Pay attention to the diagnosis and treatment of cervical precancerous lesions to stay away from cervical cancer

  Cervical cancer is one of the most common malignant tumors in women, with the second highest incidence rate (after breast cancer) and the first in developing countries, with nearly 500,000 new cases worldwide each year, 80% of which occur in developing countries. The incidence of cervical cancer has been steadily increasing in the past decade and tends to be younger, which has seriously threatened the health and lives of women and has attracted widespread attention.  Cervical cancer is an infectious carcinoma, the only disease among all cancers that can be completely prevented and is a tumor that can be completely defeated because it has a long and reversible precancerous period, its etiology is clear and has a clear relationship with human papillomavirus (HPV) infection, the treatment effect of early cervical lesions is much better than that of cervical cancer, the 5-year survival rate of cervical invasive cancer is reported to be 67%, and that of early cervical cancer is 90%. Early detection of cervical precancerous lesions and early cervical cancer, and timely and appropriate treatment can lead to a very good prognosis.  The outermost part of normal cervical tissue is composed of squamous epithelium of the vaginal part of the cervix and columnar epithelium of the cervical canal. The intersection of columnar epithelium and squamous epithelium of the ectocervix is a good site for cervical cancer, and under the stimulation of some substances (bacteria, virus, etc.), poor differentiation of cells, disorganized arrangement and abnormal nuclei can occur, forming cervical squamous intraepithelial neoplasia (CIN), which is also known as cervical atypical hyperplasia. According to the degree of epithelial cell heterogeneity and the extent of involvement, it can be divided into three types: mild cervical intraepithelial neoplasia (CINⅠ), moderate cervical intraepithelial neoplasia (CINⅡ) and severe cervical intraepithelial neoplasia (CINⅢ), which are equivalent to mild, moderate and severe atypical hyperplasia, respectively. atypical hyperplasia can have three transformation results, and after treatment, most of them can be restored to normal, some of them have no change, and some of them are transformed into cancer. The risk of developing CINⅠ, CINⅡ and CINⅢ to cancer is 15%, 30% and 45% respectively. The average statistic for pre-cancerous atypical hyperplasia of the cervix, from mild to moderate to severe, is about ten years, which would be an important and non-negligible time. If a woman is inadvertently infected with a virus that happens to have a carcinogenic effect, and under the continuous action of the virus, the cervix starts to develop lesions, according to the time it takes about ten years from HPV infection to the occurrence of cervical cancer, during these ten years If she goes to the hospital once for a checkup, the lesions may be found. Therefore, if we ask every woman to go to the hospital for regular checkups, for example, every one year or even every three to five years, the lesions may be detected, and the development of cancer can be completely blocked, and the tumor can be eliminated in the pre-cancerous process. It is well known that Anita Mui and Li Yuan Yuan both died of advanced cervical cancer. In terms of the development pattern of the disease, there were many opportunities for them to destroy this tumor within ten years of the pre-cancerous lesion, but unfortunately, they went to the hospital too late. Therefore, from the gynecologist’s point of view, we hope that women will have regular gynecological checkups, cervical cell smears, and go for checkups even without symptoms, so as to detect and treat precancerous cervical lesions in time and stop their development to cervical cancer.  There is no symptom in the early stage of cervical cancer. As the disease progresses, patients may have irregular vaginal bleeding. Early symptoms are a small amount of bloody leucorrhea and contact vaginal bleeding, and patients often come to the clinic for a small amount of vaginal bleeding after sexual intercourse or defecation. Younger patients may show prolonged periods, shortened cycles, increased menstrual flow, etc. Older patients often show vaginal bleeding after menopause. Vaginal bleeding in cervical cancer is often extremely irregular, usually less and then more, sometimes more and sometimes less. In advanced stages, when the cancer erodes large blood vessels, it can cause fatal heavy bleeding. Another more common symptom is vaginal discharge, which is manifested as increased vaginal discharge, white or bloody, thin like watery or rice soup-like, with fishy odor. In advanced stage, depending on the extent of the disease, symptoms such as frequent urination, urgent urination, anal swelling, constipation, urgency and pain in the lower limbs may occur, which may lead to ureteral obstruction, hydronephrosis and even uremia.  The examination methods for cervical lesions include cervical cytology, HPVDNA test, visual observation, colposcopy, and cervical biopsy. Based on the pathological diagnosis, the individualized treatment plan is taken into account in the specific situation. The main treatment methods are physiotherapy and surgery. Physical therapy includes freezing, laser, electrocoagulation, microwave, etc., all of which destroy tissue cells through physical action to achieve treatment. Before using the above treatment methods, cervical cytology and histological examination should be done to make sure there is no cervical cancer or suspected malignant changes, so as to avoid missing diagnosis or delaying the best time for treatment. Surgical treatment includes cervical conization and hysterectomy to ensure the best quality of life while treating the disease, and the principle of treating HPV infection is “treat the disease, not the virus”.  It is very important to follow up after treatment of cervical precancerous lesions. The first review will be conducted 4-6 weeks after treatment, every 6 months for two years, and once a year after two years, and if four consecutive reviews are normal, routine screening can be returned. Screening is very important due to the specific nature of cervical lesions. Screening refers to the detection of suspected cancer patients from the “healthy” population without symptoms and/or signs through certain screening methods, followed by early diagnosis and early treatment. The screening interval is once a year for traditional cytology smear, once every two years for thin layer liquid-based cytology (TCT), and once every 2-3 years for 3 consecutive normal times after the age of 30. Early diagnosis and treatment is the purpose.  Women are reminded that they must pay attention to the diagnosis and treatment of cervical lesions, and cervical cancer is not terrible, it is a preventable and curable disease. The key to prevention is to improve women’s hygiene, develop good living habits and healthy life attitude, have regular medical checkups, detect and treat cervical precancerous lesions in time to stop them from developing into cervical cancer, and let’s work together to keep away from cervical cancer.