Cervical cancer is the most common malignant tumor of the female reproductive system worldwide. It has the highest incidence in developing countries, especially in parts of Asia, South America and Africa. Cervical cancer ranks second after gastric cancer in the number of deaths from all malignant tumors among women in China. Its geographical distribution is characterized by a high incidence area linked together, forming a high incidence zone from Inner Mongolia, Shanxi through Hunan, Hubei to Jiangxi. Rural areas are higher than urban areas. The age of onset of the disease ranges from 15 to 80 years old, with the peak age being 50 years old. In recent years, the number of people younger than 40 years old has increased.
I. Risk factors
1.Sexual factors cervical cancer has been included in sexually transmitted diseases.
(1) Sexual behavior: People with disordered sexual life (having sex with more than one man) and sexually transmitted diseases have an increased risk of cervical cancer. The relative risk of cervical cancer in the wife of a husband with two extramarital sexual partners increases.
(2) Early age of first sexual intercourse (before 18 years old): It has been confirmed that the incidence of cervical cancer in women who have sex at an early age is four times higher than that of women in general. Most cervical cancers occur in those married under 20 years old, which may be related to the immature development of the lower genital tract of young women and their sensitivity to the stimulation of cancer-causing factors.
(3) Poor vulva hygiene and lack of attention to menstrual hygiene by oneself or spouse. The male partner is overcircumcised, circumcised, etc. If the husband is circumcised and has not been removed, the risk of cervical cancer in the wife increases.
2. Marriage and pregnancy factors ① The incidence of cervical cancer increases significantly if one or the spouse is married more than once. The incidence of cervical cancer is significantly higher in women who have been married more than twice than those who have been married once. ②Multiple births: those who have given birth more than 7 times have the highest risk of cervical cancer.
3. High-risk husbands High-risk husbands are men who have cancer of the reproductive tract such as penile cancer, prostate cancer or the ex-wife of the man who has cervical cancer. The risk of cervical cancer increases for the wife of a penile cancer patient. (9) Wives of prostate cancer patients have increased risk of cervical cancer. (3) The risk of cervical cancer in the current wife of a man whose ex-wife has cervical cancer also increases.
4.The risk of cervical cancer increases in women who smoke for a long time compared to women who do not smoke. Some scholars have monitored the cervical mucus of smoking women and found that the nicotine content is quite high.
5.Endocrine factors ①Some people tested that estrogen can induce cervical squamous carcinoma in mice. ② Contraceptive pills can cause excessive endocervical canal hyperplasia and even polyp-like formation. It has been studied that the relative risk of cervical cancer increases in those who have taken oral contraceptives for more than 8 years.
6.Infection factors ① Trichomonas vaginitis often coexists with cervical cancer or precancerous lesions. Some people have been successful in inducing cervical cancer with trichomonas infection. ②Viral infection: According to statistics, about 35.5% of cervical cancer patients have more than 4 types of reproductive tract viral infections at the same time. Human papillomavirus (HPV) and herpes virus are considered to be carcinogenic agents of the cervix. ③Fungal infection: fungus is a predisposing factor for cervical cancer and cervical erosion, which can cause cancer directly and also produce carcinogenic toxins. ④Low immunity, such as women with chronic kidney disease, AIDS or other immune system diseases. ⑤ Cervical laceration and cervical erosion. Data show that cervical cancer is common in women with birth lacerations that are not repaired in time. The incidence of cervical cancer is higher in patients with cervical erosion than in normal people.
7.Socio-economic status Agricultural workers with low economic, cultural and health level and women who do not pay attention to health care.
8. The risk of cervical cancer for women engaged in certain occupations such as stevedoring, construction, tanning and fur industry is more than ten times or even tens of times higher than that for women in other occupations.
Abnormal manifestations
Increased leucorrhea is an early symptom of cervical cancer, which mostly occurs before vaginal bleeding. In the early stage, leucorrhea may be mucus or plasma in nature, and may be rice-soup-like or blood-water-like as the disease progresses. It has fishy odor, and in late stage, secondary infection may appear with large amount of purulent foul-smelling liquid.
2.Vaginal bleeding is a common symptom of cervical cancer. Vaginal bleeding of cervical cancer is divided into three cases as follows.
(1) Contact bleeding: it is manifested as bleeding after sexual intercourse or bleeding during gynecological examination. This symptom can sometimes appear before the increase of leucorrhea.
(2) Irregular bleeding: It is vaginal bleeding other than normal menstruation, and the amount of bleeding is sometimes more or less, and the bleeding is incomplete. In the early stage, the bleeding is mostly small, but in the late stage, when the lesion is large, it may show a lot of bleeding and even life-threatening. Young patients may show prolonged periods, shortened menstrual cycles, and increased menstrual flow.
(3) Postmenopausal bleeding: It mainly manifests as irregular vaginal bleeding after menopause in the elderly.
(3) Pain is mostly a symptom of late stage, caused by tumor compression. Patients may have lower abdominal discomfort and pain, lumbago, sciatica, edema and pain in lower limbs, etc.
4.Other symptoms such as invasion of bladder may cause frequent urination, urgent urination, painful urination, falling and hematuria. In serious cases, vesico-vaginal fistula may appear, causing urine to be discharged from vagina without control.
5. In the late stage, symptoms such as emaciation, anemia and fever may appear.
III. Preventive health care
Cervical cancer is a disease that can be detected and diagnosed at an early stage. The majority of cervical cancer has a slow course and its precancerous lesions can be advanced by 10~30 years. Vaginal cytology examination can prevent and treat precancerous lesions in time, and can eliminate cervical cancer in the early stage. Therefore, the prevention of cervical cancer should be given high attention.
Carry out adolescent sexual health education, so that female adolescents know that the cervical is in the period of squamous epithelial metamorphosis during adolescence, which is particularly sensitive to carcinogenic substances, so as to realize the danger of early sexual intercourse and not to have sexual life too early.
2. Don’t get married too early, get married at the right age and undergo premarital examination. If the man is found to be circumcised during the premarital examination, he should be married after circumcision.
3.After marriage, pay attention to sexual organs, sexual hygiene and menstrual hygiene. Insist on family planning. Avoid birth injuries. Do a good job of contraception, avoid abortion. Contraceptive methods to use condoms is preferred.
4, both couples should be clean, avoid extramarital sexual partners, prevent viral infections and sexually transmitted diseases.
5.Do not actively smoke and try to avoid passive smoking.
6.Women over 30 years old should actively participate in cancer screening, at least once every 5 years. For gynecologists regardless of the patient’s complaints at the time of consultation, cervical smear cytology should be given as long as no census examination has been done in the past 3-5 years. For women over 35 years old, early prevention and treatment of precancerous lesions such as chronic cervicitis, cervical erosion, cervical squamous epithelial atypical hyperplasia and cervical leukoplakia.
7. Women with a history of sexually transmitted diseases should be actively treated for STDs, followed up closely and attended annual screening.
8.Human reproductive tract viruses are mostly carried by circumcision and spread through unclean sex, so men should pay attention to genital hygiene, pay attention to cleanliness before sexual intercourse, and remove the foreskin as soon as possible if it is found to be too long.
9, there are “high-risk husbands” of women, such as the census results of the cervical abnormalities should be closely followed up, generally once every 3 to 6 months.
10.Be alert to cancer signals such as bleeding after sexual intercourse or irregular vaginal bleeding, and go to oncology hospital for examination as soon as possible.
11. Go to regular hospital for treatment and follow-up in time after cervical cancer is detected. Patients with cervical cancer should have regular vaginal cell smear examination after treatment.
12. Pay attention to a balanced diet and eat more fresh vegetables and fruits to maintain sufficient vitamin intake.
To sum up, to reduce the risk of cervical cancer, women must stop smoking pay attention to personal hygiene and most importantly safe sex, i.e. fix one sexual partner or else use condoms.
Cervical cancer is one of the few tumors that have been fruitful in cancer prevention and screening in China.
IV. Early signs
Early symptoms of cervical cancer include increased leucorrhea, abnormal vaginal bleeding, pain in the waist and abdomen or difficulty in urination and defecation, etc.
1.Women with precancerous lesions and early cervical cancer usually have no symptoms, which is the importance of regular screening.
2.Abnormal vaginal bleeding: bleeding after sexual intercourse, non-intermenstrual bleeding, increased menstrual volume or prolonged menstrual period.
3.Vaginal discharge: Cervical cancer will cause increased vaginal discharge with odor.
4.Pain: painful intercourse or spontaneous pain.
No matter how much bleeding or the color of vaginal discharge is dark or light, you should see a doctor for a clear examination.
V. Sign of recurrence
1.Vaginal bleeding, increased leucorrhea and other pre-treatment symptoms of cervical cancer, and the appearance of vaginal bloody plasma discharge with bad odor are typical symptoms of cervical cancer recurrence.
2.Discomfort in lower abdomen, and gradually appear pain in lower limbs, edema in lower limbs, pelvic pain, often radiating to thighs and buttocks, also manifested as pain in buttocks or deep central pelvic pain, difficulty in urination and defecation, and sometimes lower abdominal mass is found.
3.Distant metastasis symptoms: coughing, coughing sputum, blood in sputum, hemoptysis, chest pain, etc. In case of lung metastasis, there are enlarged lymph nodes on the clavicle and groin with hard texture and poor mobility. In the case of bone metastasis, focal pain in the corresponding area of the bone is observed. In the case of liver metastasis, discomfort or pain in the right upper abdomen and jaundice may appear in the advanced stage. If it spreads to the ureter and causes obstruction, the patient may develop renal failure.
Vaginal bleeding or abnormal discharge is an early sign of tumor recurrence, but it should be noted that patients may also experience this phenomenon within a few months after radiation treatment, so patients should review regularly and make correct judgment in time after examination by specialists. Moreover, if the recurrence of cervical cancer can be detected early, patients still have a chance to be cured. Therefore, after cervical cancer treatment, patients must pay attention to the above abnormal signals and follow the doctor’s instructions for regular re-examination. When tumor recurrence or metastasis is suspected, biopsy as well as ultrasound, CT, MRI or isotope lymphography should be performed by a specialist to make a clear diagnosis.
High risk groups
1. Those who have bad sexual behavior, such as early sexual life for the first time or disorderly sexual life.
2.Women with early marriage, early childbirth and multiple births.
3.Atypical cervical hyperplasia, especially those with moderate or severe degree.
4.Husbands with sexually promiscuous behavior or unclean sex habits. Husbands who are circumcised, circumcised or suffering from penile cancer.
5.People with human papilloma virus infection.