Cervical intraepithelial neoplasia

　　1. Some people believe that the wife of a husband with a long foreskin or phimosis has a higher relative risk of developing cervical cancer. Women with penile cancer or prostate cancer, or whose former wife had cervical cancer, or men with multiple sexual partners, have a higher chance of their wives developing cervical cancer. Therefore, this is one of the causes of cervical cancer.

　　2. Pathogen causes, various pathogens are closely related to cervical cancer, especially human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2), human cytomegalovirus (HCMV), chlamydia trachomatis (CT), and Epstein-Barr virus (EBV).

　　3. Viral or fungal infections are also causes of cervical cancer. Herpes simplex virus type 2, human papillomavirus, human cytomegalovirus, and fungal infections may be related to the occurrence of cervical cancer. However, the questions of which virus is the main trigger or under which conditions several viruses协同下易发生宫颈癌 have not been solved.

　　4. Sexual promiscuity and sexually transmitted diseases, some surveys and studies have shown that sexual promiscuity plays an important role in the etiology of cervical cancer. Those who start sexual life before the age of 15 or have more than 6 sexual partners have a 10 times higher risk of developing cervical cancer, and male sexual promiscuity also increases the risk of illness in their partners.

　　5. The cause of marriage and childbearing, sperm is one of the causes of cervical cancer, and seminal fluid has a strong mutagenic effect on the squamous epithelium of the cervix, especially for adolescent girls, when the cervical epithelium is in a highly sensitive period, the mutagenic effect of seminal fluid is even more dangerous. In addition, according to epidemiological surveys, nulliparous women account for only 10% of cervical cancer patients; early childbirth age is associated with a high incidence of cervical cancer. This may be related to factors such as the cervix being prone to tears and injuries during childbirth, reduced immune function during pregnancy, making the cervical epithelial cells susceptible to external pathogenic factors. Therefore, the number of deliveries also has a certain impact on the occurrence of cervical cancer.

　　6. Cervical erosion, laceration, and eversion can also trigger a high incidence of cervical cancer. Due to the physiological and anatomical reasons of the cervix, it is easy to be stimulated by various physical, chemical, and biological factors, including trauma, hormones, and viruses. This is also the cause of cervical cancer.

　　7. Smoking has shown in recent epidemiological studies that the risk of cervical cancer in smokers is doubled, smoking strengthens the HPV infection factor, and the amount of smoking is positively correlated with the risk of cervical cancer.

　　Cervical cancer combined with pregnancy is relatively rare. In China, it accounts for 0.92% to 7.05% of the total number of cervical cancers reported. According to foreign literature, it accounts for 1.01%. Patients may seek medical attention due to threatened abortion or prepartum hemorrhage. Vaginal smear and biopsy can determine the diagnosis. For early pregnant women with vaginal bleeding, routine examination of the cervix and cervical smear cytology examination should be performed.

　　The influence of pregnancy on cervical cancer. During pregnancy, due to increased blood supply and lymphatic flow in the pelvic cavity, it may promote the metastasis of cancer; and cancer dissemination may occur during delivery. Severe bleeding and postpartum infection. Due to the influence of estrogen during pregnancy, the activity of cervical transitional zone cells increases, which can be similar to the lesion of intraepithelial neoplasia. But there is directional differentiation, and polarity is still maintained. These changes can be restored after delivery. Cervical intraepithelial neoplasia may also be complicated with pregnancy. It cannot be restored after delivery and should be carefully distinguished.

　　The treatment method needs to be determined according to the development of the tumor and the number of gestational months. For those with stage I and IIa cervical cancer combined with early pregnancy, radical surgery can be used; or radiotherapy can be performed first. After the fetus dies and is naturally excreted, radical surgery can be performed again. Or continue radiotherapy. For early pregnancy, cesarean section can be performed to remove the fetus. At the same time, radical surgery can be performed. For patients with cervical cancer at any stage combined with late pregnancy or delivery, cesarean section should be performed. Subsequent surgery or radiotherapy can be performed later.

　　1. Vaginal bleeding

　　Irregular vaginal bleeding is the main symptom of cervical cancer patients, especially vaginal bleeding after menopause should be paid attention to. The amount of vaginal bleeding can be more or less, and vaginal bleeding is often caused by the rupture of tumor blood vessels, especially the bleeding symptoms of cauliflower-type tumors appear earlier and the amount is also greater. If bleeding occurs frequently, excessive blood loss can lead to severe anemia.

　　2. Increased vaginal discharge

　　This is the main symptom of cervical cancer patients. It often occurs before vaginal bleeding. Initially, the vaginal discharge may have no smell. As the tumor grows, secondary infection and necrosis can cause an increase in the amount of discharge, such as rice water-like or mixed with blood, and it has a foul smell. When the tumor spreads upwards and involves the endometrium, the discharge can be blocked by the cervical cancer tissue, cannot be discharged, and can form hydrometra or pyometra in the uterine cavity, causing symptoms such as discomfort in the lower abdomen, lower abdominal pain, back pain, and fever in the patient.

　　3. Frequent urination, urgency, and dysuria

　　When the tumor spreads forward, it can invade the bladder, causing symptoms such as a feeling of坠 and frequent urination, urgency, dysuria, and hematuria, which are often misdiagnosed as urinary tract 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 a feeling of坠, difficulty defecating, urgency, and hematochezia. 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 the supraclavicular lymph node metastasis, which manifests as nodules or masses in this area. The tumor can spread to distant organs through the blood or lymphatic system, resulting in metastatic foci and corresponding symptoms in the affected areas.

　　4. Pain

　　These are the symptoms of advanced cervical cancer. The tumor extends along the surrounding tissues, invades the pelvic wall, compresses the surrounding nerves, and is manifested clinically as persistent pain in the ischial nerve or one side of the sacral and iliac region. The compression or erosion of the ureter can cause stenosis and obstruction, leading to renal pelvis hydrops, manifested as one-sided lumbar pain, even severe pain, which can further develop into renal failure and ultimately uremia. The invasion of the lymphatic system can lead to lymphatic obstruction, resulting in edema and pain in the lower limbs and other symptoms.

     1. Advocate for late marriage and fewer births, and give priority to quality births. Delaying the onset of sexual activity and reducing the number of births can both reduce the risk of cervical cancer.

　　2. Actively prevent and treat conditions such as cervical erosion and chronic cervical inflammation. Pay attention to avoiding cervical lacerations during childbirth, and if there are lacerations, they should be repaired promptly.

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

　　4. Men with phimosis or an elongated prepuce should pay attention to local cleaning, and it is best to undergo circumcision. This not only reduces the risk of cervical cancer in their wives but also prevents the occurrence of penile cancer in themselves.

　　5. Special attention should be paid to regular health checks for high-risk groups of cervical cancer, including those with early and frequent sexual activity, early and frequent childbirth, and dense childbirth, as well as women with promiscuity, multiple sexual partners, and a history of irregular sexual life. Women in areas with poor hygiene conditions and a lack of knowledge about sexual health should also be particularly vigilant. Women with symptoms such as cervical erosion, tears, chronic inflammation, and vaginal infections should pay special attention to regular health checks. Women whose partners have phimosis or an elongated prepuce should also pay special attention. Those who have the conditions can try cervical cancer pessaries for preventive treatment.

　　Cervical scraping examination refers to taking a small sample of cells from the cervix, placing them on a glass slide, and then studying them under a microscope to determine if there are any abnormalities. It is currently the simplest and most effective diagnostic method for the widespread screening of cervical cancer.

　　1. Matters to be noted when performing cervical scraping examination

　　1. Please seek the examination from experienced obstetrician-gynecologists, as in addition to the site and collection technique of cervical smear sampling, the observation with the naked eye and the internal examination by obstetrician-gynecologists are also essential tasks. The combination of clinical experience and pap smear accuracy can be improved.

　　2. It is important to avoid washing the vagina in the 24 to 48 hours before the examination, as many women perform local and vaginal irrigation before visiting a gynecologist, which can affect the results of the pap smear.

　　3. The examination is clearer after the menstrual period, and it can be sampled at any time if there is no menstrual period, abnormal bleeding, or malodorous discharge.

　　4. It is essential to have a result after the examination. Nowadays, there are many gynecological and obstetric patients, and some may forget to check the results due to personal busy schedules. Know that no result is equivalent to doing nothing, and in severe cases, it may delay the disease, but there are also patients who are personally informed by their doctors of abnormal cell changes and are asked to return immediately. However, there are also many people who do not respond accordingly.

　　5. Cervical smears can only be used for cancer screening, and cannot be used as a formal diagnosis. The final conclusion is based on the report of the pathologist, so do not be anxious if abnormal cell changes are detected.

　　Secondly, in order not to affect the diagnostic rate of cervical smears

　　Attention should also be paid to the following issues:

　　1. Avoid sexual activity within 24 hours before the smear examination.

　　2. Do not rinse the vagina or use vaginal suppositories within 24-48 hours before the examination, nor should a vaginal examination be performed.

　　3. If there is inflammation, treatment should be given first, and then scraping to avoid the presence of a large number of white blood cells and inflammatory cells in the smear, which may affect the diagnosis.

　　4. It is best to schedule the examination during the non-menstrual period.

    The diet of patients with cervical in situ carcinoma should be light and easy to digest, with an emphasis on eating more vegetables and fruits, and a reasonable diet should be followed, ensuring adequate nutrition. In addition, patients should also avoid spicy, greasy, and cold foods.

　　The treatment of cervical in situ carcinoma depends on factors such as the patient's willingness, age, reproductive requirements, compliance, follow-up conditions, and the equipment and technical conditions of the hospital where the patient is treated. At present, most scholars advocate that the treatment of cervical in situ carcinoma should be surgical resection, with the choice of conization surgery or hysterectomy surgery.

　　1. Cervical conization surgery

　　Cervical conization is both a reliable diagnostic method and an effective treatment, and therefore the preferred method for the treatment of cervical in situ carcinoma. Patients diagnosed with in situ carcinoma after pathological examination following conization can be followed up or undergo hysterectomy 4-6 weeks later; if the pathological results show invasive carcinoma, effective treatment measures should be taken as soon as possible according to the specific situation. Common methods of conization include cold knife conization, laser conization, and LEEP conization. Attention should be paid to the following during conization surgery: ① The operation should be performed under iodine staining or colposcopy to clarify the extent of the lesion; ② The excision range should include the abnormal lesions seen under colposcopy, the entire transformation zone, the entire squamocolumnar junction, and the lower segment of the cervix, but not exceeding the internal os of the cervix; ③ The excision width should be 0.5cm outside the lesion, and the cone height should extend to 2-2.5cm into the cervical canal. When the lesion is on the surface of the cervix, the conization should be wide and shallow; if the lesion involves the cervical canal, the conization should be narrow and deep to avoid leaving any residual lesions. In addition, attention should be paid to the age of the patient; elderly women have a squamocolumnar junction that moves inward into the cervical canal, and the excision should be deep; pregnant women have a squamocolumnar junction that moves outward, and the conization should be shallow; ④ The conization specimen should be checked in detail and marked if necessary; ⑤ If hysterectomy is needed after cervical conization, it is advisable to wait for 4-8 weeks.

　　The main complications after cervical cone biopsy are bleeding, infection, cervical stenosis, and cervical insufficiency, etc.

　　2. Hysterectomy

　　Hysterectomy is the removal of the entire uterus, including the cervix. For patients with cervical in situ cancer who do not have a desire to bear children, they should be able to accept a total hysterectomy. Hysterectomy can be performed directly or after cervical cone biopsy, and the latter is recommended. If direct surgery is chosen, a detailed colposcopic evaluation is necessary. There is still controversy about whether the vagina should be removed during total hysterectomy, and most scholars currently believe that it should be done extraperitoneally in principle. Since CIS involves about 2-3% of cases with lesions extending to the vaginal fornix, the vaginal resection should be 0.5 cm. If the lesions involve the vagina, the hysterectomy should be expanded.

　　3. Management of CIS during Pregnancy

　　For CIN lesions in pregnant women, 75% of patients can regress after childbirth, so conservative observation is advocated. Since the cytological changes during pregnancy can return to normal in 6 weeks after childbirth, a re-examination should be started 6 weeks after childbirth, and treated according to the principles of non-pregnancy. For pregnant women with CINⅢ/CIS, they should be decided based on the gestational age and the urgency of the patient's demand for the fetus. In principle, pregnancy should not be terminated, nor should special treatment be required. They must be followed up closely, including vaginal biopsy under colposcopy when necessary. Diagnostic cone biopsy should only be performed when invasive cancer is suspected. Although most scholars believe that cone biopsy during pregnancy is safe, the depth of cone biopsy should not exceed 1 cm. If the pathological diagnosis is still in situ cancer after cone biopsy, follow-up can be continued until 6 weeks after childbirth before further treatment.

　　4. Special Treatment

　　If patients diagnosed with CIS have serious diseases and have contraindications for surgery, they can consider choosing intracavitary radiotherapy.