Treatment of cervical cancer

Cervical cancer is one of the most common malignant tumors, and its incidence rate ranks second among female tumors. About 200,000 women die from this disease every year worldwide. So what are the treatments for cervical cancer? Let's take a look!

1. Treatment principles

1. Atypical hyperplasia: If the biopsy shows mild atypical hyperplasia, it is temporarily treated as inflammation, and the scraping is followed up for half a year and biopsy is performed again when necessary. If the lesion persists, it can be observed. For those diagnosed with moderate atypical hyperplasia, laser, freezing, and electric ironing should be used. For severe atypical hyperplasia, total hysterectomy is generally recommended. If you urgently want to have children, you can also follow up regularly and closely after cone excision.

2. Carcinoma in situ: Generally, most people advocate total hysterectomy, retaining both ovaries; some advocate simultaneous removal of 1-2 cm of the vagina. In recent years, laser treatment has been used at home and abroad, but close follow-up is required after treatment.

3. Microscopic early invasive cancer: Generally, extended total hysterectomy and 1-2 cm of vaginal tissue are recommended. Because the possibility of lymph node metastasis of microscopic early invasive cancer is extremely small, it is not necessary to eliminate 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 radiation, surgery, and chemotherapy. Generally speaking, radiotherapy is suitable for patients of all stages; the surgical effect of stage Ib to IIa is similar to that of radiotherapy; cervical adenocarcinoma is slightly less sensitive to radiotherapy, and a combined treatment of surgical resection and radiotherapy should be adopted.

(II) Surgical treatment includes extensive hysterectomy and pelvic lymph node removal. The removal range includes the entire uterus, bilateral adnexa, upper vagina and paravaginal tissues, and pelvic lymph nodes (paracervical, obturator, internal iliac, external iliac, and lower common iliac lymph nodes). The surgery must be thorough, safe, strictly follow the indications, and prevent complications.

(III) Surgical complications and their treatment

1. Surgical complications include intraoperative bleeding, postoperative pelvic infection, lymphocele, retention, urinary tract infection and ureterovaginal fistula.

2. Treatment of surgical complications. In recent years, the incidence of the above complications has been significantly reduced due to improvements in surgical methods and anesthesia techniques, the use of preventive antibiotics, and the use of extraperitoneal negative pressure drainage after surgery.

(IV) Radiotherapy is the first choice for cervical cancer and can be applied to all stages of cervical cancer. The radiation range includes the cervix and the affected vagina, uterine body, paracervical tissue and pelvic lymph nodes. The irradiation method generally adopts a combination of internal and external irradiation. Internal irradiation is mainly aimed at the primary lesion of the cervix and its adjacent parts, including the uterine body, the upper part of the vagina and its adjacent paracervical tissue (point "A"). External irradiation is mainly aimed at the area where the pelvic lymph nodes are distributed (point "B"). The internal radiation source uses intracavitary radium (Ra) or 137cesium (137Cs), which is mainly aimed at the primary lesion of the cervix. The external radiation source uses 60 cobalt (60Co), which is mainly aimed at metastatic lesions outside the primary lesion, including the pelvic lymph node drainage area. At present, it is advocated to perform internal irradiation first for early cervical cancer. For advanced cancer, especially those with huge local tumors, active bleeding, or concomitant infection, it is appropriate to perform external irradiation first.

(V) Chemotherapy: So far, cervical cancer is insensitive to most anti-cancer drugs, and the effectiveness of chemotherapy does not exceed 15%. Patients in the advanced stage can adopt comprehensive treatments such as chemotherapy and radiotherapy.