Two days ago, I wrote an article “Cervical problems, you can’t be lazy in this area! I happened to meet several fans who belonged to the case of “accidental cervical cancer” mentioned in it. Sorry for the anxiety caused by the lack of thoroughness in the previous article. For early stage cervical cancer treatment, the first choice is surgery. Although the mainstream view is that surgery should be the primary treatment, there are some views that early-stage cervical cancer should be treated by radiation therapy rather than surgery. On the issue of accidental detection of cervical cancer, the reason why it is written in the NCCN guidelines (the global guidelines for the prevention and treatment of tumors, can’t figure out what is called NCCN, just know that it is the authority), it shows that this phenomenon is not limited to China, the old United States, the old British, the old French, which we think is very bullish, the moon is particularly round, medical technology “super awesome” places also have. The “superb” place will also have. And the guidelines clearly state that the so-called “accidental detection of cervical cancer” is mostly found by accidental detection of CIN2~3 without first doing conization, but directly doing total hysterectomy, and of course also includes cases of hysterectomy for other reasons, such as uterine fibroids, adenomyosis, etc. Since we know that it is better to do conization first and then total excision for CIN2~3, why do so many people, even so many doctors, directly advise patients to do total excision? China is still a poor country in the end, especially when it comes to medical care, no one wants to spend more money. I had no intention of keeping my uterus, so why should I go under the knife twice? Isn’t it a waste of money? This is indeed true. Because for patients with CIN 2~3 found on cervical biopsy, only a very, very small number of them are combined with cervical cancer. This means that the strategy of conization followed by total excision will make the majority of people suffer from a cervical conization for nothing. Why do people who are not bad off choose to go for a full conization? Because of the “pain” ah! Why should I choose to have two cuts when the uterus is unwanted and the flesh is cut from the body anyway? Similarly, for most patients with CIN2-3 cervical biopsy results, choosing the strategy of conization and then total excision means an extra cut on the body for nothing. I wouldn’t want to do this if I were you. I am sure that the first reaction of many patients who were unexpectedly found to have cervical cancer was “Oh no, I didn’t have enough surgery, what should I do?” after reading my last article. They must be very anxious inside. Although doctors generally do not recommend this, it is still a good idea for patients who have been “accidentally discovered” to find psychological balance from this guide. “At least we’ve already cut out most of it, those people haven’t even had surgery yet.” There are remedial strategies in the guidelines for “accidental detection of cervical cancer”. The general steps are as follows: (Content referenced from the Chinese Journal of Obstetrics and Gynecology Clinical Guidelines Collection, 2015 edition) 1. Comprehensive assessment. When cervical invasive carcinoma is found unexpectedly after surgery, the depth and extent of the lesion should be reassessed comprehensively in the first instance. Regardless of the cause of the result at the beginning, there is no need for us to delve into the past, but the key is that this follow-up process should be done correctly. The methods of assessment include (1) pathology report, if the surgery was done in a primary hospital, the pathology slides can be sent to an authoritative institution for consultation of the slides; (2) imaging examinations, such as CT, MRI, PET-CT and other examinations. For those who have economic conditions, PET-CT (PET-CT) can be preferred. This examination has the highest recognition rate of tumor cells, however, because of the strong sensitivity, there is also the possibility of misclassifying normal proliferating active tissues as tumors, followed by MRI (magnetic resonance imaging) which is more advantageous for the recognition of vascular infiltration. 2. Grading. After secondary assessment of the disease according to pathological findings and imaging, remedial plan is formulated, and the main remedial strategy is simultaneous radiotherapy (radiotherapy + chemotherapy). (1) Stage A1 and without interstitial infiltration of the vasculature can be treated without secondary surgery or radiotherapy. (2) Those with stage A2 and above, or those with vascular infiltration, have two options. Secondary radical surgery is to cut the part not cut again according to the standard of radical cervical cancer surgery. Although the effect is not as good as the first direct radical surgery, it is still a remedy, but this problem, on the one hand, is difficult to operate, and on the other hand, it is difficult to have a large sample of authoritative data to assess how effective it is. If no metastasis is found in the pelvic lymph nodes after surgery, it can also be observed, but if the primary tumor is relatively large and the interstitial infiltration is deep, additional radiotherapy will be needed. Instead of secondary radical surgery, simultaneous radiotherapy is directly chosen. Please consult with gynecologic oncologist for details on how to choose. (Please note that it is a gynecologic oncologist, not an obstetrician/gynecologist, this section is very detailed. Even if I am familiar with the NCCN guidelines, I can provide consultation and indicate the general direction, but I can’t implement specific treatment, at least not at the moment.) This don’t pro, also don’t be frustrated, although I know you go to the hospital, the doctor will be a variety of “intimidation”, so you are very desperate, feel that the doctor all kinds of bad attitude, no medical ethics, these issues are not important, the important thing is that we now know what to do next. The development of things always moves forward in waves and spirals. Although surgery dominates the treatment of cervical cancer, the complications brought by surgery, such as urinary dysfunction and sexual dysfunction, will more or less affect the quality of life. And radiotherapy also has the disadvantages of radiotherapy. It is really difficult to distinguish between the good and the bad. Our clinicians can only give advice to patients based on their own personal experience, combined with the clinical guidelines at the time, and it is up to God whether this advice is optimal and whether the outcome is the best. Evidence in evidence-based medicine is always growing as it is overturned by constant “questioning”. What is considered very correct today may be overturned tomorrow. And what was proven wrong 10 years ago may suddenly be proven right today. Life goes on, no matter how the previous outcome was determined and how it went through. For people suffering from maladies, it is more important to see through life and death and life earlier, and not to spoil the limited view of life because of the obsession with life. We all have to die when we are born, and we have known this for a long time, haven’t we? There is nothing different now than knowing that my future days may not be as long as I thought they would be in the past!