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Abstract: Patient Auntie Wang, 45 years old, had recurrent symptoms of bleeding after intercourse or irregular vaginal bleeding. She initially thought it was an incomplete menstruation, but the symptoms persisted and worsened, so she came to our hospital for consultation. After examination, it was found to be squamous cell carcinoma of the cervix among cervical malignancies. After timely open radical hysterectomy and pelvic lymph node dissection, the cancer was completely removed, and there was no recurrence on regular review.
Basic information】Female, 45 years old
Disease Type】Stage Ib squamous cell carcinoma of the cervix
Hospital】Beijing Friendship Hospital, Capital Medical University
Date of Consultation】November 2021
Treatment plan】Surgical treatment (open radical hysterectomy + pelvic lymph node dissection)
Treatment Period】2 weeks in hospital, regular review
Results】Wound healing is good, no recurrence
I. Initial consultation
Aunt Wang, 45, came to our gynecology department with “irregular vaginal bleeding for 2 years, aggravated for 1 month”. She complained of irregular vaginal bleeding with no obvious cause 2 years ago, with low volume and bleeding after intercourse. At first, she thought it was a menstrual problem and did not pay attention to it, and took Yunnan Baiyao capsules on her own without any significant improvement. In the past month, she had recurrent vaginal bleeding, and the amount of bleeding was higher than before.
The doctor found that the vagina was open, the discharge was mucous and bloody, the cervix was enlarged, a superfluous organism of about 1 cm in diameter was visible on the upper lip of the cervix, blood was obvious on palpation, the uterus was anteriorly positioned, normal size, no pressure pain, and no obvious abnormality in the bilateral adnexa. There was no thickening of the cervical sacral ligament. The cytological examination of cervical scraping suggested severe cervical intraepithelial neoplasia (HSIL) and HPV16 infection, followed by colposcopic biopsy suggesting cervical squamous cell carcinoma. The doctor diagnosed “cervical malignancy” and admitted her to the hospital.
Treatment history
After admission, the patient underwent pelvic MRI (plain scan + enhancement), which indicated that the high-signal tumor of the cervix protruded into the low-signal stroma of the cervix. The focal abnormal signal was moderately high signal on T2WI with an intact low signal ring around the tumor, high signal on DWI with diminished ADC value and early enhancement after enhancement (Figure below). CT examinations of the chest and abdomen did not reveal clear malignant occupying lesions and enlarged lymph nodes. After completing relevant preoperative examinations, the final diagnosis was “cervical squamous cell carcinoma stage Ib.
We proposed to perform “open radical hysterectomy and pelvic lymph node dissection”, improved the preoperative preparation, explained the patient’s condition to the patient and her family, informed them of the risks and signed the surgery consent form. The operation went smoothly as scheduled, and the postoperative pathology was in accordance with the preoperative diagnosis. The postoperative pathology was in accordance with the preoperative diagnosis. The cut margin was negative, there was no metastasis in the pelvic lymph nodes, no metastasis in the parametrial tissues and no tumor embolism in the vasculature. The patient had regular postoperative outpatient follow-up examinations.
Nuclear magnetic examination, marked as malignant tumor lesion
III. Treatment effect
The patient had a smooth surgical procedure, and the postoperative pathology was in accordance with the preoperative diagnosis, with negative margins, no metastasis in pelvic lymph nodes, no metastasis in parametrial tissues, and no tumor thrombus in the vasculature. The postoperative wound healed well, and the catheter was removed after 2 weeks, and the patient was discharged with good urination. The patient’s vaginal stump healed well and there was no recurrence of tumor after regular postoperative review.
IV. Notes
We are sincerely happy to see that the operation of this patient went well, including good postoperative recovery, but the following matters still need attention.
1.After surgery, attention should be paid to the recovery of the patient, especially to the recovery of urination and defecation function, in addition to the healing of the patient’s wound.
2. The 5-year survival rate of stage I cervical squamous cell carcinoma patients is about 85%, so the long-term prognosis of this patient is good, but the follow-up after initial treatment is also very important, which should include pelvic examination, cytological examination of vaginal stump, chest X-ray and blood routine, etc.
3. Patients should develop good lifestyle habits, avoid staying up late, smoking and alcohol abuse, eat nutritious food and exercise in moderation to help recovery.
V. Personal insight
Squamous cell carcinoma of the cervix is the most common malignant tumor of the cervix. Patients often have bleeding after repeated intercourse or irregular vaginal bleeding as the first manifestation, which is easy to be ignored. In this case, the patient did not seek medical attention in time because of irregular vaginal bleeding, and then came to the clinic with increased bleeding. It is recommended that women pay attention to cervical cancer screening, including cytological screening and cervical papillomavirus screening, to achieve early diagnosis and early treatment of cervical malignancies.