Do you know what is the most common malignant tumor in women? Breast cancer, and the second one is cervical cancer. Cervical cancer is the most common malignant tumor of the female reproductive tract. There are about 470,000 new cases each year worldwide, 2/3 of which are in developing countries and 1/3 of which are in China alone. About 150,000 new cases of cervical cancer are detected in China every year. The World Health Organization reports that its incidence is also increasing at a rate of 2% to 3% per year, and there is a trend toward younger age. The prognosis of advanced cervical cancer is very poor, with a five-year survival rate of only about 30-50%. The famous singer Anita Mui in Hong Kong and the famous actress Li Yuan Yuan in mainland China. They both lost their precious lives to cervical cancer in their prime years of prosperity and career. Such patients are no longer a minority and bring great losses to the society and families. Therefore, cervical cancer is a fatal and serious malignant disease. The high-risk factors of cervical cancer include viral infection, such as HPV infection; sexually transmitted factors: such as young age of first intercourse, multiple sexual partners, sexually transmitted diseases, high-risk sexual partners, multiple births, etc.; other factors such as smoking, immunosuppression, low income, etc. Is cervical cancer really that scary? Actually, cervical cancer is preventable and treatable because we basically know the causes of cervical cancer now, and cervical cancer can be diagnosed and treated early, and the 5-year survival rate is as high as 90% or even 100%. In contrast, the cure rate of cervical cancer at advanced stage is significantly reduced, and the 5-year survival rate is only about 30-50%. Therefore, early diagnosis of cervical cancer is the most important, and the purpose of early diagnosis is to detect precancerous lesions or early cervical cancer. Thus, cervical cancer becomes a truly preventable malignancy. Why is early diagnosis suitable for cervical cancer? It is due to three conditions: the cervix is visible and palpable; its location is easy to examine; the cause of cervical cancer is clear and the development time of cervical cancer is very long. Anatomically speaking, the uterus is located in the female pelvis in an inverted pear shape, consisting of the uterine body above and the cervix below. The cervix is about 2-3 cm long and opens at the tip of the vagina. As for the cause, cervical cancer is the only malignant tumor with a clear cause, and the main culprit is the human papillomavirus (HPV). In 2008, the German researcher Harald K. Chur? Trull? He was awarded the Nobel Prize, the highest prize in medicine, for two reasons: First, he discovered that the culprit of cervical cancer is the human papillomavirus, and promoted the development and marketing of the HPV vaccine for the prevention of cervical cancer. Secondly, the process of cervical cancer development is very long, let’s take a look at this chart. First of all, HPV infection clears up on its own in most people, but if it doesn’t, it continues for 8 to 24 months to progress to cervical intraepithelial neoplasia (CIN), which is a precancerous lesion. This is when the large, deeply stained heterogeneous cells with large nuclei are still confined within the complex cervical squamous epithelium and have not broken through the basement membrane. How do we understand the basement membrane? The basement membrane is actually very strong and very difficult to penetrate, and can be compared to a dam. You may have heard the idiom that a thousand miles of dike is destroyed by an anthill, or that a colony of ants breaks the dike. We can imagine that these heterogeneous epithelia are like many ants, and it is actually impossible for them to destroy the dam of basement membrane in a short period of time. However, after 5 to 10 years, it is eventually possible to destroy the dam, which is the basement membrane. At the beginning, only a few heterotypic cells break through the basement membrane, which is the early stage of cervical cancer. However, once a large number of heterozygous cells break through the basement membrane and even spread to the whole body, it will become advanced cervical cancer and the mortality rate will be significantly higher, just like ants following the flood. As we can see, it usually takes 5 to 10 years for HPV infection to develop into cervical cancer, which provides us with sufficient time for early diagnosis. Which women need to be screened for cervical cancer? Because early cervical cancer is often asymptomatic, it may be too late to wait until there are symptoms before getting screened. Because cervical cancer is caused by HPV infection, which is sexually transmitted, women who have had sex for more than three years or women who have had sex at the age of 21 need to have cervical screening once a year. There are three screening and diagnostic methods for cervical cancer, used in sequence, called the three-step diagnostic procedure. (1) Cytology and HPV screening are done first for initial screening in the general population. The first step is cervical cytology, in which cells are brushed from the surface of the cervix and the cervical canal with a brush after a speculum is placed in the vagina, placed in a vial with liquid, and tested for cytology and HPV, and the cell morphology is observed under a microscope after filming. As an annual screening test, cytology is non-invasive, affordable, easy to perform, and very sensitive. Since its invention, cytology has reduced cervical cancer by 50-70%. (2) For those with abnormal primary cytology or positive HPV, further colposcopy can be performed to determine the extent and degree of the lesion and to guide the biopsy site, which can improve the accuracy of the diagnosis. This is because many times early lesions of cervical cancer are undetectable by the naked eye. Colposcopy can magnify the image 6 to 20 times, thus allowing closer observation of the cervical surface for heterogeneous epithelium and abnormal blood vessels, and can detect microscopic lesions that cannot be distinguished by the naked eye. The local epithelium turns white after applying 5% acetic acid to the cervix and is called vinegar white epithelium. Also, after applying iodine solution to the surface of the cervix, the areas that are not colored with iodine are abnormal. In turn, biopsies are taken from these abnormal areas and sent for pathological examination to improve the positivity of the diagnosis. (3) Biopsy and pathology under colposcopy is the gold standard for diagnosis and treatment. A biopsy is performed under colposcopy and sent for pathological examination to make the final diagnosis. As shown in the diagram above, CIN is when the heterogeneous epithelial cells occupy part of the squamous epithelial cell layer, CIN 1 when they occupy the lower 1/3 of the layer, CIN 2 when they occupy the lower 2/3 of the layer, CIN 3 when they occupy almost the entire layer, leaving only one or two superficial layers of normal cells, and carcinoma in situ when the heterogeneous epithelial cells occupy the entire squamous epithelial cell layer. Finally, depending on the degree and extent of the lesion, the patient’s age and fertility requirements, the doctor will develop an individualized treatment plan.