How to prevent the occurrence of cervical cancer?
Cervical cancer is the most common malignant tumor of the female reproductive tract, with the second highest incidence rate among female tumors, after breast cancer. There are 500,000 new cases and 250,000 deaths per year worldwide, and the number of new cases in China is estimated to be nearly 100,000 per year, accounting for about 1/5 of the total number of new cases in the world; the number of deaths is about 30,000. Epidemiological data in recent years show that the incidence of cervical cancer tends to be younger and on the rise.
Cervical cancer is an infectious disease, mainly caused by human papillomavirus (HPV) infection, with HPV types 16 and 18 being the most common. HPV infection can lead to cervical intraepithelial neoplasia (CIN), i.e. cervical precancerous lesions. The general time for cervical precancer to develop to cervical cancer is about 10 years, and it is the only preventable gynecological cancer.
I. Who are the high-risk groups of cervical cancer?
1.Women with high-risk human papilloma virus infection in the reproductive tract
2.People who have multiple sexual partners or frequent sexual intercourse
3.High-risk male sexual partners (those who have had precancerous cervical lesions or cervical cancer)
4. women with a low age of first sexual intercourse
5. women with other sexually transmitted diseases, especially those with a mixture of multiple sexually transmitted diseases
6, women who are receiving immunosuppressive therapy
7, women who smoke.
8, women who have had cervical lesions, such as chronic cervicitis without timely treatment, CIN and a history of malignant tumors of the reproductive tract
9.Women with HIV infection.
What are the main symptoms of cervical cancer?
Typical symptoms include: vaginal bleeding, especially bleeding after intercourse, which is a danger signal of early cervical lesions; in the middle and late stages, there may be increased vaginal discharge or leucorrhea with bad odor; in the late stages, there may be frequent urination, urgent urination, anal swelling, constipation, lower abdominal pain, sciatica, swelling and pain in lower limbs, etc.
How to screen for cervical precancer and cervical cancer?
1.Cervical cytology examination, i.e. vaginal exfoliative cell smear, is the main method for screening and early detection of cervical cancer, and the detection rate of screening can be improved if women over 35 years old are preferably tested for high-risk HPV virus in combination.
2.Colposcopy should be performed. For those with suspicious or positive cervical smear cytology but no obvious cancer foci can be seen with naked eyes, colposcopy should be performed with vinegar white test and iodine test at the same time to determine the biopsy site according to what is seen, so as to improve the correct rate of biopsy.
3.Cervical and cervical canal biopsy is the most reliable and indispensable method to confirm the diagnosis of cervical cancer. When cervical scraping cytology is positive for many times but biopsy is negative, continuous pathological section of cervical conical excision should be performed to further confirm the diagnosis. Pathological diagnosis is the gold standard for cervical cancer diagnosis.
Optimal screening protocol: For those who are financially capable, high-risk HPV test combined with cervical liquid-based cytology (TCT, Autocyte) is recommended, which is highly sensitive, with very low leakage rate and accuracy rate up to 97%, and for those who are HPV negative and have normal cervical cytology, the risk of development is very low and the follow-up interval can be extended to 3-5 years; for those who are HPV positive but have negative cervical cytology, annual follow-up is recommended. For those who are positive for HPV but negative for cervical cytology, the follow-up interval can be extended to 3-5 years; for those who are positive for HPV and cervical cytology at the same time or negative for HPV but positive for cervical cytology, colposcopy should be performed and some tissues should be taken for pathological section under colposcopic guidance to confirm the diagnosis.
4. How to prevent cervical cancer
1. Practice late marriage and family planning, avoid early marriage and early childbirth, multiple births and disorderly sex life.
2. Practice hygiene and maintain proper sexual behavior.
3. Actively treat gynecological diseases, such as chronic cervicitis, cervical erosion, white spots, polyps and infections such as trichomonas and mycobacteria in the reproductive tract.
4. Male health; attention should be paid to the cleanliness of the foreskin, and those with excessively long foreskin should be treated surgically and cleaned before sex.
5. Primary screening screening for cervical cancer: any woman who has had sex for more than 3 years or has sexual intercourse over 21 years old, while the population of high-risk women is the focus of screening. Screening interval is 1 year.
V. About the cervical cancer vaccine
There are two companies producing HPV vaccines in the world: a 4-valent vaccine for HPV-6, HPV-11, HPV-16 and HPV-18, and a 2-valent vaccine for HPV-16 and HPV-18, both of which are high-risk types of HPV that cause cervical cancer. Data from 2003-2006 show that more than 20% of girls in the 14-19 age group are already infected with HPV, with HPV infection rates peaking at nearly 50% between the ages of 20-24. Since HPV is most commonly transmitted through sexual contact, girls aged 11-12 years without sexual contact are the most suitable group for vaccination, but the age of vaccination may be relaxed to 45 years.
However, it should be noted that the cervical cancer vaccine is not a panacea. While high-risk types HPV-16 and HPV-18 cause 70% of cervical cancers associated with HPV infection, the other high-risk HPV types cause 30% of cervical cancers that are not prevented by these 2 vaccines. For infections with high-risk subtypes other than the two or four viral subtypes that this vaccine can fight against, vaccination also does not provide protection, and continued condom use can reduce cervical cancer even more.
VI. Fertility problems of cervical cancer
1. A comprehensive gynecological examination must be done before pregnancy and cervical cancer screening must not be omitted!
Pre-cancerous lesions of the cervix and cervical cancer do not affect pregnancy in early stages, and even if there are symptoms of vaginal bleeding, they are often mistaken for the phenomenon of pre-miscarriage and ignored. Some women already have cancer before they get pregnant, but they are not tested or detected at that time. Therefore, women should have a comprehensive gynecological examination 2 to 3 months before they are ready to get pregnant.
2.Pregnancy can accelerate and worsen cervical cancer
According to medical research, the body’s resistance will decrease after pregnancy, and the change of estrogen and progesterone secretion will accelerate and worsen the cancer, and it will be too late to treat it after giving birth to a child. Therefore, once the lesion is detected, the doctor will make a solution based on the age of the pregnant woman, the extent of the lesion, and the requirements for childbirth. If necessary, in order to protect the safety of the mother, the pregnancy should be terminated and the cervical cancer should be actively treated in time for patients with combined middle and late stage cervical cancer.
3. Having cervical cancer does not mean that fertility cannot be preserved absolutely
It depends on the specific condition of the lesion. If it is a precancerous cervical lesion, the treatment can basically be carried out on an outpatient basis and does not require hospitalization. Nowadays, there are many treatment methods, such as laser, freezing, LEEP (a kind of electric scalpel used to remove part of the cervical lesion area) surgery, etc. If it is in situ cancer, it can be treated by conical excision surgery and can be discharged from hospital 2 to 3 days after surgery. For early-stage cervical cancer, extensive cervical excision with preservation of fertility can also be performed, which can preserve the uterus and the patient’s reproductive function.
If the disease has progressed to the middle or late stage of cancer, then extensive total hysterectomy combined with radiotherapy and chemotherapy will have to be used as a comprehensive treatment, and fertility cannot be preserved. Therefore, the treatment of cervical cancer emphasizes early detection and early treatment.
VII. Treatment of cervical cancer
Early stage cervical cancer is mainly treated by surgery, and the cure rate of in situ cancer and stage IA cervical cancer is close to 100%. Surgery is applicable to patients with cervical cancer stage IA to IIA, while patients with middle and late stage mostly choose integrated treatment such as radiotherapy plus chemotherapy.