diagnose
For patients with cervical cancer or suspected cervical cancer, endoscopic examination should be performed first, and then digital examination, vaginal digital examination, vaginal double-river examination and triple examination of rectum, vagina and abdominal wall should be performed to understand the hardness and elasticity of the lesion area and determine the situation and scope of parauterine infiltration. Colposcopy and vaginal microscope can be used for biopsy to improve the diagnostic rate. Vaginal smear plays an important role in early detection of cervical cancer. In addition, it can also be used as HCD1ca17; +07; CTH、HCD 1ca 12； B-ultrasound, isotope examination, etc. Help to determine the scope of infringement.
treat cordially
Surgical treatment is the main treatment for early cervical cancer. Advanced cervical cancer is mainly treated by radiotherapy or a combination of radiotherapy and surgery.
prevent
In order to prevent cervical cancer, the following people should have a gynecological cancer prevention examination every 2 ~ 3 years: 18 years old who had sex and got married before; Sexual dysfunction, frequent sexual intercourse and sexually transmitted diseases; Early marriage and multiple births; Cervical inflammation and erosion; Vaginal bleeding after sexual intercourse, postmenopausal leucorrhea, especially bloody secretion; Asymptomatic people over the age of 45 should also have regular routine examinations. Self-prevention methods of cervical cancer are:
(1) No promiscuity.
(2) Advocate late marriage and late childbearing and family planning to avoid damaging the cervix.
③ Pay attention to hygiene and keep the lower body clean.
(4) Male foreskin should be circumcised if it is too long, and the skin scale should be removed with water frequently to keep the genitals clean.
⑤ If hysterectomy is performed for other reasons, curettage should be performed before operation.
⑥ Actively treat chronic inflammation and deal with precancerous lesions.
In addition, to prevent cervical cancer, avoid alcohol and tobacco, and avoid cold and greasy food.
The cause of cervical cancer is still unclear. A large number of data at home and abroad confirm that the prevalence rate of women who are married early, have more children and have sexual dysfunction is higher. At present, it is also believed that cholesterol in skin scales can be transformed into carcinogens after bacterial action. It is also an important cause of cervical cancer.
In recent years, it has also been found that cervical cancer has a certain relationship with some viruses transmitted during sexual intercourse, such as: ① human scar virus type II (HSV-2), because the HSV-2 antibody in patients with invasive cervical cancer is 80% ~ 100% positive; (2) The detection of human papillomavirus (HPV) and HPV-specific antigens in various cervical cancer tissues showed that the incidence of cervical cancer was related to HPV infection; ③ Human cytomegalovirus. It has been reported at home and abroad that the titer of serum CMV antibody in patients with atypical hyperplasia of cervical precancerous lesions is high; Animal experiments prove that CMV-DNA has the ability of malignant transformation. Therefore, viral infection has become one of the important topics in the study of the etiology of cervical cancer in recent years.
2. Etiology
1), because of marriage, most patients with cervical cancer are married women. Premature sexual intercourse and too many sexual partners are closely related to cervical cancer. The more sexual partners, the higher the relative risk of cervical cancer, and the incidence rate among prostitutes is four times that of normal people. Therefore, sexual life and marriage are closely related to cervical cancer.
2) Birth factors lead to early primiparity and high incidence of cervical cancer.
3) Pathogenic factors Many pathogens are closely related to cervical cancer, especially human papillomavirus (HPV) and herpes simplex virus type II (HSVII).
4) Other factors Some studies believe that penis scales, trichomonas vaginalis infection, syphilis and gonorrhea are all related to the occurrence of cervical cancer.
3. Dissemination and transfer
Metastasis route: Because the epithelial layer of the cervix lacks lymphatic vessels and blood vessels, the basement membrane is a histological barrier, which can prevent the infiltration of cancer cells, so the cancer in situ does not metastasize. When carcinoma in situ turns into invasive carcinoma, the cancer will spread. The main transfer routes are as follows:
1) Direct diffusion: spread to vagina. Exogenous cervical cancer lesions often spread downward, first infiltrating the vaginal vault, and then spreading to the middle and lower segments of the vagina. The lesions in the cervical canal expand, the cervical canal thickens and hardens, spreads upward and involves the uterine cavity, penetrates the uterine wall, and has abdominal cavity spread. It spreads to the tissues beside uterus and invades bilateral main ligaments and sacral ligaments, and the whole pelvic cavity can form a hard cancer focus, which is a "frozen pelvis". Cancer that infiltrates the uterus can also compress one or both ureters, leading to ureteral obstruction. When invading the bladder and rectum, it can cause hematuria and the feeling of "internal urgency before weight".
2) Lymphatic metastasis: Cervical cancer can invade lymphatic vessels and form tumor thrombus, which will flow with lymph to adjacent lymph nodes and spread in lymphatic vessels. The metastasis routes are: ① Basal lymphatic vessels of cervical cancer focus → Parauterine lymph nodes-obturator lymph nodes → Internal and external iliac lymph nodes → Common iliac lymph nodes → Abdominal paraaortic lymph nodes → Supraclavicular fossa lymph nodes. ② Lymphatic vessels of cervical cancer focus → presacral lymph nodes → subaortic lymph nodes.
3) Blood metastasis: Patients with advanced or poorly differentiated diseases can spread to lung, liver, kidney, bone, brain, skin and other parts.
4. Experts talk
The highest incidence rate in the world is South Africa, followed by Asia. Every year, the number of new cases in China exceeds 1.3 million, accounting for 73-93% of the incidence of malignant tumors in female reproductive system. In developed countries, the incidence of cervical precancerous lesions has obviously decreased, which is largely attributed to the early diagnosis and treatment of cervical precancerous lesions. In developing countries, the incidence of cervical cancer in China is six times higher than that in developed countries due to the imperfection of cervical screening and the neglect of cervical diseases by women.
There are 500,000 new cases in the world every year, and China accounts for 1/4. It is particularly noteworthy that, due to environmental pollution and bad hygiene habits in life, most women in their 50s used to suffer from cervical cancer, and now they are targeting young women.
Clinical stage
Stage 0: carcinoma in situ, confined to cervical epithelium, without local invasion.
Stage I: Cancer is confined to the cervix (whether it invades the uterus or not).
Stage II: The cancer has exceeded the cervix, but the infiltration has not reached the pelvic wall. Cancer has involved the vagina, but it has not reached the next third.
Stage III: the tumor has infiltrated into the pelvic wall, and there is no gap between the tumor and the pelvic wall during rectal examination; The tumor involved the vagina1/3; All patients with hydronephrosis or renal failure belong to stage ⅲ, except those caused by other reasons.
The fourth stage: the cancer has spread beyond the real pelvis, or has invaded the bladder or rectal mucosa clinically.
Clinical manifestations of cervical cancer
In developed countries, the incidence of cervical cancer has dropped significantly, which is largely due to the early diagnosis and treatment of precancerous lesions. In developing countries, the incidence of cervical cancer is six times that of developed countries because of the imperfect cervical screening work. According to the screening results of tens of thousands of patients with cervical lesions by experts from Beijing Friendship Hospital, 607 cases were found to be abnormal, and 345 cases of cervical precancerous lesions and 9 cases of cervical cancer were finally diagnosed. The youngest patients with cervical precancerous lesions are 23 years old, and the patients with cervical cancer are 34-48 years old, of which 33.3% are under 40 years old and 66.6% are 40-48 years old. Cervical cancer has seriously threatened the health and life of young and middle-aged women.
Cervical cancer has no symptoms in the early stage. As the disease progresses, the patient may have abnormal vaginal bleeding. Because young women are sexually active and have high estrogen levels and frequency of sexual intercourse, they are more likely to have bleeding during sexual intercourse as the first symptom. In addition, the increase of leucorrhea is also a common symptom of cervical cancer, and about 80% of cervical cancer patients have this symptom.
Clinical follow-up observation shows that it takes about 10 years to develop from general cervical precancerous lesions to cervical cancer. From this perspective, cervical cancer is not terrible, it is a preventable and treatable disease. The key to prevention and treatment lies in: regular gynecological examination, timely detection and treatment of cervical precancerous lesions, and termination of its development to cervical cancer. If preventive measures can be implemented, the cure rate of cervical cancer is very high.
Early asymptomatic, there is no obvious difference with chronic cervicitis, and sometimes even the cervix is smooth, especially for elderly women whose cervix has shrunk.
The main symptoms are:
Vaginal bleeding: Young patients often show contact bleeding, which mostly occurs in sexual life, gynecological examination and bleeding after defecation. The amount of bleeding can be more or less, generally depending on the size of the lesion and the invasion of interstitial blood vessels. The amount of bleeding in the early stage is small, and the large lesions in the late stage show massive bleeding. Once the larger blood vessels are eroded, it may cause fatal massive bleeding. Young patients can also show prolonged menstrual period, shortened cycle and increased menstrual flow. Elderly patients often complain about irregular vaginal bleeding after menopause.
Vaginal drainage: patients often complain of increased vaginal drainage, which is white or bloody, as thin as water sample or rice soup, and has a foul smell. In the late stage, due to cancer tissue ulceration, tissue necrosis and secondary infection, a large number of purulent or rice-soup-like malodorous leucorrhea are discharged.
Symptoms of advanced cancer: secondary symptoms appear according to the degree of lesion invasion. When the lesion spreads to pelvic connective tissue, pelvic wall, compression of ureter or rectum, sciatic nerve, frequent urination, urgency of urination, anal dilatation, constipation, acute diarrhea, lower limb swelling and pain, etc. In severe cases, it can lead to ureteral obstruction, hydronephrosis and uremia. At the end of the disease, patients may have emaciation, anemia, fever and general failure.
The diagnosis of cervical cancer is mainly based on the history and clinical manifestations, especially contact bleeding, which requires detailed general examination and gynecological triple diagnosis, as well as cervical smear cytology, iodine test, nitrogen laser intratumor fluorescence diagnosis, colposcopy, cervical biopsy and cervical conization. After the diagnosis of cervical cancer, chest X-ray, lymphography, cystoscopy and proctoscopy should be done according to the specific situation to determine its clinical stage.
5. Difficulties and countermeasures
At present, the single treatment of cervical cancer has its shortcomings. For example, although surgical treatment is one of the important methods to treat cervical cancer, it can achieve the goal of radical cure for most early patients, but if a small amount of cancer tissue remains during the operation, especially subclinical lesions around the cervix or distant metastasis, it can cause local recurrence or distant metastasis after the operation; In addition, surgery may also cause local cancer cell implantation and blood-borne or lymphatic spread, so it may cause local recurrence or distant metastasis. Radiotherapy for cervical cancer is also the main treatment method, but it will also make the treatment effect unsatisfactory for some reasons, such as: some tumors or pelvic lymph nodes are missed or the radiation dose is not enough; Some pathological types of cancer tissues are not sensitive to radiation; There was subclinical distant metastasis before radiotherapy; Due to serious radiation reaction, such as serious reaction of bladder, rectum and other organs, radiotherapy was terminated or the radical dose could not be achieved.
One of the difficulties: how to improve the cure rate of cervical cancer
1), combined surgery and radiotherapy for cervical cancer preoperative radiotherapy: preoperative radiotherapy for cervical cancer can reduce local recurrence and metastasis and improve the cure rate of patients, which is an important progress in the treatment of cervical cancer in the past 40 years.
2) Combined treatment of surgery and anticancer drugs The main causes of death after cervical cancer surgery are tumor recurrence and metastasis. Recurrence is due to incomplete surgery, cancer cells remain in the primary site, and later develop into detectable tumors. Metastasis is that cancer cells have left the primary focus before or during surgery, and migrated to other parts through tissue gaps, lymphatic vessels and blood vessels for implantation.
3) Radiotherapy and comprehensive treatment of anticancer drugs Radiotherapy is the main method to treat cervical cancer at present, and the radiotherapy technology is also improving. However, radiotherapy, like surgical treatment, is a local treatment, and tumor recurrence and metastasis are still a difficult problem.
The second difficulty: how to improve the long-term curative effect of cervical cancer
Western medicine has a certain effect on cervical cancer, especially in situ cancer and early cases. But in the middle and late cases, the treatment effect is not ideal. If Chinese medicine cooperates with treatment, the curative effect can be greatly improved.
1), after Chinese medicine combined with simple operation, some residual cancer cells in the deep and cervical canal can be treated by surgery. From some surgical specimens after TCM treatment, we can further study and discuss the therapeutic effect and function of TCM.
2) Combination of traditional Chinese medicine and radiotherapy
3) Traditional Chinese medicine combined with chemotherapy, if the disease stage is late or the tumor is large, local injection, intravenous injection or arterial infusion of chemotherapy drugs can be combined, which can improve the curative effect and surgical resection rate.
6. Experience and experience
1). Understanding the pathogenic factors of cervical cancer, taking corresponding measures, advocating late marriage and family planning, actively preventing and treating women's diseases such as cervicitis, and insisting on tumor screening can greatly reduce the incidence of cervical cancer. Because tumor screening can find precancerous lesions and carcinoma in situ early, the cure rate is greatly improved through effective treatment, which plays a great role in reducing cervical infiltration and advanced cancer.
2). Traditional Chinese medicine has a good effect on cervical cancer, especially for early cervical cancer. Local use of traditional Chinese medicine is the main method, supplemented by oral administration of traditional Chinese medicine based on syndrome differentiation.
3). Even for advanced cervical cancer, TCM can treat it according to syndrome differentiation, that is, according to the pathogenic factors, physical condition, clinical manifestations and changes in the external environment of the patient, measures such as strengthening the body resistance and eliminating pathogens, attacking and reinforcing simultaneously, treating the symptoms and curing the root causes can alleviate the symptoms of patients with cervical cancer and prolong their lives.
4) Radiotherapy is the main treatment for cervical cancer. Radiotherapy in vivo and in vitro is seriously harmful to human body, and many patients stop treatment because of radiotherapy reaction. Therefore, many units cooperate with the use of traditional Chinese medicine in the treatment to reduce side effects, which may have a sensitizing effect on radiotherapy, which can not only successfully complete the treatment, but also improve the cure rate and survival rate.
Don't be afraid!
Go to a regular hospital.