With the progress of international and domestic cervical cancer screening, some progress has been made in the prevention and early diagnosis of cervical cancer, but due to the vast area of China and the uneven economic level, there are still gaps in the general awareness of prevention and control and screening concepts of the residents, so the overall prevention and control is still not optimistic. Domestic situation The incidence rate of cervical cancer in China is still much higher than that in many middle-developed and developed countries, and the incidence rate in China is around 30,000-40,000 per year; another problem is that the age of the incidence of cervical cancer in China tends to be younger, which also puts forward a lot of new and serious problems for us, so we should strengthen the civic education and screening efforts, and make concerted efforts to reduce the incidence rate of cervical cancer. Characteristics and risk factors Small cell carcinoma of the cervix is a rare and unique primary cervical malignant tumor, which belongs to a kind of neuroendocrine cancer. Its incidence is very low, accounting for about 1-3% of cervical cancers. Compared with common cervical cancer, it also has many individual characteristics: 1, easy to metastasize in early stage; 2, high recurrence rate; 3, short survival time; 4, high false-negative rate of screening; 5, diagnosis is not easy; 6, some neuroendocrine factor markers need to be done to confirm the diagnosis. High-risk factors are similar to common cervical tumors: most of them are also associated with high-risk HPV infections, especially HPV18 subtype is the most common; in addition, some scholars believe that there is a correlation with genetic factors, such as heterozygous deletion of the short arm of chromosome 3, and so on. How to make clinical decisions As I said earlier, the incidence of small cell carcinoma of the cervix is low and disseminated, accounting for only 1%-3% of the cervical cancer incidence, and it is often encountered only once a year or a few years in the clinic, and there is a lack of large number of case studies, so there is no guideline for the doctors to follow, and most of the doctors are based on their own experience and exploration during the diagnosis and treatment process, but in recent years, there is also a certain amount of progress made. For example, the importance of chemotherapy in the treatment of small cell carcinoma of the cervix has been emphasized in recent years due to its characteristic of early bloodstream metastasis. The treatment plan based on chemotherapy, supplemented by surgery and radiotherapy has gradually gained recognition, but the specific long-term effects are yet to be observed and summarized. Interestingly, in 2014, I received 3 patients in about one month in a row, so it stimulated my research interest, we reviewed some similar cases diagnosed and treated in our department in the previous 10 years, and had postgraduate students do a survey follow-up, and we found that those patients all died within one year of the diagnosis of the disease, and according to some literature statistics, the average survival from the time of diagnosis of the patient to the time of death is 14.6 months. So this tumor is really a challenge for us. Since we don’t have complete norms and guidelines for diagnosis and treatment now, is it possible to make some attempts to treat it under the known basic principles? Because of the different stages, different ages, I met one in his 20s, one in his 30s, one in his 40s, and different stages, respectively IB1, IB2, and stage IIB, we personalized the treatment plan according to the different conditions of each patient, but the overall plan was based on surgery, supplemented with extracorporeal irradiation and radiotherapy, and 3 courses of chemotherapy before and after the radiotherapy were given respectively. In retrospect, all three patients have survived for two years, and all of them are tumor-free. From these three cases, we seem to have accumulated a little bit of experience that the “sandwich” therapy based on surgery, supplemented by chemotherapy, radiotherapy and then chemotherapy, may also be a better choice. Of course, we still need to observe and summarize whether this is a widely recommended method. However, the general principle is: control the whole body with chemotherapy, control the local area with radiotherapy, and remove the lesion with surgery. Current status of neoadjuvant chemotherapy in small cell carcinoma of the cervix This is a good question. Neoadjuvant chemotherapy for cervical cancer was advocated a lot around 2005, and there seems to be a different view in recent years, because many studies found that neoadjuvant chemotherapy could not improve the long-term prognosis, but based on the clinical experience, a considerable number of people still got the opportunity to have clinical surgery, and the complications during the surgery were also reduced. Neoadjuvant therapy is valuable, especially in our country, where there is a serious shortage of postoperative treatment. In particular, small cell carcinoma of the cervix is relatively sensitive to chemotherapy and has the characteristics of early stage and easy distant metastasis, so neoadjuvant chemotherapy is more meaningful, and it can even be said to be the main treatment rather than adjuvant treatment, so that its value is more prominent.