What is cervical cancer?

  Cervical cancer is a malignant tumor that seriously threatens women’s life and health, and its peak age of incidence and death is 33-55 years old, which is the prime time for women. According to the information published by the China Cancer Foundation, there are more than 130,000 new cases of cervical cancer in China every year, and 20,000-30,000 women die of cervical cancer every year, with a trend of younger incidence.  The cervix, along with the body of the uterus, fallopian tubes and ovaries, are known as the internal reproductive organs of women. Unlike the uterus, fallopian tubes and ovaries, the cervix is located outside the peritoneal cavity. Although the site is hidden, it can still be seen through a vaginal speculum. The surface of the cervix, located inside the vagina, is covered mainly by non-keratinized, compound squamous epithelial cells, while the cervical canal is lined with a single layer of columnar epithelial cells. The intersection of these two types of epithelial cells is the cervical migratory zone. The cervical migratory zone is the site of cervical intraepithelial neoplasia and cervical cancer. In women of childbearing age, the location of the migratory zone is variable. To perform cervical cytology, cells from the migratory zone must be included.  The development of cervical cancer requires a long process, and cervical intraepithelial neoplasia (CIN) is now commonly used clinically to reflect the evolution and progression of cervical cancer. Cervical intraepithelial neoplasia includes cervical atypical hyperplasia and cervical carcinoma in situ. Normally, the transformation from normal cervical epithelial cells to cervical intraepithelial neoplasia requires specific environmental conditions, such as human papillomavirus (HPV) infection. It can be said that without HPV infection, cervical cancer does not occur. However, even with HPV infection, not all cervical cancer has to occur; only repeated and persistent HPV infection is a prerequisite for cervical cancer to occur. Because repeated and persistent infection may cause cervical intraepithelial neoplasia, this lesion has to go through mild, moderate, severe and then invasive cervical cancer, at least for several years or even more than ten years, during which the lesion is in a state of flux, i.e. the lesion fades, persists and progresses to deterioration. The overall risk of progression from cervical intraepithelial neoplasia to invasive cervical cancer is 15%, while the chances of mild, moderate and severe cervical intraepithelial neoplasia developing into cervical cancer are 15%, 30% and 45%, respectively. In general, the higher the degree of cervical intraepithelial neoplasia, the higher the risk of developing cervical cancer.  The most common clinical manifestation of cervical cancer is contact bleeding, especially vaginal bleeding that occurs after sexual intercourse. In advanced cases, there is a large amount of purulent or rice-water-like leukorrhea with foul odor due to rupture of cancerous tissue, necrosis and secondary infection. However, cervical pre-cancerous lesions, cervical intraepithelial neoplasia, usually have no obvious symptoms and signs, and about nearly half of them have normal cervical appearance. Some patients may show signs of chronic cervical inflammation such as increased leucorrhea, leucorrhea with blood, contact bleeding, and cervical hypertrophy, congestion, erosion, and polyps. Even if cervical intraepithelial neoplasia develops into cervical carcinoma in situ, there are still half of the patients without clinical symptoms. Therefore, it is impossible to diagnose cervical intraepithelial neoplasia and cervical cancer by visual observation. At present, clinical diagnosis requires the combined use of several auxiliary examination methods, such as cervical cytology, human papillomavirus examination, colposcopy combined with cervical biopsy, cervical canal scratching and conical hysterectomy.