The incidence rate of cervical cancer is the first among gynecological malignancies, which seriously threatens women’s health and survival. In recent years, the incidence of cervical cancer has been increasing year by year, by 2% to 3% per year, and the incidence has a tendency to be younger, and it is not uncommon to see cervical cancer patients in their 20s to 30s clinically. Scholars at home and abroad believe that the increasing incidence of cervical cancer and the tendency of youthfulness are related to factors such as early marriage, early childbirth and disorderly sexual life. Human papillomavirus (HPV) infection of the cervical epithelium is closely related to the occurrence of cervical cancer.
Clinical studies have proved that prevention of cervical cancer and reduction of cervical cancer mortality lies in early detection and timely treatment, and early cervical cancer can be completely cured. The progression from cervical precancerous lesions to cervical cancer is a long process of about 10 years. Therefore, cervical cancer is a preventable and curable gynecological malignancy, and the key lies in blocking the precancerous lesions of cervical cancer. Routine cancer prevention screening can not only detect cervical precancerous lesions and cervical cancer at an early stage, but also be diagnosed and treated promptly by early diagnosis.
Cervical intraepithelial neoplasia (CIN) CIN is a group of pre-cancerous lesions closely related to cervical invasive cancer, which reflects the continuous process of cervical cancer occurrence and development, including cervical pre-cancerous lesions and carcinoma in situ. Cytologically, squamous cell abnormalities are classified as atypical squamous epithelium (ASC), mild squamous cell intraepithelial lesion (LSIL) and severe squamous intraepithelial lesion (HSIL). ISIL is equivalent to CIN1, which is less likely to develop into cervical cancer, while HSIL is equivalent to CIN2 and CIN3, which may develop into cervical cancer. Cervical atypical hyperplasia (Dysplasia) has the same meaning as CIN.
CIN is a precancerous lesion that can be normal in appearance but has abnormal proliferative changes on cytological or histological examination. According to its degree of atypical proliferation, CIN is classified as CIN Ⅰ, CIN Ⅱ and CIN Ⅲ. CIN grade I corresponds to very mild and mild atypical proliferation; CIN grade II corresponds to moderate atypical proliferation; CIN grade III corresponds to severe atypical proliferation and carcinoma in situ. Sometimes the differences can be very small, yet 15% of CIN overall can progress to cervical cancer. It is sometimes difficult to predict the outcome of each case of CIN, which is at risk of further malignant development; the development of CIN into invasive carcinoma is 7 times more common than normal, which is the reason to pay attention to CIN and manage it properly.
Timely treatment of cervical lesions can effectively stifle their carcinogenesis: that is, the process of CIN – early invasive carcinoma – invasive carcinoma development can be interrupted thanks to treatment. The process from cervical precancerous lesions to invasive cancer is about 10 years. The so-called cervical cancer is a preventable and curable disease, and its key also lies in the timely diagnosis and correct treatment at this stage. It is recommended for married women to have cervical cytology examination routinely every year.
Diagnosis
Cervical intraepithelial neoplasia (CIN), like cervical cancer, must be diagnosed by histopathological examination. For the following reasons, the diagnosis of CIN can be made only with the combined use of several complementary diagnostic methods.
Clinical manifestations: CIN often does not have typical clinical symptoms and signs, so CIN cannot be diagnosed by gynecological examination, visual examination and palpation alone, and most literature reports that about half of in situ carcinomas (CIN III) do not have clinical symptoms. In recent years, some authors counted 172 cases of carcinoma in situ, 72.6% were asymptomatic, 12.2% had a small amount of irregular vaginal bleeding, and contact bleeding accounted for only 5.2%. According to the comprehensive literature, only 1.4%-3.6% of the CIN signs were clinically suspected to be cancerous, on the contrary, 10%-50% were smooth cervical cases, and some of them showed chronic cervicitis, different degrees of cervical erosion and cervical polyps.
Cytological pick-up: The accuracy of cytological examination for the diagnosis of CIN and early cervical cancer reported by different authors abroad varies greatly (67% to 92.6%), while the false negatives of cytological detection of CIN range from 10% to 35% and even up to 50%. About 30% of CIN is missed by single cytology.
Combined examination: Back in the 60s and 70s many authors reported that the accuracy of applying combined cytology and colposcopy to diagnose early cervical cancer was 98%-99.4%. Since the 1990s, there has been great progress in the diagnostic techniques for CIN and early cervical cancer.
Diagnostic methods
1.Cervical cytology (TCT)
2.Colposcopy
3.Cervical biopsy (Cervical biopsy) and endocervical curettage (ECC)
4.Conical hysterectomy (conization for short)
5.HPV testing
Cervical cytology.
Cytological examination is of great significance for the diagnosis of CIN and early cervical cancer, and has now become one of the routine gynecological examinations and the preferred screening method for cancer prevention screening. Thin-layer liquid-based cytology TCT method is used clinically and can completely replace conventional cytology. The introduction of TCT is an important innovation in cytology production, which improves the sensitivity and specificity of CIN and early cervical cancer screening by providing clear smears, uniform cell distribution and easy reading through negative pressure filtration thin layer production. The results of cytological examination are not the final diagnosis of cervical lesions and cannot be used as a basis for diagnosis and treatment. Further tests such as colposcopic cervical biopsy and cervical cone histopathology should be performed to confirm the diagnosis if there is any problem.
Cervical conization (conization for short)
Cervical conization is an ancient and traditional method of diagnosis and treatment that has been used for almost a century. Before colposcopy was widely used, conization was used for most cytologic abnormalities to definitively diagnose and exclude invasive cancer.
Treatment
The choice of treatment for CIN depends mainly on ① the grade of CIN and the extent of the lesion. ② Age, requirements for fertility and quality of life. ③Whether there is a combination of persistent and high-risk HPV infection. ④Follow-up conditions, etc. In recent years, the treatment of CIN tends to be conservative, so that the treatment of CIN is standardized and individualized.
The treatment of CIN is divided into two major categories: ①physical treatment ②surgical treatment
1.Physical treatment
The advantages and disadvantages of freezing, laser, electrocoagulation, etc. Physical therapy is mainly used for CIN grade I with small lesions and low grade, and electrocoagulation has the best effect.
2.Cervical conization
Cervical conization currently includes three kinds of ① Cold knife conization (CKC); ② Loop electrosurgical excision procedure (LEEP); ③ Laser conization.
In recent years, with the increasing incidence of CIN and the rejuvenation of cervical cancer patients, a lot of clinical studies have been made on the indications, contraindications, cure rate and complications of conization. With the emphasis on quality of life today, people have updated their concepts and reacquainted themselves with the clinical value of conization in the diagnosis and treatment of CIN, which can be used for young patients with in situ cancer who require preservation of reproductive function. Cervical loop electrosurgery is safe, simple and effective, and can be performed on an outpatient basis.
3.Total hysterectomy
Total hysterectomy is a thorough treatment method for middle-aged and elderly CIN III patients without fertility requirements.