases lies in the occurrence of secondary tumor foci - metastases.

A cancer cell, breaking away from the main tumor in one of the possible ways, for example, using lymph or blood flow, moves to other distant organs, where it forms a new tumor.

Metastases occur in cervical cancer, already at later stages of the disease. This type of oncology was no exception. In some cases, individual metastases make themselves known faster than the main tumor.

Cervical cancer has two types of metastasis, the most widespread is lymphogenous . In this case, the atypical cell enters the lymph and affects the lymph nodes.

Cancer cells

Regional lymph nodes that are damaged in cervical cancer are six groups:

pericervical;
periuterine;
obturator;
internal iliacs;
external iliac;
common iliacs.

Metastasis to the peri-aortic and inguinal lymph nodes occurs much less frequently. The iliac lymph nodes are the first to be affected by metastases, and later all other types.

The second type of metastasis is hematogenous . It is characterized by the movement of a cancer cell through blood vessels along with blood. In this case, a secondary neoplasm can occur in distant organs; the liver, bones, lungs and kidneys are most often affected.

Possible risk factors

Representatives of the beautiful part of humanity, who can be classified as a subgroup at risk for cancer of the genital organs, should be wary of metastases in the uterus and its structures:

with diagnosed primary infertility;
with existing menstrual cycle disorders of various etiologies;
absence of childbirth;
menopause period;
obesity;
tumors and polycystic ovaries;
hormonal storms;
uncorrected hormone replacement therapy;
long-term use of estrogens;
diabetes;
negative hereditary predisposition.

It is especially recommended to carefully monitor the situation for those women in whose family there have already been cases of death from any neoplasms. Timely detected and treated uterine cancer significantly improves the prognosis and chances of a full recovery, without the risk of recurrence.

Causes of the disease

Human papillomavirus (HPV) has been proven to be the leading cause of cervical cancer. Several subtypes of this virus are moderately dangerous, but more than ten subtypes are called oncogenic and cause a severe form of dysplasia, which qualifies as a precancerous condition of the cervix, and cancer itself.

It can take a long time from the moment of infection with the papilloma virus to the appearance of a tumor. The tumor does not appear suddenly; it develops in several stages. During this time, there is a high chance of detecting a tumor or previous dysplasia using colposcopy and cytological examination of smears.

Many women become infected with HPV, but not all go on to develop cancer. Taking this into account, we can identify some risk factors that contribute to the disease:

frequent change of sexual partners;
a male partner who often changes his sexual partners;
early onset of sexual activity;
presence of sexually transmitted diseases;
a large number of births or abortions;
weak immunity;
smoking.

Symptoms

At an early stage of their occurrence, metastases from cervical cancer may not manifest themselves in any way. However, most often they behave much more aggressively than the main tumor. Thus, damage to the pelvic lymph structures is necessarily accompanied by swelling of the tissues of the lower extremities.

With the hematogenous spread of metastases, their symptoms will directly depend on the organ in which the secondary focus has formed. For example, localization of a malignant neoplasm in the structures of the lungs will not only be accompanied by persistent coughing, but also hemoptysis, hyperthermia, as well as increasing shortness of breath and general intoxication.

If the liver parenchyma is affected, the main clinical manifestations will be intense pain impulses in its projection – the right hypochondrium. And also - a change in the coloration of the skin and mucous membranes to a jaundiced tint, dyspeptic disorders in the form of the urge to nausea and vomiting, alternating constipation with diarrhea.

Disease in numbers

Despite the fact that the tumor is localized in such a way that it can be detected by visual examination by a gynecologist, in 40% of cases the pathology is diagnosed in an advanced stage. Mortality during the first year after detection of the disease occurs in 20% of patients; the main reason for this is the prevalence of the process throughout the body in the form of metastases, as well as relapse of the pathology.

The prognosis for patients with identified individual metastases is disappointing. According to statistics, only 10-15% of women survive to one year with a similar diagnosis. Treatment in most cases is palliative and ineffective.

According to studies of cervical cancer patients with different stages in the gynecology department of the Federal State Institution “RNIOI” of the Ministry of Health and Social Development of the Russian Federation, the following statistics were revealed:

the average number of patients with metastases at different stages of pathology was 12.5%;
Lymph nodes in cervical cancer were affected in 55%, lungs and pleura in 19%, and liver in 11.6%;
the frequency of metastasis depends on the stage and depth of tumor invasion. Thus, at the first stage, secondary lesions were detected in no more than 2.8% of patients, at the second stage in 10.2%, and at the third degree of pathology in 15%. At the fourth stage, metastases occurred in more than 76% of patients;
Depending on the depth of invasion, metastases were noted as follows: lesions up to 3 mm. — 5%, up to 5 mm. - 6.7%, up to one centimeter 34%. With invasion deeper than one centimeter, metastasis is more than 54%;
most often metastases form in women aged 40 to 60 years, their percentage is 28.5%;
interesting data were obtained regarding the timing of the occurrence of secondary lesions. In 38% of patients, metastases occurred in the first year of pathological progression. From one to three years, metastases were detected in 50% of women, in 8% secondary formations were identified with a period of disease progression from 3 to 5 years. Patients with a disease duration of more than five years experience metastases in 3.5% of cases.

Patients with cervical cancer with metastases have different mortality rates. Survival depends on the stage of the disease, tumor invasion, and treatment undertaken.

Stages of disease development

So five-year survival rate:

at the first stage it is 86%;
at the second stage - 48%;
at the third stage 22%;
The fourth stage has only a two-year survival rate, it is 11%.

Diagnostics

Any deviations in a woman’s well-being should be alarming and subject to careful analysis and examination by a specialist. Early diagnosis of the cancerous focus in the uterus, as well as its metastases, is half the success on the path to recovery.

Diagnostic procedures are aimed at establishing not only the location of the neoplasm, but also its histological structure and the stage of the pathological process. All this information allows the oncologist to assess the criticality of the situation and predict the further course of the disease, as well as draw up an adequate plan for treatment.

In order to timely detect cancer metastases, a woman is recommended to undergo the following set of diagnostic studies:

various blood tests;
gynecological examination with collection of biomaterial from suspicious areas;
Ultrasound of the pelvis, abdominal structures;
radiography;
CT or MRI of organs.

Only completeness of information allows us to judge the presence of metastases and the further prognosis of the patient’s life.

Signs of stage 4

At this stage, signs will appear:

spotting, even bleeding, from the vagina; pain in the sacrum, lower back, pelvic area; unpleasant-smelling white discharge with pus; problems with emptying the bladder and bowels; sudden weight loss; swelling of the legs.

In addition to the main symptoms characteristic of the primary tumor, other signs may be detected due to damage to other organs by metastases. The cancer spreads to the lungs, liver, bones and kidneys.

With metastases in the gallbladder and liver, jaundice will be a sign of the problem. If the lungs are affected, the patient will be bothered by a cough with hemoptysis. With metastases in the bones, severe pain is felt.

When patients complain of symptoms that have nothing to do with the tumor, but with the activity of metastases. Sometimes they grow faster than the primary tumor and can cause death.

Treatment tactics

The pathological process of formation of secondary cancer foci requires an integrated approach to drawing up a treatment plan. Main directions in the treatment of cancerous lesions:

the use of x-rays - radiation therapy;
use of specific medications - chemotherapy;
pharmacotherapy – medications that help strengthen and raise a woman’s body’s own defenses;
supportive, palliative care - in severe cases of the cancer process, identification of many secondary malignant foci in various organs.

Surgical excision of a tumor as a grown metastasis is possible only if it is single and accessible for such a procedure. Otherwise, treatment tactics are based on chemotherapy and radiation therapy.

The selection of the optimal set of treatment methods is carried out by a specialist individually after assessing information from laboratory and instrumental studies.

Among the preventive measures to prevent recurrence of uterine cancer, experts indicate the following. This is the implementation of all recommendations given by an oncologist to a woman during primary treatment procedures and a timely visit to the attending physician with dynamic monitoring of women’s health parameters.

Where does cervical cancer metastasize?

The hidden danger of all oncological diseases lies in the occurrence of secondary tumor foci - metastases. A cancer cell, breaking away from the main tumor in one of the possible ways, for example, using lymph or blood flow, moves to other distant organs, where it forms a new tumor.

What types of bone metastases can there be?

According to clinical and radiological characteristics, all bone lesions are divided into three groups:

osteoblastic - with a predominance of compaction beyond the physiological measure, but additionally grown tumor tissue does not impart strength to the bone and can compress the nerves passing nearby;
osteolytic - destruction of the structure prevails and the likelihood of a fracture increases as the cancer grows;
mixed - a combination of two types and this situation occurs most often.

It almost never happens that a patient has exclusively osteolytic or only osteoblastic foci; as a rule, a combination with a predominance of either a sparse lytic or an excessive blastic structure is diagnosed.