Cervical cancer, also known as cervical cancer, is a malignant tumor that occurs at the junction of squamous epithelial cells in the vaginal part of the cervix or migratory zone and columnar epithelial cells in the lining of the cervical canal. The mortality rate of cervical cancer in China is the fourth of the total cancer mortality rate and the second of female cancer.
Etiology
So far, the cause of cervical cancer is still inconclusive. Most mathematicians believe that it is the result of multiple factors, and its incidence is related to factors such as early marriage, early childbirth, multiple births, cervical erosion, too frequent sexual intercourse, circumcision and sex hormone imbalance. It is also related to socioeconomic status and mental stimulation. Recently, many authors have suggested that viral infections such as human papilloma virus are related to the occurrence of cervical cancer.
Early symptoms
Early stage of cervical cancer often has no obvious symptoms, or there is increased leucorrhea and irregular bleeding, occasionally contact bleeding after sexual intercourse or gynecological examination, and there is no obvious difference with chronic cervicitis, sometimes even smooth cervix, especially in elderly women with atrophied cervix. In some patients with cervical cancer, because the lesion is located in the cervical canal and the vaginal part of the cervix has normal appearance, it is easy to be overlooked and missed or misdiagnosed.
Middle and late stage symptoms
Once the symptoms appear, most of them have reached the middle and late stage. Common symptoms are as follows.
1. Vaginal bleeding: Irregular vaginal bleeding is the main symptom of cervical cancer patients (80%-85%). At the beginning, it is often bleeding after sexual intercourse, defecation, activity or gynecological examination, and the initial amount is small and often stops by itself; in advanced stage, the lesion is larger and then it will show multiple bleeding, or even a large amount which is life-threatening.
Younger patients may show prolonged periods, shortened menstrual cycles, and increased menstrual flow, while older patients often show postmenopausal vaginal bleeding in small or large amounts. If bleeding is frequent, the high blood loss can lead to severe anemia. In advanced cases, massive vaginal bleeding may lead to shock, mostly seen in tumors with aggressive growth.
2.Increased vaginal discharge: About 82.3% of patients have increased leucorrhea in various conditions and degrees, which is also the main symptom of cervical cancer patients. It is white, yellowish, bloody or pus-blooded, thin like watery or rice slop-like, fishy and smelly. It is foul-smelling or purulent if it is complicated by infection in advanced stage.
Pain: It is a symptom of advanced cervical cancer, with an incidence rate of 41.1%, mostly seen in stage III and IV patients. Patients may have symptoms such as lower abdominal discomfort, abdominal pain and lumbago.
4. Systemic symptoms: Fever is caused by metabolism of cancerous tissues, absorption of necrotic tissues or combined infection in late stage patients, and the body temperature is usually around 38℃, and a few of them can be over 39℃. Patients often show clinical manifestations such as emaciation, anemia, fever, systemic failure and cachexia in the late stage.
5.Spreading and metastasis symptoms: cancer tumor can invade the bladder when it spreads to the front, and patients will experience frequent urination, urgent urination, painful urination, falling and hematuria. The cancer can spread backward and invade the rectum, which can cause symptoms such as falling, difficulty in defecation, urgency, blood in stool, etc. Further development can lead to vaginal-rectal fistula. Distant metastasis may occur in the advanced stage of the disease. The symptoms may vary depending on the site of metastasis. The more common one is supraclavicular lymph node metastasis, in which nodes or masses appear. Lung metastases, liver metastases and bone metastases are also more common.
Physical signs
(1) There may be no positive findings in the early stage. In the late stage, the lymph nodes on the body surface are enlarged and occasionally metastatic cancer foci can be seen on the body surface.
(2) Positive pelvic signs can be seen in gynecological examination.
(① Vaginal speculum examination: the cervix has different degrees of local manifestations, such as erosion type, cauliflower type, nodular type, ulcerated type, and mostly contact bleeding.
② Internal examination: double and triple diagnosis, local hardening and coarsening of the cervix can be palpated, or a raised mass. The uterus is usually not large. The parametrium may have varying degrees of thickening, loss of elasticity, or a mass.
Common complications
(1) Pus accumulation in the uterine cavity: mostly caused by the cancer blocking the cervical canal, accompanied by generalized fever and foul-smelling vaginal discharge.
(2) Pelvic inflammatory disease: mostly associated with pain in the lower abdomen and lumbosacral pain, etc.
(3) Anemia: Mostly caused by tumor rupture and bleeding or erosion of larger blood vessels, easily combined with infection.
(4) Urinary tract obstruction: Mostly due to advanced tumor invasion of the parametrium, resulting in ureteral obstruction, hydronephrosis, and in serious cases, causing uremia, etc.