What are the physical signs of patients with early cervical cancer

(I) General examination Gynecological examination is the focus, but do not ignore the general examination, especially the examination of superficial lymph nodes. Advanced cervical cancer can have distant metastases in multiple parts, such as supraclavicular lymph node metastasis, lung metastasis, liver metastasis, bone metastasis, subcutaneous metastasis, inguinal lymph node metastasis, etc. Some metastases can be found through physical examination, such as supraclavicular, inguinal lymph node metastasis, and subcutaneous metastasis. Enlarged, fused and fixed lymph nodes can be touched, and fine needle puncture can obtain evidence of cancer cell metastasis. However, metastasis in some parts is more hidden and requires the help of other auxiliary examinations to be discovered.

(II) Morphology of cervical tumors In the early stage of cervical cancer, there are no local macroscopic lesions. It may be cervical erosion of varying degrees, that is, the surface of the cervix is ​​ruddy, and the mucosal surface has epithelial destruction of varying depths, presenting a granular rough surface, which is easy to bleed when touched. As the tumor develops, it can show different tumor morphologies, the most common of which are cauliflower type, nodular type, ulcerative type and endogenous type. Cauliflower type cancer obviously protrudes into the vagina, with nipples of varying sizes on the surface, shaped like cauliflower, rich blood supply, brittle texture, and easy to bleed. Therefore, when placing the speculum, it should be gradually advanced and viewed, and it must not be inserted into the deep part of the vagina at once, so as not to touch the tumor and cause heavy bleeding. Nodular type tumors are formed by the infiltration of tumor tissue into cervical tissue, fusion to form nodules, hard texture, and the surface of the cervix has epithelial destruction of varying depths. Ulcerative type is formed by the necrosis and shedding of cancer tissue during growth, forming ulcers of varying depths, with irregular ulcer edges and hard bottom and edges. Endophytic cervical cancer is caused by the infiltration and growth of cancerous tissue in the cervical canal, resulting in the appearance of a barrel-shaped cervix. The surface of the cervix may be smooth or ulcerated, but the texture of the cervix is ​​hard, which is different from general cervical hypertrophy.

(III) Vaginal vault and vulva As cervical cancer progresses, cancerous tissue often involves the vaginal vault, causing it to become shallower or even disappear. When it invades the vagina, it can cause vaginal stenosis, hardening of the vaginal wall tissue, and lack of elasticity. During visual examination, it is recommended to use a transparent speculum to facilitate comprehensive observation of the vagina and avoid missing lesions.

(IV) Paracervical tissue, bladder, and rectum Cervical cancer often spreads to the paracervical tissue, such as the cardinal ligament and sacral ligament, forming nodular or mass-like lesions, causing the paracervical tissue to thicken, shorten, and harden. It further invades the pelvic wall tissue, forming the so-called "frozen pelvis". The cancer can invade the bladder forward and the rectum backward, causing vesicovaginal fistula or rectovaginal fistula.

(V) Gynecological examination of the uterus and adnexa also requires understanding of the position, shape, size, texture, and mobility of the uterus. Cervical cancer can infiltrate the uterus, resulting in fixed uterus and poor mobility; if uterine cavity pyometra occurs, it may manifest as enlarged uterus, obvious tenderness, and fever. It is also necessary to understand whether there is a mass in the bilateral adnexa.

It is worth reminding that the triple diagnosis examination is the best method for examining cervical tumors, and it is also a necessary means to determine the degree of paracervical infiltration.