Currently, cervical cancer is one of the widest-spread forms of malignant neoplasms. This disease occupies seventh place in incidence among all malignant neoplasms and third place in women (after mammary and colorectal cancers). Recently, a considerable increase in frequency of diagnosing different forms of cervical cancer in young women (up to 40 years old) has been observed.

Possible etiologic factors for developing cervical cancer include the early start of sex life, viral (human papilloma virus, HIV and genital herpes virus) and Chlamydia infections, a large number of sexual partners, traumas of the uterine cervix at childbirth and hereditary predisposition.

The main factors determining prognosis in patients with cervical cancer comprise the morphological texture of the tumor and the character and degree of tumor dissemination. It is accepted to distinguish two histological types of cancer of the uterine cervix: planocellular cancer accounts for 95–97% of all malignant neoplasms here, while 4.5% are adenocarcinomas. Undifferentiated cancer, melanoma, lymphoma and sarcoma are observed very seldomly (less than 1% of cases). It has been established that invasive planocellular cancer of the uterine cervix develops from the normal epithelium, passing through all the stages of precancerous dysplasia. Cancer in situ or preinvasive cancer is characterized by minimum signs of atypia and by absence of tumor dissemination beyond the basal membrane of the epithelium of the uterine cervix.

Cancer of the uterine cervix disseminates in three directions: to the vagina, to the uterine body and to the parametrium. In late stages the tumor may infiltrate the pouch of Douglas and urinary bladder. Lymphogenic metastasis occurs through lymph collectors of the parametrium to pelvic, iliac and, in still later stages, to paragastric lymph nodes. Hematogenic metastases of cervical cancer are most often observed in the lungs, liver and bones. In case of exophytic forms, as well as in the presence of mixed and endophytic tumor growth, a high frequency of lymphogenic metastasis is observed, while the vaginal variant of spreading is characterized by a lower metastasis rate. Adenocarcinoma is characterized by early metastasis and relapse (up to 12 months), while for planocellular cancer generalization is possible over 36 months.

The classification of cancer of the uterine cervix is presented in Table 13.1.

Cancer of the uterine cervix for long time has no clinical manifestations. Sometimes patients complain of abundant bloody or serous discharge from the vagina and hemorrhages. In case of small size of tumor there may be contact hemorrhages, which occur immediately after coitus. Later, pain syndrome appears. Pains are localized in the lumbar area, above the pubes and in the crotch. Pain syndrome usually intensifies when the tumor infiltrates the adjacent organs: the urethra, intestine, and urinary bladder.