Cervical cancer

　　Cervical cancer is a common gynecological malignant tumor. The early symptoms are not obvious, and vaginal bleeding may occur in the later stage, posing a serious threat to the patient's life and even safety. The main causes of cervical cancer include the following aspects：

　　1. Sexual life, marriage：A large number of foreign studies have confirmed that women who marry early, have children early, have multiple births, and have irregular sexual life have a higher incidence of the disease. Women who start having sex before the age of 18 have a 4-fold higher incidence of cervical cancer than those who start having sex after the age of 18. The incidence of cervical cancer is higher in women who have multiple marriages.

　　2. Related to sexual partners：The relative risk of cervical cancer in women whose partners have a long foreskin or phimosis is higher. Women who have penile cancer or prostate cancer or whose former wife has cervical cancer, or whose partners have multiple sexual partners, have a higher chance of developing cervical cancer.

　　3. Viral or fungal infection：Herpes simplex virus type 2, human papillomavirus, human cytomegalovirus, and fungal infections may be related to the occurrence of cervical cancer.

　　4. Cervical erosion, laceration and inversion：Due to the physiological and anatomical characteristics of the cervix, it is prone to various physical, chemical, and biological factors, including trauma, hormones, and viruses, etc.

　　5. Long periods of inactivity：People who sit in one place for a long time or do not move for a long time accumulate toxins, such as Mahjong card games, office activities, etc., which is also a cause of the disease.

　　6. Oral contraceptives：Compared with women who never take oral contraceptives, women who use oral contraceptives have a significantly increased risk of cervical cancer.

　　7. Genetic factors：Cervical cancer is related to heredity. Women of childbearing age who are exposed to certain physical or chemical factors in daily life for a long time may experience畸变 in their germ cells. Their offspring are often prone to cancer after birth.

　　8. Multiple pregnancies：The incidence of cervical cancer increases with the number of pregnancies.

　　Common complications after cervical cancer surgery include：

　　1. Urinary retention：Urinary retention is the most common complication after radical treatment for cervical cancer, with the diagnostic criteria being inability to urinate spontaneously for more than 14 days after surgery or the presence of residual urine of more than 100ml even if urination is spontaneous.

　　2. Hemorrhage：Hemorrhage after cervical cancer surgery often occurs within one week after surgery, usually due to incomplete hemostasis during surgery and secondary infection.

　　3. Lymph囊肿：Lymph囊肿 often occurs after extensive total hysterectomy and pelvic lymphadenectomy, caused by poor drainage of lymph fluid. Patients with lymph囊肿 usually manifest as discomfort in the lower abdomen, and may also have edema of the lower limb on the same side and pain in the waist and legs.

　　4. Venous thrombosis: Venous thrombosis after cervical cancer surgery is more common in lower limb veins, and its occurrence is closely related to factors such as long surgery time, prolonged obstruction of lower limb veins, trauma to the venous wall during surgery, and acceleration of coagulation mechanism.

　　5. Ureterovaginal fistula and vesicovaginal fistula: Ureterovaginal fistula and vesicovaginal fistula often occur 7-14 days after surgery and can be distinguished by injecting a little blue liquid into the bladder.

　　6. Postoperative abdominal infection and urinary tract infection.

　　Cervical cancer has no symptoms in the early stage. As the condition progresses, patients may experience abnormal vaginal bleeding, and the severity of clinical symptoms is related to the stage of the disease. Common symptoms in the late stage include the following:

　　1. Pain is a symptom of advanced cervical cancer. The tumor extends along the surrounding tissue, invades the pelvic wall, compresses the surrounding nerves, and is clinically manifested as persistent pain in the ischiadic nerve or one side of the sacral and iliac region. The tumor compresses or erodes the ureter, causing stenosis and obstruction of the channel, leading to hydronephrosis of the renal pelvis, manifested as unilateral lumbar pain, even severe pain, which can further develop into renal failure, even uremia. Invasion of the lymphatic system can cause obstruction of the lymph vessels, resulting in edema and pain in the lower limbs.

　　2. Systemic symptoms: Patients with advanced cervical cancer may develop fever due to the metabolism of tumor tissue, the absorption of necrotic tissue, or complications such as infection. The body temperature is usually around 38℃, and a few can exceed 39℃. Anemia, weight loss, and even cachexia can occur due to bleeding and consumption.

　　3. Metastasis symptoms: In advanced cervical cancer, the tumor can spread forward and invade the bladder, causing symptoms such as frequent urination, urgency, dysuria,坠感和 hematuria, which are often misdiagnosed as urinary system infection and delayed in diagnosis. Severe cases can form a vesicovaginal fistula. The tumor can spread backward and invade the rectum, causing symptoms such as坠感, difficulty in defecation, urgency, hematochezia, and further development can lead to a vaginal-rectal fistula. In the late stage of the disease, distant metastasis can occur. The symptoms vary depending on the site of metastasis, with the most common being supraclavicular lymph node metastasis, which manifests as nodules or masses in this area. The tumor can spread to distant organs through the vascular or lymphatic system, causing metastases and corresponding symptoms in the affected areas.

　　4. In advanced cervical cancer patients, the metabolism of tumor tissue, the absorption of necrotic matter, and infection lead to fever, which is usually low fever, and a few can exceed 39℃. Bleeding and tumor consumption affect metabolism, leading to cachexia.

　　Although cervical cancer is可怕的, it is the only cancer that can be prevented and cured. As long as regular gynecological examinations are carried out, the precancerous lesions of cervical cancer can be detected and treated in time, and the development into cervical cancer can be prevented, thus avoiding the risk.

　　1. Regular checks are particularly important for women with a family history of cervical cancer. Women over 30 should regularly go to the hospital for cervical smear cytology tests. Generally, a check should be done once a year, and young women should have a gynecological examination every two years. As long as the general survey is consistently carried out, early detection and treatment can be achieved.

　　2. Delayed marriage and childbearing, fewer births with better quality. Delaying the age of sexual debut and reducing the number of births can both reduce the incidence of cervical cancer.

　　3. Actively prevent and treat cervical erosion and chronic cervicitis. Pay attention to avoiding cervical laceration during childbirth. If there is a laceration, it should be repaired in a timely manner.

　　4. Pay attention to sexual and menstrual hygiene. Moderately restrict sexual activity, avoid sexual intercourse during the menstrual period and postpartum period, pay attention to the cleanliness of both reproductive organs, and it is best to use a condom during sexual intercourse to reduce and eliminate multiple sexual partners.

　　5. Men with phimosis or overlong prepuce should pay attention to local cleaning and consider circumcision. This can not only reduce the risk of cervical cancer in their partners but also prevent the occurrence of penile cancer.

　　6. Maintain a good mental state. Long-term worry or depression can interfere with the human nervous and endocrine system, leading to hormonal imbalance and decreased immunity. Many cases of cancer are related to frequent bad moods.

　　Cervical cancer is one of the common malignant tumors in women, seriously threatening women's health and life. Early detection, early diagnosis, and early treatment are very critical. To diagnose cervical cancer, the following examinations are required.

　　1. Cervical cytology examination:It is the main method for screening and early detection of cervical cancer, simple and easy to perform, with an accuracy rate of up to 95%, and it must be performed on the cervical transformation zone.

　　2. Colposcopy examination:Colposcopy cannot directly diagnose cancer, but it can assist in cervical examination for biopsies. According to statistics, the diagnosis rate for early-stage cervical cancer reaches about 98% with the assistance of colposcopy. Colposcopy can magnify the lesion 6 to 40 times, allowing direct observation of the fine morphological changes of the cervical epithelium and blood vessels under strong light sources. For those with suspicious or positive cervical smear cytology but no visible cancerous lesions, colposcopy can observe the lesion directly.

　　3. Biopsy of the cervix and cervical canal:This is the most reliable and indispensable method for diagnosing precancerous lesions and cervical cancer. Generally, multiple biopsies should be performed under colposcopy guidance, in areas where the acetic acid white epithelium and iodine test do not stain or in suspicious areas of cancerous changes visible to the naked eye, and the specimens should be sent for pathological examination. When the cervical smear cytology examination is suspicious or positive, but the biopsy is negative, the cervical canal should be scraped and sent for examination.

　　4. Conization of the cervix:If it is not possible to determine whether there is invasive cancer through a biopsy, a conization of the cervix can be performed.

　　The following points should be noted in the diet of cervical cancer patients:

　　Early-stage cervical cancer patients should try to supplement nutrients such as proteins, sugars, fats, and vitamins, which can be reasonably consumed to enhance the patient's ability to resist diseases and improve immune function; when the patient has excessive vaginal bleeding, they should eat more foods that can nourish blood, stop bleeding, and fight cancer, such as Job's tears, hawthorn, black fungus, and plum.

　　After surgery, the diet of cervical cancer patients should focus on boosting Qi and nourishing blood, and include more foods such as longan, goji berries, pork liver, turtle, sesame seeds, and donkey hide glue.

　　During radiotherapy and chemotherapy for cervical cancer patients, the diet should focus on nourishing blood and yin, strengthening the spleen and kidney, and can include moderate amounts of beef, pork liver, mushrooms, spinach, celery, placenta, ejiao, turtle, banana, and other foods.

　　4, For advanced cervical cancer patients, they should eat more protein and calorie-rich foods such as beef, turtle, red beans, mung beans, milk, eggs, fresh lotus root, spinach, etc.

　　One, Treatment Principles

　　1, Atypical Hyperplasia: If the biopsy shows mild atypical hyperplasia, it is temporarily treated as inflammation, and follow-up scraping and biopsy are performed as necessary every half year. Lesions that remain unchanged can be continued to be observed. For those diagnosed with moderate atypical hyperplasia, laser, cryotherapy, and electrocautery should be applied. For severe atypical hyperplasia, it is generally recommended to perform total hysterectomy. If there is an urgent need for childbearing, regular close follow-up can also be performed after conical resection.

　　2, In situ cancer: It is generally recommended to perform total hysterectomy and retain both ovaries; there are also those who advocate for the simultaneous resection of 1-2 cm of the vagina.

　　3, Microscopic early invasive cancer: It is generally recommended to perform extended total hysterectomy and 1-2 cm of vaginal tissue. Since the possibility of lymph node metastasis in microscopic early invasive cancer is extremely small, it is not necessary to remove pelvic lymphatic tissue.

　　4, Invasive cancer: The treatment method should be based on the clinical stage, age, general condition, and equipment conditions. Common treatment methods include radiotherapy, surgery, and chemotherapy. Generally speaking, radiotherapy can be applied to patients in all stages; the efficacy of surgery for stages I b to II a is similar to that of radiotherapy; cervical adenocarcinoma is slightly less sensitive to radiotherapy, and combined treatment with surgical resection and radiotherapy should be adopted.

　　Two, Surgical Treatment

　　It adopts extensive hysterectomy and pelvic lymph node dissection. The range of resection includes the whole uterus, both sides of the adnexa, the upper segment of the vagina and the parametrial tissue, as well as the pelvic internal lymph nodes (parametrial, obturator, internal iliac, external iliac, and common iliac inferior lymph nodes). The operation requires thoroughness, safety, strict control of indications, and prevention of complications.

　　Three, Radiotherapy

　　It is the first-line treatment for cervical cancer and can be applied to all stages of cervical cancer. The range of radiation includes the cervix, affected vagina, uterine body, parametrial tissue, and pelvic lymph nodes.

　　Four, Chemotherapy

　　So far, cervical cancer is not sensitive to most anticancer drugs, and the effective rate of chemotherapy does not exceed 15%. Advanced patients can adopt comprehensive treatments such as chemotherapy and radiotherapy. Chemotherapy drugs can be administered by intravenous or local injection, such as 5-fluorouracil and doxorubicin.