Recurrent cervical cancer refers to tumor reappearance after curing cervical cancer by radical treatment. Recurrent cervical cancer mostly occurs after treatment of advanced cervical cancer (including locally advanced), and it has also been reported that about 35% of invasive cervical cancer recurs after treatment. Recurrent cervical cancer is difficult to treat, has a poor prognosis, and is the most important cause of cervical cancer death.
In addition to the extent of surgical resection affecting the recurrence rate especially the location of recurrence, in fact, even the largest surgery can only do a maximum resection of the tumor confined to the uterus or even the pelvic cavity. In terms of the route of spread of cervical cancer, lymphatic, blood and direct spread are all possible, so the chance of recurrence is inevitable. The recurrence of cervical cancer has corresponding clinical symptoms and signs depending on the site of recurrence and the degree of lesion, which may be asymptomatic in the early stage. Clinical manifestations are gradually progressive. The main symptoms and signs of patients with recurrent cervical cancer are often manifested as wasting.
Central recurrence.
1. the most common symptoms include irregular vaginal bleeding and/or increased leucorrhea.
2. parametrial (or pelvic wall) recurrence.
3. Early discomfort in the lower abdomen may occur, and with the development of lesions, pain in the affected lower limbs, edema, pain in the sacroiliac region (or hip), lumbago, lower abdominal pain, difficulty in urination and defecation, and sometimes lower abdominal or pelvic masses may be found.
(1) Recurrence site.
The pelvis is the main site, accounting for more than 60%.
(1) Recurrence of cervical cancer after surgery.
Local recurrence rate is 59.8% and distant metastasis accounts for 40.2%, among which lung (16.9%), supraclavicular lymph nodes (12.0%) and bone and liver are most common.
②Recurrence after radiotherapy.
Most of them reported more intrapelvic recurrence than extra-pelvic metastasis. 43% were reported by Graham et al. (1962) to occur in the parametrium (including the pelvic wall, 27% in the cervix, uterus or upper vagina, 6% in the lower 2/3 of the vagina, 16% in the distant area, and 8% were unknown). The Cancer Hospital of Chinese Academy of Medical Sciences has made a series of reports that among the cases of cervical cancer that failed after conventional radiotherapy, intrapelvic recurrence accounted for 70%, distant metastasis accounted for 30%, lung metastasis was common among extra-pelvic organ metastasis, accounting for 2.4%, supraclavicular lymph node metastasis rate was 1.62%, bone metastasis accounted for 0.88%, and foreign reports were 1.3%-8.9% (lung), 2.97% (supraclavicular With the rapid development of radiotherapy equipment and techniques after 1980s, Manetta et al. (1992) believed that central recurrence had been reduced, and Sun Jianheng (1993) reported that intracavitary recurrence decreased to 41% and distant metastasis accounted for 59% after intracavitary post-mounted radiotherapy. Zhang Xiaochun et al. (1995) reported that the pelvic recurrence rate after cervical cancer treatment was only 19.7%, of which pelvic wall recurrence was 53.3% and central recurrence accounted for 46.7%.
(2) Recurrence time.
Most of the reports at home and abroad reported that more than 60% occurred within 2 years. According to the statistics of Cancer Hospital of Chinese Academy of Medical Sciences, among 95 cases of cervical cancer recurrence after radiotherapy, 42.1% occurred within the first year, 60% within 2 years, 10.5% after 5 years, and 6.3% after 10 years. Zhang Xiaochun et al. (1995) reported that 60.8% occurred within 2 years, and Li Mengda et al. (1992) reported that recurrence of cervical cancer after surgery accounted for 36.9% within 1 year, 61.9% within 2 years, 72.8% within 3 years, and more than 93% within 5 years.
Distant recurrent metastasis
For example, cough, chest pain and/or back pain, coughing sputum, blood in sputum or hemoptysis in pulmonary metastasis, fixed focal pain often in bone metastasis, discomfort or pain in liver area, hepatomegaly, etc., and enlarged supraclavicular lymph nodes in liver metastasis.
Patients with advanced cachexia may present with systemic wasting syndrome.
1, such as loss of appetite, rapid weight loss or wasting within a short period of time, or even cachexia, etc.
2. The diagnosis of recurrent cervical cancer must be combined with clinical, pelvic examination and multiple auxiliary examinations to make a comprehensive assessment and analysis for timely detection and early diagnosis.
3.The occurrence of the above symptoms and signs after a period of cervical cancer treatment should alert the possibility of recurrence, but the final diagnosis still needs to be based on pathological histological examination. Central recurrence can often be diagnosed by clinical, cytological and histological examinations, while the diagnosis of parametrial and distant metastasis mainly relies on medical history, pelvic examination and adjuvant examinations.
Early diagnosis of intrapelvic recurrence after radiotherapy is generally considered to be more difficult, which may be due to the following reasons.
① certain symptoms of recurrence resembling post-radiotherapy side effects.
(ii) parametrial (or pelvic wall) recurrence often lacks clear objective indicators.
③ post-radiotherapy cervical atrophy and parametrial fibrosis affect the examination and sampling.
④The radio-responsive changes of exfoliated cells after radiotherapy are often mistaken for uncontrolled tumor or recurrence, so it is difficult to assess the actual clinical significance when cancer cells are found by cytological examination.