Cervical cancer is the first gynecologic malignancy in the female reproductive system in terms of incidence. China is a high incidence region in the world, with about 150,000 new cases of cervical cancer each year, accounting for nearly a quarter of the total global incidence. One of the main reasons is that Chinese women have not yet formed the awareness and habit of routine screening. In addition, the traditional Pap smear technique also has an excessively high false negative rate. In fact, cervical cancer can be prevented by paying attention to screening, early detection and early treatment of cervical precancerous lesions, which is an important initiative.
A large number of epidemiological studies have shown that the risk factors for the development of cervical cancer are mainly, early sexual debut, multiple sexual partners, and high-risk sexual partners. In addition, history of sexually transmitted diseases, multiple births, smoking, low social class, and low immune function are also associated with the development. Human papillomavirus (HPV) infection is the central link in the development of cervical cancer. HPV is mainly transmitted through sexual intercourse, and the peak age of new infections is 20-24 years old every year. Most HPV infections have no clinical symptoms. Most HPV infections are transient and can subside on their own without progressing to become cervical intraepithelial neoplasia (CIN: cervical precancer) or malignancy, but in a small percentage of women, the virus does not disappear and the infection persists. Persistent infection leads to the development of cervical intraepithelial neoplasia (CIN) in about 5-10% of those infected. Moreover, this persistent infection is necessary for the development and progression of CIN. This may lead to the persistence of CIN and eventually to invasive cervical cancer in a very small percentage of cases. Relevant studies have shown that the average time from infection to development of cervical cancer is about 15 years. Therefore, routine screening, timely detection of HPV infection and CIN, and appropriate treatment can stop disease progression and effectively prevent the development of cervical cancer. A three-step diagnostic procedure, i.e. cytology-colposcopy-pathology, is currently recommended. 1.Cervical exfoliative cytology
The most effective method for cervical cancer screening. It is recommended to check cervical cytology once a year for sexually active women or married women, and a negative test for 3 consecutive years can extend the screening interval. Concurrent HPV testing is recommended where available. Because of the high rate of false negatives with traditional Pap smears, computerized thin-layer cytology techniques such as TCT testing have mostly been used. Colposcopy and colposcopic biopsy For abnormal cytology, colposcopy should be performed to further clarify the diagnosis, if necessary, by biopsy. This facilitates the appropriate and timely management of cervical lesions. The treatment of cervical lesions includes pathogenic treatment, physical therapy and, if necessary, surgery. A few tips: 1. In the past, it was thought that cervical endometriosis (formerly called cervical erosion) was a pre-cancerous lesion of the cervix, which led to unnecessary over-treatment, especially physical therapy. For those who do not have symptoms of co-infection such as increased discharge or contact bleeding, regular follow-up is usually sufficient and no treatment is needed. However, pathogenic and cytological examination should be performed. Those with co-infection should be treated. On the one hand, unreasonable treatment can increase the risk of cervical cancer, and on the other hand, over-treatment can increase the chance of complications. It is important to go to a regular hospital for timely and proper treatment. 3 Acute cervicitis is mainly caused by gonococcal and chlamydial infections. Chlamydial infection can lead to miscarriage, stillbirth, premature rupture of membranes, preterm birth, and neonatal infection. The increased vaginal discharge and inflammatory response due to inflammation can lead to cervical adhesions, cervical polyps, cervical stenosis or affect sperm viability and motility leading to infertility. Chlamydia infection during pregnancy can not only cause adverse pregnancy outcomes but also lead to infection in the newborn. It should be treated early, as should the sexual partner. Common clinical cervicitis is a chronic inflammation of the cervix including: cervical polyps, cervical erosion, cervical nuchal translucency, and cervical hypertrophy. Cervical cytology should be performed to exclude cervical precancerous lesions CIN and cervical cancer. Among them, cervical polyps should be removed, while others usually do not require treatment.