How is cervical cancer screened and treated?

  Screening age 1. Young women under 25 years of age have the highest rate of HPV infection, but the vast majority of infections will clear within 2 years, so primary screening with HPV in this population should be avoided and HPV testing should be used for triage only after atypical squamous epithelial cells of undefined significance (ASCUS) are detected on liquid-based thin-layer cytology (TCT); 2. Women over 40 years of age with persistent high-risk HPV infection It is important to pay attention to the fact that although it usually takes 10-15 years to develop cervical cancer, about 25% of patients can develop cervical cancer within 5 years; 3. Women under 30 years of age use TCT primary screening and HPV triage strategy, i.e., HPV detection when ASCUS is available on TCT, and combined TCT and HPV testing is available for women over 30 years of age.  There is no report on whether cervical cancer is hereditary, but it is recommended that women with a family history of cervical cancer should be treated as a high-risk group and be strictly and regularly examined.  The traditional treatment model used to be based on radiotherapy. In recent years, with the younger incidence, the demand for preserving function after treatment has become increasingly strong, so neoadjuvant chemotherapy has come into being, and the current treatment model prefers surgery, preoperative chemotherapy and preserving function.  1.Precise radiotherapy treatment In recent years, various high-tech facilities have developed rapidly, and imaging examinations such as CT, MRI and PET-CT can be used to pinpoint the location before treatment, and radiation therapy can be administered after surgery.  However, the most important side effect of radiotherapy is that it inevitably damages ovaries and guidance function, and is irreversible for life.  Therefore, radiotherapy is not preferred for young patients, and this modality is mainly for advanced patients or middle-aged and old patients who do not need to preserve ovarian function and sexual function.  2.Surgical treatment The precision surgery of cervical cancer is increasingly developed, the scope of extensive hysterectomy is more accurate, and different types of surgery are given according to different stages; asymmetric type of extensive surgery can also be performed according to different conditions of the same stage.  The surgical approach Transabdominal surgery: the basic procedure for extensive hysterectomy and the basis for other types of surgery; transvaginal surgery: must have the basis for transabdominal surgery and vaginal hysterectomy; laparoscopic surgery: the basis for transabdominal surgery; robotic laparoscopic surgery: as above.  It can be performed either transabdominally or transvaginally, with removal of the cervix below the endometrium and also removal of the sacral ligament, the main ligament and 2 cm each of the vagina, followed by anastomosis of the uterine body and vaginal stump above the endometrium.  The pregnancy and delivery rate after this procedure is 37% within 12 months and 60% within two years.  3. Neoadjuvant chemotherapy Preoperative neoadjuvant chemotherapy reduces the size of the tumor and increases the rate of surgical resection; reduces the viability of cancer cells and reduces intraoperative dissemination and postoperative metastasis; eliminates subclinical lesions and reduces the risk of recurrence; can “reduce the stage” and provide the opportunity for surgery.  Neoadjuvant chemotherapy is still controversial. Some studies have concluded that it does not increase postoperative survival rates, while it delays surgical treatment, results in acute and subacute toxic reactions, prolongs treatment cycles, and is relatively expensive.  There is no conclusive evidence in this regard, and some studies in China have also found that neoadjuvant chemotherapy is effective in extending the 5-year tumor-free survival rate.