Cervical cancer in adolescents and younger sons

　　Cervical cancer in adolescents and younger sons originates from Gartner duct or paramesonephric duct, and its etiology is still unclear. Most authors believe that the occurrence of cervical cancer is related to early marriage, early and frequent sexual activity, smegma, multiple childbirths, multiple pregnancies, cervical erosion, cervical laceration, cervical ectropion, hormonal imbalance, and viral infection. The possible factors for the occurrence of cervical cancer in adolescents and younger sons are as follows:

　　1. Estrogen action

　　If the mother is exposed to estrogen during the embryonic period, the incidence of cervical adenosis in her offspring increases. Some authors believe that cervical adenosis rarely develops into adenocarcinoma, but when cervical adenosis coexists with squamous metaplasia, if stimulated by certain promoting carcinogenic factors, the squamous epithelial cells may have abnormal structures, and 0% to 5% may transform into in situ carcinoma.

　　2. Cervical ectropion

　　The normal cervix is anatomically divided into the vaginal part and the cervical canal. The vaginal part is covered with squamous epithelium and has no glands. The cervical canal is covered with columnar epithelium and has glands. The cervix is histologically divided into the vaginal part, the transitional zone, and the cervical canal. The transitional zone is located between the vaginal part and the cervical canal, composed of cervical endometrial stroma and glands, covered with squamous epithelial cells. Newborns are influenced by maternal estrogen in the body, causing the columnar epithelium of the cervical canal to overgrow and extend towards the external os of the cervix. After birth, the influence of maternal hormones disappears, the vaginal acidity changes, and the squamous epithelium of the vaginal part extends and covers the columnar epithelium, known as squamous metaplasia. If this physiological transitional zone is stimulated by carcinogenic factors, it can eventually lead to cancer.

　　3. Sexual behavior

　　Early sexual activity, early marriage and early childbirth, and multiple sexual partners are closely related to cervical cancer. Epidemiological studies have shown that those who start sexual life early have a higher incidence of cervical cancer. The incidence of cervical cancer in those who have their first sexual intercourse before the age of 18 is 13.3 to 25 times higher than that of those who start after the age of 20, because the cervical epithelium in adolescence has not yet matured and has poor resistance to diseases. Moreover, the immune system of adolescent girls is relatively unprimed and susceptible to the stimulation of carcinogenic factors, which can lead to disease. With the development of age and sexual experience, the female reproductive tract system is sensitized and matures, thus gaining normal disease resistance. Early marriage, premarital sex, and frequent sexual activity promote the carcinogenic effect of smegma. Premature delivery increases the opportunities for cervical laceration, inversion, and erosion, thus increasing the incidence of cancer. In addition, the risk of developing cervical cancer is directly proportional to the number of sexual partners, and those with more than 10 sexual partners have a relative risk 3 times higher than those with less than or equal to 1 sexual partner. For those with more than 6 sexual partners and whose first sexual intercourse was before the age of 15, the risk of developing cervical cancer rises more than 10 times.

　　4, Maternal factors

　　Women of childbearing age, if they are exposed to certain physical or chemical factors for a long time in daily life, reproductive cells may mutate, and their offspring are often prone to cancer after birth. If women take birth control pills or use estrogen during pregnancy, their daughters have a high possibility of developing cervical adenocarcinoma in the future. In addition, the age of the mother, the number of deliveries, multiple pregnancies, and the occurrence of preeclampsia may also be related to the occurrence of cervical cancer in the offspring.

　　5, Viruses and other pathogens

　　Human papillomavirus (HPV), herpesvirus type 2 (HSV), human cytomegalovirus (CMV), and STD infections can all increase the incidence of cervical cancer. Women who have been infected with chlamydia are prone to cervical cancer. Human papillomavirus is the main risk factor for cervical cancer, and more than 100 types of HPV have been identified so far, among which HPV16 is most closely related to the occurrence of cervical cancer, with more than 10 other related types. Viral infection is a sexually transmitted disease. If both partners or one partner has unclean sexual life or too many sexual partners, it is possible for the female partner to be infected with these viruses or pathogens. If the mother has the above infection factors and does not pay attention to her daughter's sexual hygiene, it can also cause cross-infection between mother and daughter, which may lead to cervical cancer in the future.

　　6, Others

　　Low immune function in adolescent girls, smoking, and characteristics of their partners' sexual behavior and other behaviors (number of sexual partners, HPV infection, genital warts and papules, penile cancer, prostate cancer, or previous spouse with cervical cancer) may all be related to the occurrence of cervical cancer, with smokers having twice the risk of cervical cancer compared to non-smokers.

　　The most common complication of cervical cancer is 'genital system deficiency syndrome' after the resection of reproductive tumors during surgery. The specific symptoms include symptoms of poor digestion such as stubborn diarrhea, bloating, nausea, vomiting, and aversion to oil, as well as symptoms of malnutrition such as general weakness, pale complexion, and listlessness. Currently, there is no effective treatment for this type of complication. Pyometra is also a common complication of cervical cancer, usually caused by the obstruction of the cervical canal by the tumor, accompanied by systemic fever and恶臭vaginal discharge.

　　The main symptom is irregular vaginal bleeding, accompanied by typical white discharge resembling washing meat water. Irregular vaginal bleeding during adolescence or before adolescence is often mistakenly diagnosed as menstrual disorders, and there is often a lack of vigilance in unmarried girls, as they are generally not accustomed to doing vaginal examinations and may be misdiagnosed. Dalley reported 2 cases (10 and 15 years old) of patients with irregular vaginal bleeding, which was mistakenly diagnosed as menstrual disorders until fragmented tissue was discharged from the vagina, and it was confirmed as cancer only after pathological examination.

　　When cancer invades the para-cervical tissue, it starts with a sense of distension, followed by dull pain, and if it involves the peritoneum, it can cause severe pain. If it involves the pelvic tissue, it can compress or invade the nerve trunk, causing intermittent low back pain to develop into persistent pain and radiating to the lower limbs. Compression or invasion of the ureter can cause renal pelvis hydrops, leading to dull pain in the lower back. Compression or invasion of the bladder often manifests as frequent urination, hematuria, and dysuria, and in severe cases, urinary retention or fistula may occur, even leading to uremia. Pain is often a late manifestation of cervical cancer.

　　The symptoms vary according to the site of metastasis. In addition to the lymphatic system, lung metastasis is more common, manifested as chest pain, cough, hemoptysis, etc., and chest X-ray examination can see the shadow of metastatic cancer. Patients with bone metastasis may have persistent pain in the corresponding area, and X-ray film can see bone destruction.

　　Cervical cancer occurs worldwide and is one of the most common cancers in humans. Not only does it occupy the first place among female reproductive organ cancers, but it is also the most common among various female malignant tumors. Cervical cancer prevention should be carried out from two aspects: etiology prevention and precancerous prevention, that is, 'three early' prevention. Women should timely undergo gynecological examinations and can achieve the effect of cervical cancer prevention, and timely detect the condition of cervical cancer.

　　One, cervical cancer prevention should start with etiology prevention

　　Although the etiology of cervical cancer is not fully understood, many factors are closely related to it, and these factors can be controlled. For example, promoting late marriage, prohibiting early marriage and sexual disorder, implementing family planning, strengthening sexual morality and hygiene education, and actively preventing and treating diseases related to the occurrence of cervical cancer.

　　The concept of cervical cancer etiology prevention must be included in the health education of adults and adolescents, and must be emphasized in this kind of education. Education for males should also start from adolescence.

　　Two, clinical precancerous cervical cancer prevention, that is, 'three early' prevention

　　The so-called 'three early' refers to early detection, early diagnosis, and early treatment, with the aim of preventing the development of the initial disease. The occurrence and development of cervical cancer have a gradual evolution process, which can take several years to several decades. It is generally believed that this evolution process goes through several stages: hyperplasia, atypical hyperplasia, in situ cancer, early invasion, and invasive cancer. Therefore, regular health checks for married women in the population can effectively prevent the occurrence of cervical cancer and reduce its mortality rate by diagnosing and treating precancerous lesions and early cancers in a timely manner.

　　Three, according to their own health status to do cervical cancer prevention measures

　　Early signs of cervical cancer1. Increase in vaginal discharge, which may not have an abnormal smell in the early stage. 2. Abnormal vaginal discharge, which may contain blood and have a foul smell. 3. Irregular vaginal bleeding, which is more common in post-coital bleeding, bleeding after exertion in the lower abdomen, and post-menopausal bleeding. 4. After the development of cervical cancer, symptoms such as urinary irritation, frequent urination, urgency, and bloody stool may occur, and swelling and pain in the pelvis and lower limbs may also occur.

　　Treatment of precancerous lesionsIf cervical erosion, CIN and other precancerous lesions are found, timely treatment is required. At present, there are still many treatment methods for precancerous lesions of cervical cancer, such as cervical electrocautery, electrocoagulation, cryotherapy, laser treatment, etc., and drug treatment can also be chosen, such as retinol acid, etc. Appropriate treatment methods should be selected according to the condition.

　　There are various methods for examining cervical cancer in adolescents and young children, and the main ones in clinical practice are as follows:

　　1. Vaginal Cytology Smear Examination

　　It is of great significance for the early detection of cervical cancer. The method of expressing the results of cytological diagnosis can continue to use the Papanicolaou 5-grade classification method, and now the FIGO recommends the widespread application of the Bethesda (TBS) classification method, CCT, and PEPNET diagnostic devices.

　　2. Iodine Test

　　When the cervical cell smear is abnormal or the clinical situation is suspicious for cancer without colposcopy, the iodine test can be used to detect abnormal areas. Currently, the commonly used iodine solution is Lugol's solution or 2% iodine solution. A positive iodine test is indicated by cells that do not stain.

　　3. Colposcopy

　　Colposcopy and colposcopic microscopy play an important role in the early detection of cervical cancer, determining the location of the lesion, and increasing the positive rate of biopsy. The colposcope can magnify the lesion 6 to 40 times. Under strong light, it can be observed directly through binoculars to see the fine morphological changes of the cervical epithelium and blood vessels. It is mainly used for examining cervical cancer and precancerous lesions. During colposcopy, the main observations are the shape of blood vessels, capillary spacing, surface of the epithelium, and the boundaries of the lesion. Biopsy at abnormal locations can significantly improve the accuracy of diagnosis.

　　4. Cervical Biopsy and Endocervical Curettage

　　This is the most reliable and indispensable method for diagnosing cervical cancer and precancerous lesions. Generally, four biopsies are taken at the 3, 6, 9, and 12 o'clock positions of the junction of the squamous and columnar epithelium at the cervical orifice, or suspicious areas observed under iodine test or colposcopy are taken for pathological examination. The tissue taken should include both epithelial and stromal tissues. If the cervical smear is at grade III or above, and the cervical biopsy is negative, a small spatula should be used to scrape the cervical canal, and the scraping material should be sent for pathological examination.

　　5. Cervical Conization

　　When the cervical smear shows positive multiple times, and the cervical biopsy is negative or the biopsy shows in situ carcinoma, but the clinical situation cannot exclude invasive cancer, a cervical conization can be performed to clarify the diagnosis.

　　6. Other examinations

　　When determining the clinical stage of cervical cancer patients according to their specific conditions, auxiliary examinations such as chest X-ray, ultrasound, intravenous pyelography, cystoscopy, and rectoscopy may be required to help with diagnosis.

　　Therapeutic diet for cervical cancer in adolescents and young children:

　　1. Papaya Porridge

　　1 papaya and 100 grams of glutinous rice. Wash the papaya, peel and remove the seeds, and cut it into extremely fine particles. First, cook the glutinous rice into porridge, then add the papaya and boil for 3-5 minutes. This is an auxiliary treatment for cervical cancer. Research has confirmed that papaya has an inhibitory effect on human cervical cancer cells.

　　2. Diyu and Huaihua Honey Drink

　　60 grams of Diyu, 30 grams of Huaihua, and 30 grams of honey. Boil Huaihua and Diyu with adequate water twice, combine the two extracts, concentrate the mixture, and then add honey. Take the mixture twice a day in the morning and evening. This recipe clears heat, cools blood, and stops bleeding to解毒, and is used to treat vaginal bleeding in cervical cancer patients.

　　Conventional methods for treating cervical cancer in adolescents and young children in Western medicine

　　Apply traditional Chinese medicine treatment for this disease, one is when the pathogen is still in the Qi phase at the early stage, and the other is after the late surgery as part of a comprehensive therapy.

　　First,辨证选方

　　3. Deficiency of both heart and spleen1. Qi stasis and blood stasis

　　Herbal MedicineTo promote Qi and resolve blood stasis.

　　Add and subtract Shaofu Decoction. 20g Danggui, 15g Chishao, 10g Chuanxiong, 15g Lingzhi, 15g Puhuang, 10g Yanhusuo, 15g Moxibustion, 10g Anxiang, 10g Ganjiang, 15g Rougui. Add Chenpi and Xiangfu for obvious Qi stasis; add Fuling and Baizhu for obvious leukorrhea; add Baihuashehetong and Huangjing for detoxification and blood stasis if the condition is severe.

　　3. Deficiency of both heart and spleen2. Damp-heat蕴毒

　　Herbal MedicineTo clear heat and eliminate dampness, detoxify and resolve phlegm.

　　Add the modified recipe of Zhi Dai Prescription. 20g Fuling, 20g Zhuli, 15g Zexie, 10g Chishao, 10g Danpi, 10g Yinchen, 10g Huangbai, 10g Zhizi, 10g Niuxi, 15g Cheqianzi, 25g Baihuashebaicao, 15g Tufuling. Add Jingyuan and Diding for excessive leukorrhea.

　　3. Deficiency of both heart and spleenTo invigorate the heart and spleen.

　　Herbal MedicineAdd Guipi Decoction. 15g Dangshen, 20g Huangqi, 15g Baizhu, 20g Fuzi, 10g Suanzaoren, 10g Guilanyou, 10g Muxiang, 10g Zhigancao, 15g Danggui, 10g Yuanzhi, 10 pieces of Dazao, 3 slices of ginger. Add Shuadi for blood deficiency; remove Dangshen and add Renshen for qi deficiency.

　　Second, Special Prescription

　　1. Hongsheng DanExternal use of red mercuric oxide powder. Function: Remove gangrene and promote muscle growth. Suitable for early stage patients with mild illness, and also suitable for patients who cannot undergo surgery in the late stage.

　　2. Huaxue Huisheng TabletEach pill weighs 6 grams, take one pill each time, twice a day, taken with warm wine or warm water after meals. Function: Dissolve blood stasis. Used for blood stasis in the recovery period after surgery.

　　3. Shiquan Dabu PillEach pill weighs 9g, water honey pill, take one pill each time, 2-3 times a day, taken with warm water. Function: Warm and nourish the vital energy and calm the mind. Suitable for the recovery period after surgery.

　　4. Ginseng and Royal JellyEach vial contains 10ml, with 250mg of red ginseng and 300mg of royal jelly. Take 10ml each time, once or twice a day. Function: Enhance physical fitness and improve immunity. Suitable for the recovery period after late surgery.