Etiology
1.Marriage and sexual life: related to early marriage, early childbirth, multiple births, premature and frequent sexual life, chaotic sexual life and other factors.
2.Infection: High-risk human papillomavirus (HPV) infection is the primary cause, and HPV infection is also a necessary factor in the development of cervical cancer. In addition, herpes virus type II, syphilis, chlamydia and other infections may also be related to the development of cervical cancer.
3.Other related: cervical cancer development is also related to cervical erosion, endocrine disorder, smoking, family history of tumor, malnutrition and other factors.
Pathology
Cervical invasive carcinoma generally develops from cervical intraepithelial neoplasia. Squamous carcinoma accounts for most of them, about 80%, followed by adenocarcinoma, adenosquamous carcinoma and other rare types. Once formed, invasive cervical cancer is irreversible and the cancer cells will continue to infiltrate and spread through local infiltration, lymphatic metastasis and hematogenous metastasis. Local infiltration of the cervix may involve the vagina, uterine cavity, main ligament, uterosacral ligament, etc. Paracervical tissue may spread to the pelvic wall or compress the ureter causing ureteral obstruction. Advanced lesions may spread into the abdominal cavity or invade the rectum and bladder. Late stage metastasis can be metastasized to liver, lung, bone, brain and other parts of the body through hematogenous metastasis.
Diagnosis
1.Symptoms: Most patients with early stage cervical cancer do not have any symptoms, while the following symptoms are common in middle and late stage patients.
(1) Increased vaginal discharge.
(2) Vaginal bleeding: irregular vaginal bleeding, contact vaginal bleeding, non-menstrual bleeding, post-menopausal vaginal bleeding, etc.
(3) Pressure symptoms: back pain, edema of the lower limbs or vulva, urinary urgency and frequency, hematuria, dyspareunia, etc.
(4) Systemic symptoms: fever or cachexia.
(5) metastatic symptoms: lung metastases may include chest pain, hemoptysis, etc., and bone metastases cause somatic pain, etc.
(2) Signs: Early cervical cancer may show localized erosion, erythema and superficial ulceration. Localized tumor progression of the cervix may show obvious neoplasia, which may be manifested as increased erosion or cauliflower-like or ulcerated neoplasia.
3.Cervical/vaginal cytology smear: It is the main method to screen for early cervical cancer.
4.Histopathology: colposcopic clamped cervical biopsy, cervical canal scraping and conical hysterectomy specimens are sent for pathological histological examination, which is the gold standard for cervical cancer diagnosis.
5.Imaging examination: vaginal ultrasound, pelvic ultrasound, CT/MRI can assist in determining the extent of cancer and the degree of infiltration.
6.Serum tumor markers: SCC is an important marker for cervical squamous carcinoma, CA199, CEA and CA125 have certain reference value for the diagnosis of cervical adenocarcinoma, and NSE has reference value for cervical neuroendocrine tumor.
Staging
Stage I; cancer is confined to the cervix.
Stage Ia; the diagnosis can be made only under microscope when no lesion is seen by the naked eye of the cervix, also known as early infiltrating carcinoma, microscopic infiltrating carcinoma, early infiltrating carcinoma in situ, etc. The depth of interstitial infiltration does not exceed 5 mm, and the horizontal range of infiltration does not exceed 7 mm.
Stage Ia1; the depth of interstitial infiltration does not exceed 3mm, and the horizontal range of infiltration does not exceed 7mm.
Stage Ia2; the depth of interstitial infiltration exceeded 3 mm but did not exceed 5 mm, and the extent of horizontal infiltration did not exceed 7 mm.
Stage Ib; the scope and depth of microscopic lesions exceeded stage Ia2, or cervical tumor lesions were visible to the naked eye on clinical examination. Interstitial infiltration, intravascular or lymphatic vessels with tumor emboli do not change the stage, but should be noted so that future judgment can be made as to whether it affects the outcome of treatment.
Stage Ib1; cervical tumor lesion Q4 cm in diameter visible to the naked eye on clinical examination.
Stage Ib2; cervical tumor lesion >4 cm in diameter visible to the naked eye on clinical examination.
Stage II; the cancer exceeded the cervix, but the vaginal infiltration did not reach the lower third and the parametrial infiltration did not reach the pelvic wall.
Stage IIa; cancer involving mainly the vagina, without involvement of the parametrium.
IIa1; the maximum diameter of the lesion does not exceed 4 cm.
IIa2; the maximum diameter of the lesion is greater than 4 cm.
Stage IIb; cancer infiltrates mainly the parametrial tissue and does not reach the pelvic wall.
Stage III; the cancer exceeds the cervix, the infiltration has reached the lower third of the vagina, and or the parametrial infiltration has reached the pelvic wall, and or it causes hydronephrosis and non-functioning kidney.
Stage IIIa; cancer involving mainly the vagina, reaching the lower third of the vagina, without invading the pelvic wall.
Stage IIIb; cancer infiltrates predominantly the parametrium, and or the parametrium infiltrates the pelvic wall, and or causes hydronephrosis and non-functioning kidney.
Stage IV; cancer spreads beyond the true pelvis or cancer infiltrates the bladder mucosa or rectal mucosa.
Stage IVa; cancer infiltrates adjacent organs.
Stage IVb; cancer infiltrates beyond the true pelvis and has distant metastasis.
Treatment
Early stage cervical cancer (stage I-IIa): in principle, surgery should be performed, while radical radiotherapy should be used for those who are not suitable for surgery.
Locally advanced cervical cancer (stage Ib2 to IIa2): simultaneous radiotherapy or radical surgery can be chosen. Neoadjuvant chemotherapy is recommended before surgical treatment, and adjuvant therapy should be administered to those with high-risk factors after surgery.
Intermediate and advanced cervical cancer (stage IIb to stage IV): synchronous radiotherapy is chosen for stage IIb to stage IVa. Synchronous radiotherapy can reduce the risk of death of patients by 40% compared with radiotherapy alone. stage IVb is absolutely advanced, palliative chemotherapy is the main treatment, and best supportive treatment is performed for those with poor basic score.
Early stage, locally advanced stage and middle and advanced stage treatment should be based on surgery and radiotherapy, and moderate combination of Chinese medicine treatment aims to deal with post-operative physical deficiency and deficiency of vital energy, as well as to reduce the side effects of radiotherapy and improve the tolerance of radiotherapy. For absolutely advanced cervical cancer, the purpose of administering Chinese medicine infusion and oral Chinese medicine at the same time as supportive treatment is to improve symptoms and reduce pain.
Prognosis
The factors affecting the prognosis of cervical cancer are mainly histological type and clinical stage. The 5-year survival rate of cervical cancer is generally around 60%. The 5-year survival rate of early-stage cervical cancer can reach 90%, while the survival rate of advanced stage is only about 10%. Some rare pathological types have poor prognosis, such as small cell type, clear cell type and neuroendocrine type.
Prevention
We advocate late marriage and late childbirth, eugenics, avoid premature, excessive and chaotic sexual life, and regular gynecological cancer screening for adult married women.