Cervical cancer

Introduction to cervical cancer Cervical cancer, also known as cervical cancer, refers to a malignant tumor that occurs in the vaginal and cervix of the uterus. It is one of the common malignant tumors in women, and the incidence rate is the second in female tumors. About 200,000 women die each year from the world. The cause of the disease is still unclear, and women with early marriage, early childbirth, prolific and sexual life disorders have a higher prevalence. There are no symptoms at the beginning, and abnormal vaginal bleeding can occur later. At present, the treatment plan is mainly surgery and radiation therapy, and comprehensive treatment of traditional Chinese and Western medicine can also be adopted, but the cure rate of middle and late patients is very low. Cervical intraepithelial neoplasia, microscopic early invasive carcinoma and very early cervical invasive carcinoma, no local lesions, smooth or mild erosion of the cervix such as general cervicitis. With the growth and development of cervical invasive cancer, local signs vary according to different types. Exogenous type of cervical sputum organisms grow outwards, which are polypoid or papillary, and then form cauliflower-like mites on the vagina. The surface is irregular. When the infection is combined, the surface is covered with gray-white exudate, which is easy to bleed. basic knowledge Sickness ratio: 0.05% Susceptible population: women with early marriage, early childbearing, prolific and sexual life disorders have a higher prevalence. Mode of infection: non-infectious Complications: peritoneal metastases, vaginal metastatic tumors

Causes of cervical cancer

Viral or fungal infections (25%):

Herpes simplex virus type II, human papillomavirus, human cytomegalovirus, and fungal infections may be associated with the development of cervical cancer. However, it is unsolved whether or not the virus is mainly induced or which kind of virus is prone to cervical cancer.

Bad lifestyle habits (20%):

Smoking as a synergistic factor in HPV infection can increase the risk of cervical cancer. In addition, malnutrition and poor sanitation can also affect the occurrence of disease. Unclean sex is easy to cause vaginitis, which may lead to cervical erosion, and long-term cervical erosion is closely related to cervical cancer.

Sexual behaviour and number of deliveries (15%):

Multiple sexual partners, initial sexual life <16 years old, primiparous age, and multiple pregnancies are closely related to cervical cancer.

Other biological factors (10%):

Infection with pathogens such as Chlamydia trachomatis, herpes simplex virus type II, and trichomoniasis has a synergistic effect in the pathogenesis of cervical cancer caused by high-risk HPV infection.

Cervical cancer prevention

1. Popularizing anti-cancer knowledge, promoting late marriage, less education, and conducting sexual health education are effective measures to reduce the incidence of cervical cancer. All married women, especially perimenopausal women with menstrual abnormalities or bleeding after sexual intercourse, should be alert to the possibility of genital cancer and seek medical advice promptly.

2. To play the role of women's anti-cancer health care network, regular screening of cervical cancer, once every 1-2 years, to achieve early detection, early diagnosis and early treatment. All women over the age of 30 who go to the gynaecology clinic should be routinely examined for cervical smears. Those with abnormalities should be further treated.

3. Active treatment of moderate and severe cervical erosion, timely diagnosis and treatment of CIN to block the occurrence of cervical cancer.

Cervical cancer complications Complications, peritoneal metastases, vaginal metastatic tumors

Uterine cancer combined with pregnancy is relatively rare, domestic reports accounted for 0.92% to 7.05% of total cervical cancer, foreign literature reported 1.01%, patients can be seen due to threatened abortion or prenatal bleeding, vaginal smear and living tissue The examination can confirm the diagnosis. If the pregnant woman has vaginal bleeding, the cervix should be examined by conventional speculum and the smear of the cervical smear.

The effect of pregnancy on cervical cancer, due to increased blood supply and lymphatic flow rate in the pelvis during pregnancy, may promote the metastasis of cancer; and the spread of cancer, severe bleeding and postpartum infection during childbirth, due to estrogen during pregnancy Cervical transition zone cell proliferation is active, similar to carcinoma in situ, but there is directional differentiation, polarity is maintained, these changes can be restored after delivery, pregnancy may also be combined with carcinoma in situ, can not be recovered after delivery, should be carefully distinguished.

Cervical cancer symptoms Common symptoms of squamous cellification, anal bulging, vaginal discharge, urinary frequency, constipation, urgency, cervical congestion, vaginal bleeding, non-stop

1, symptoms

Vaginal bleeding: young patients often show contact bleeding, occur in sexual life, gynecological examination and post-surgical bleeding, the amount of bleeding can be more or less, generally according to the size of the lesion, invading the interstitial blood vessels, the amount of early bleeding Less, advanced lesions are characterized by massive hemorrhage. Once the larger blood vessels are eroded, it may cause fatal bleeding. Young patients may also show prolonged menstruation, shortened cycle, increased menstruation, etc. Older patients often complain of irregular vaginal bleeding after menopause.

Vaginal drainage: patients often complain of increased vaginal discharge, white or bloody, thin as watery or rice soup, have a stench, late stage due to cancer tissue ulceration, tissue necrosis, secondary infection, etc., a large number of purulent or rice soup The foul leucorrhea is discharged.

Symptoms of advanced cancer: secondary symptoms appear according to the extent of lesion invasion, lesions affect pelvic connective tissue, pelvic wall, compression of ureter or rectum, sciatic nerve, often complain of frequent urination, urgency, anal bulge, constipation, urgency, lower limbs Swelling and so on, severe ureteral obstruction, hydronephrosis, and finally uremia, to the end of the disease, patients may appear weight loss, anemia, fever and systemic failure.

2. Signs

Cervical intraepithelial neoplasia, microscopic early invasive carcinoma and very early cervical invasive carcinoma, no local lesions, smooth or mild erosion of the cervix such as general cervicitis. With the growth and development of cervical invasive cancer, local signs vary according to different types. Exogenous type of cervical sputum organisms grow outwards, which are polypoid or papillary, and then form cauliflower-like mites on the vagina. The surface is irregular. When the infection is combined, the surface is covered with gray-white exudate, which is easy to bleed. Endogenous type see cervical hypertrophy, hard, cervical tube expansion such as barrel, smooth surface of the cervix or superficial ulcer. In the late stage, due to necrosis of cancerous tissue, a depressed ulcer is formed, and the entire cervix is sometimes replaced by a hollow, covered with gray-brown necrotic tissue and stench. Invasion of the vaginal wall of the cancerous foci is seen in the vaginal wall, and the tissues are invaded to the sides. The gynecological examinations are thickened on both sides, nodular, and the texture is similar to that of the cancerous tissue. Sometimes it infiltrates into the pelvic wall to form a frozen pelvis.

Cervical cancer examination

According to the medical history and clinical manifestations, especially those with contact bleeding, the possibility of cervical cancer should be considered. Detailed systemic examination and gynecological examination should be performed, and the following auxiliary examinations should be used.

1. Cervical scraping cytology

It is commonly used to screen for cervical cancer. A blade inspection must be performed in the cervical transition zone. Under the light microscope, you need to be careful and careful to avoid missed diagnosis and misdiagnosis. The anti-cancer smear was stained with Pap smear, and the results were grade 5, grade I normal, grade II inflammation, grade III suspicious, grade IV suspicious and positive, grade V positive. Class III, IV, and V smears should be repeated for smear examination and parallel cervical biopsy. The second-stage smear should be further examined by repeated smear after inflammatory treatment.

2. Iodine test

The iodine solution was applied to the cervix and vaginal wall to observe the coloration. Normal cervix and vaginal squamous epithelium are rich in glycogen and stained brown or dark reddish by iodine solution. If not stained, it is positive, indicating that the squamous epithelium does not contain glycogen. Squamous epithelium such as scar, cyst, cervicitis or cervical cancer does not contain or lack glycogen, and does not stain, so this test is not specific for cancer. However, the iodine test is used to detect CIN, which is mainly to identify the risk zone of cervical lesions, in order to determine the site of biopsy and improve the diagnostic rate.

3. Nitrogen laser tumor intrinsic fluorescence diagnosis

According to the affinity of fluorescein and tumor, the original fluorescence (ie, intrinsic fluorescence) in the human body is used to transmit the laser through the optical fiber (usually nitrogen laser) to stimulate the lesion, and the different colors emitted by the lesion tissue and the normal tissue are visually diagnosed: see the cervix The surface was purple or purple-red positive, suggesting a lesion; blue-white was negative, suggesting no malignant lesions.

4. Colposcopy

Cervical smear cytological examination of grade III or above, or patients with positive tumor fluorescence detection, should be observed under colposcopy, the presence or absence of abnormal epithelial or early cancer on the surface of the cervix; and select the lesion for biopsy to improve Diagnostic accuracy rate.

5. Cervical and cervical biopsy

It is the most reliable and indispensable method for the diagnosis of cervical cancer and its precancerous lesions. At the 3, 6, 9, and 12 points of the cervical squama-column junction, 4 biopsy was taken, or the biopsy was taken in the suspicious part of the iodine test, the tumor intrinsic fluorescence test, and the colposcopy. The tissue to be taken must have both epithelial tissue and interstitial tissue. If the cervical smear is a grade III or above smear, and the cervical biopsy is negative, a small curette is used to cure the cervical canal, and the scraping is sent for pathological examination.

6. Cervical conization

When the cervical smear is positive for multiple examinations, and the cervical biopsy is negative; or the biopsy is carcinoma in situ, but can not rule out invasive cancer, cervical conization should be performed, and the cut cervical tissue is divided into 12 pieces, each The block was examined for 2-3 sections to confirm the diagnosis. But now there are a variety of auxiliary examinations, plus cervical multi-point biopsy and cervical canal scraping can replace most of the cervical conization, so it is rarely used for diagnostic cervical conization.

After the diagnosis of cervical cancer, chest X-ray, lymphography, cystoscopy, and colonoscopy were performed to determine the clinical stage according to the specific conditions.

Diagnosis and diagnosis of cervical cancer

diagnosis

Diagnosis can be performed based on clinical manifestations, examinations, and the like.

Differential diagnosis

According to the symptoms and signs are not difficult to identify with other tumors of the uterus such as uterine fibroids, uterine body cancer.

Uterine fibroids:

Hemorrhage during January and menstruation: especially submucosal uterine tumors.

2 Pain: The general pain is only a vague pain, unless the uterus itself discharges the submucosal uterine fibroids, causing the uterus to contract.

3 compression symptoms: uterine fibroids can be compressed into the bladder, ureters, blood vessels, nerves and intestines, and produce a variety of operations that affect these organs.

4 infertility: uterine fibroids can affect the structure of the uterine cavity and the operation of the endometrium, making the implantation difficult, but also patients with uterine fibroids, the same can be normal pregnancy, normal production.

Uterine body cancer:

1. Vaginal persistent or irregular bleeding after vaginal bleeding; no menopause may have menorrhagia or irregular bleeding.

2. A small number of patients with vaginal discharge have watery or bloody discharge in the early stage of the disease. When the necrotic infection is complicated in the late stage, stench and pus and blood secretions may appear.

3. Pain generally only occurs in the advanced stage. When the cervical canal is blocked by cancerous tissue and causes hysteral hemorrhage or empyema, it may cause pain in the lower abdomen or cancer, which may cause pain. When the advanced cancer infiltrates the pelvic wall, There may be low back pain.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.