Cervical stump cancer

　　Cervical stump cancer is caused by the transformation of the remaining cervical cancer after subtotal hysterectomy for other gynecological diseases. The causes of cervical cancer transformation include:

　　1, Sexual behavior

　　Early age of first sexual intercourse, multiple sexual partners, and the sexual behavior of male partners are all considered to be related to the occurrence of cervical cancer. It is believed that this is related to the squamous metaplasia of the cervix during adolescence, which is more sensitive to carcinogens.

　　2, Human papillomavirus infection

　　Human papillomavirus infection is the main risk factor for cervical cancer.

　　3, Menstrual and delivery factors

　　In rural China, poor hygiene (not washing the vulva, etc.) and women with prolonged menstrual periods have a significantly increased risk of cervical cancer. This also includes poor hygiene during menstruation and postpartum. In addition, more and more facts show that multiple childbirths are closely related to cervical cancer.

　　4, Male sexual behavior and related factors

　　Male sexual behavior is closely related to cervical cancer. By comparing the characteristics of sexual behavior and other behaviors of the spouses of women with cervical cancer and healthy women, the role of males in the onset of cervical cancer is studied. All these studies have reached a consistent conclusion, that the number of sexual partners of the spouses of women with cervical cancer is much higher than that of the control group. The study also points out that the spouses of most patients with cervical cancer have various sexual histories, including genital warts, gonorrhea, and genital herpes, while women who often use condoms have a lower risk of cervical cancer.

　　5, Smoking

　　It may be one of the factors leading to cervical cancer. The risk of both in situ and invasive cancer increases in smokers. After controlling other various factors, it is found that the impact of smoking still exists. In most studies, the risk of cervical cancer in smokers increases twice, and most high-risk patients are long-term heavy smokers, suggesting the possibility of late effects. It is believed that the effect of smoking is only evident in squamous cell carcinoma patients, and is unrelated to adenocarcinoma or adenosquamous carcinoma.

　　6, Contraception methods

　　The relationship between oral contraceptives and the risk of cervical cancer is influenced by various factors, especially the impact of sexual behavior. Most studies, after considering the effects of relevant factors, have proven that the risk still increases. For those who have taken oral contraceptives for ≥8 years, the risk increases twice.

　　7, Herpesvirus Type II (HSV-Ⅱ) and other HSV-Ⅱ

　　It is the virus that was first considered to play an important role in the etiology of cervical cancer. Some units in China have conducted serological epidemiological surveys on HSV-Ⅱ and cervical cancer using various methods, and found that the positive rate of HSV-Ⅱ antibodies in cervical cancer patients was as high as over 80%, while the control group was only 14.14% to 57.14%, and the antigen positive rate was also much higher than that of normal controls and chronic cervicitis. The use of in situ hybridization and HSV-Ⅱ DNA probe detection also found that the HSV-Ⅱ DNA related sequences in cervical cancer tissues were much higher than those in normal cervical tissues.

　　In summary, although the etiological relationship between HSV-Ⅱ and cervical cancer cannot be definitely confirmed, it cannot be excluded either, especially since it may interact with HPV.

　　Cervical stump cancer refers to the occurrence of cancer in the residual part of the cervix after subtotal hysterectomy. The main complications of cervical stump cancer are complications such as infection, adhesion of surrounding tissues, and recurrence.

　　The clinical symptoms and signs of cervical stump cancer can vary due to different clinical stages and tumor growth patterns. Early cases of cervical stump cancer may sometimes be asymptomatic, accounting for about 6%. They are only discovered during general surveys or due to other reasons. Patients with infiltrative cervical stump cancer generally have irregular vaginal bleeding and increased vaginal discharge, the main symptoms are completely the same as cervical cancer. Some patients with cervical stump cancer, 75% to 80% have vaginal bleeding, and 10% to 14% have increased leukorrhea. If the tumor is secondary to infection and tissue necrosis, the discharge may be malodorous, and patients may have symptoms such as low back pain and lower abdominal坠胀.

　　To reduce the incidence of cervical stump cancer, strict examination must be conducted to exclude cervical cancer before deciding on subtotal hysterectomy or total hysterectomy. After subtotal hysterectomy, patients should regularly participate in general surveys, and early diagnosis and timely and appropriate treatment are more important for stump cancer. Regular checks should be made after subtotal hysterectomy, such as routine cervical cancer screening smears, and colposcopy and cervical biopsy may be performed as necessary to exclude malignancy, in order to avoid missed diagnosis. If patients report vaginal bleeding after subtotal hysterectomy, early diagnosis and treatment should be sought. After treatment, regular follow-up according to routine should also be carried out, and active treatment should be given if recurrence occurs.

　　Cervical stump cancer can occur within several months to 2 years after subtotal hysterectomy, or it can occur several years or even longer after the operation. The clinical examination of this disease is as follows.

　　1. Cervical smear cytology examination:It is commonly used in cervical cancer screening and must be performed by scraping the cervix at the transition zone, mainly based on nuclear changes in cells to judge cell malignancy.

　　2. Iodine testIodine test is not specific for cancer. Since normal cervical epithelium is rich in glycogen, it will be stained brown-black by iodine, while cancerous epithelium lacks glycogen and will not be stained, so take living tissue from the unstained area to improve the accuracy of diagnosis.

　　3. Colposcopy examinationObserve the surface of the cervix for atypical epithelium or early cancer changes, and select the lesion site for histological examination to improve the accuracy of diagnosis.

　　4. Cervical and cervical canal biopsy: It is the most reliable and indispensable method for diagnosing cervical cancer and its precancerous lesions.

　　During radiotherapy for cervical stump cancer patients, diet should focus on nourishing the blood and moistening the yin, and foods such as pork liver, lotus root, mushrooms, spinach, celery, and water chestnuts can be consumed. If radiotherapy causes radiation cystitis and radiation proctitis, a diet with a cooling and damp-drying, yin-nourishing, and detoxifying effect should be given, such as coix seed, red beans, water caltrop, lotus root, and spinach. During chemotherapy, diet should focus on strengthening the spleen and kidney, and foods such as yam, coix seed porridge, animal liver, placenta, glue, turtle, mushrooms, and goji berries can be consumed. When digestive tract reactions such as nausea, vomiting, and loss of appetite occur, a diet for strengthening the spleen and harmonizing the stomach should be taken, such as sugarcane juice, ginger juice, black plum, and kumquat. For advanced cervical cancer, high-protein and high-calorie foods such as milk, eggs, turtle, red beans, mung beans, fresh lotus root, spinach, and winter melon should be chosen. Cervical cancer patients should avoid smoking and drinking, and eat less chive and scallion. Foods that should be avoided include greasy, sweet, spicy, aromatic, fried, and roasted foods that produce dampness, phlegm, dryness, and are prone to bleeding.

　　The treatment methods for cervical stump cancer are the same as those for general cervical cancer, mainly involving surgery and radiotherapy. For advanced cases, a comprehensive treatment approach combining surgery, radiotherapy, and chemotherapy is adopted. The effectiveness of treatment is related to the clinical stage before radiotherapy and chemotherapy, the morphological characteristics of the tissue, the growth pattern of the tumor, and the overall condition of the patient. Due to the removal of the uterine body, adhesions between the bladder, rectum, and cervical stump are formed, along with surrounding adhesion foci and scars, all of which make treatment difficult. Surgical treatment is suitable for early cervical stump cancer. Special attention should be paid to anatomical relationships during surgery to prevent and reduce complications. Most stage II and III cervical stump cancer patients and those with general cervical cancer use radiotherapy, and intracavitary treatment is still an important part of radiotherapy for stump cancer. However, due to the removal of the uterine body, the cervical canal shortens, resulting in a reduction in the total dose of intracavitary irradiation, which increases the possibility of local recurrence. If the dose of intracavitary treatment is increased, the survival rate can reach the level of general cervical cancer, but the incidence of radiation-induced proctitis and cystitis will increase accordingly.