Cervical cancer is the most common gynecological malignancy and ranks second after breast cancer in terms of incidence among women’s cancers. Its mortality rate is the first among malignant tumors in women. Globally, there are about 500,000 new cases and 200,000 women die from cervical cancer every year; in China, about 80,000 women die from cervical cancer every year.
In developed countries, its incidence has decreased significantly, which is largely attributed to the early diagnosis and treatment of cervical precancerous lesions. In contrast, the low standard of living of people in developing countries, the awareness of medical personnel and the general public on preventive health care is not strong, and cervical cancer screening is not popular; in addition, cervical cancer has no symptoms or the symptoms are not obvious in the early stage, so 80% of the patients are already in the middle and late stage of cancer when it is detected, and its treatment effect is poor.
In China, due to women’s neglect of cervical diseases, the incidence of cervical cancer is six times higher than that in developed countries. It is especially noteworthy that due to the change of people’s attitude towards sexual life, HPV infection has increased, so that cervical cancer, which originally occurred mostly in women around 50 years old, is now also targeting young women, with patients around 20 years old accounting for about 5% of the incidence rate.
Human papillomavirus (HPV) infection is currently considered to be the main cause of cervical cancer. In addition, other factors associated with the development of cervical cancer include early sexual intercourse (before the age of 18), multiple sexual partners or sexual partners with multiple sexual partners; sexual partners with cervical cancer; HIV-infected individuals; individuals with other sexually transmitted diseases; individuals undergoing immunosuppressive therapy; individuals who smoke or are drug addicts; and low socioeconomic class.
Early stage cervical cancer often has no obvious discomfort and can be easily ignored.
Ms. Liang, who was in her early forties, always had vaginal bleeding after intercourse in the last six months, and had not been to the hospital for examination because she was very busy at work. After the news of Anita Mui’s death due to cervical cancer broke out, Ms. Leung finally gathered the courage to come to the hospital.
Early stage cervical cancer often has no obvious symptoms or special signs, and is not distinct from chronic cervicitis, so it is easy to be overlooked and missed or misdiagnosed. The earliest symptoms of cervical cancer patients are vaginal bleeding and increased leucorrhea. Vaginal bleeding: Young patients often complain of vaginal bleeding after sexual intercourse or gynecological examination. Increased leucorrhea: leucorrhea is white, yellowish, bloody or pus-blooded, thin like water or rice slop, fishy and smelly.
Early diagnosis method of cervical cancer.
After understanding Ms. Liang’s situation, the attending obstetrician and gynecologist immediately performed a gynecological examination for her, took a small amount of cells on the surface of the cervix with a small brush and sent them for examination, and did a vaginal magnification examination. The whole procedure took only a few minutes and Ms. Liang did not feel any discomfort. A week later, Ms. Liang came to the hospital for a follow-up examination. The doctor told her that the test result was very early stage cervical cancer.
Although cervical cancer has a high incidence and mortality rate, it is one of the easiest tumors in the whole body to make early diagnosis. The special anatomical location of the cervix makes it very easy for gynecologists to observe its changes. The diagnosis can be made with a few relatively simple tests (usually without any pain). Tests for cervical cancer are divided into two categories: screening and confirmatory. The most commonly used screening tests include cytology, HPV-DNA test and colposcopy.
Cytology has the advantages of simple sampling, non-invasive and easy to repeat. A small number of cells are taken from the surface of the cervix with a special wooden scraper or a small brush, and then examined in detail under a microscope, and the whole process is painless. The Pap smear method has been used since the 1950s until now, and the recent advent of liquid-based cytology testing (TCT) technology is a great advancement in cytological examination. TCT was approved by the FDA in May 1996 and is widely used in the United States, United Kingdom, and Australia, and is recommended by the American Academy of Pathology, the National Institute for Clinical Excellence (NICE), and the Hong Kong Government’s Family Planning Association.
HPV-DNA testing is another screening method. Since HPV infection can be detected in the majority of cervical cancer patients to date, HPV infection is now considered to be the main cause of cervical cancer. Therefore, by testing for HPV, early cervical cancer can be detected.
Colposcopy is also one of the methods of cervical cancer screening. Colposcopy can magnify the cervix 16 – 40 times, allowing closer observation of cervical epithelial changes and making early diagnosis through identification of cervical changes. Colposcopy requires very high equipment and experience of the examiner and is only suitable for early diagnosis by specially trained gynecologists in large hospitals where available.
The diagnosis of cervical cancer requires a biopsy under the guidance of colposcopy and eventually a pathological examination.
How to do cervical cancer screening?
In order to prevent and reduce the occurrence of cervical cancer, the Ministry of Health of China has recently developed a cervical cancer screening program suitable for China’s national conditions.
In the light of the actual situation in Guangdong, we suggest that
1.Women with good economic condition: TCT plus HPV screening.
2.Women with average economic condition: TCT examination
3.Women in poor economic condition: Pap smear.
The age of starting screening for cervical cancer is usually set at 30 years old, but those under 30 years old should also be screened if they are unwell. Screening interval for cervical cancer: Currently, it is believed that it generally takes about 10 years from HPV infection to the development of invasive cervical cancer. Therefore, if the result is negative after TCT and HPV examination, the screening interval can be extended to 3 – 5 years. If only one of TCT, HPV or Pap smear has been performed, the recommended interval is 1 year.
How to prevent cervical cancer?
1. Popularize the knowledge of cancer prevention and promote late marriage and less childbearing. Married women, especially those who have bleeding during sexual intercourse or abnormal menstruation before or after menopause, should seek medical advice to exclude reproductive tract tumors.
2.Sound women’s cancer prevention and health care network, regularly carry out census and general treatment of women’s diseases, especially cervical cancer, to achieve early detection, early diagnosis and early treatment. All women over 30 years old should routinely undergo cervical smear or high-risk HPV-DNA examination when they come to the clinic. Colposcopy or multi-point cervical biopsy should be performed when abnormalities are found.
3. Actively treat precancerous lesions to interrupt the occurrence of cervical cancer.
Some changes in views on cervical cancer.
1. In the past, it was thought that cervical cancer occurred in people with disordered sex life, and those without sex life would not get cervical cancer (such as nuns), but now it is thought that cervical cancer is due to HPV infection. Since HPV can live about 16 hours outside the body, so those without sex life can also be infected with HPV and therefore can also get cervical cancer. Advanced cervical cancer has been reported in 16-year-old girls with no history of sex. It can be seen that sex is only a risk factor for the development of cervical cancer, and we cannot simply think that cervical cancer is not related to those who have no sex.
2.The previous view was that cervical erosion was a risk factor for cervical cancer and patients with cervical erosion should be treated actively to prevent cervical cancer. Nowadays, it is believed that cervical cancer is related to persistent HPV infection and no treatment is needed for asymptomatic patients with cervical erosion.
As warts are also caused by HPV infection, it used to be thought that those with warts are prone to cervical cancer. Due to the continuous research on HPV typing, it is now clear that warts are caused by low-risk HPV infection, while cervical cancer is caused by high-risk HPV infection and there is no crossover between the two. Therefore, screening for cervical cancer should test for high-risk HPV.
Therefore, cervical cancer is not scary, and with the current medical level, it can be diagnosed and treated at an early stage, even before it develops into cancer, and early intervention can be made so that it does not develop into cancer. At present, cervical cancer vaccine is under development, and it is believed that in the near future, the introduction of cervical cancer vaccine will make cervical cancer the first preventable tumor for human beings, so that women can say goodbye to cervical cancer forever.