What are the early symptoms of cervical cancer? How to diagnose cervical cancer in its early stages?

Clinical symptoms and diagnosis methods of cervical cancer:

First, symptoms. Carcinoma in situ and early invasive cancer usually have no symptoms and are usually found during census. The main symptoms of cervical cancer are vaginal bleeding, increased vaginal discharge, and pain. The form and degree of its manifestation are related to the early or late onset and pathological type of cervical cancer.

(1) Increased vaginal discharge. Most cervical cancer patients have varying degrees of increased vaginal discharge. In the early stages, the presence of cancer stimulates the cervical glands to secrete more frequently, producing mucous vaginal discharge. As cancer progresses, cancerous tissue necroses, falls off, and becomes infected, causing the vaginal discharge to become turbid, like rice washing water or pus-like with blood and a special odor.

(2) The early manifestations of irregular vaginal bleeding are a small amount of bloody leucorrhea and contact vaginal bleeding. Patients often experience a small amount of vaginal bleeding after sexual intercourse or defecation. Postmenopausal women with vaginal bleeding should pay attention to finding the cause. Vaginal bleeding from cervical cancer is often very irregular, usually less at first and more later, sometimes more and sometimes less. Cauliflower bleeding occurs early and in large amounts. Late-stage cancer can cause fatal heavy vaginal bleeding after erosion of large blood vessels. Due to long-term and repeated bleeding, patients often develop secondary anemia.

(3) Pain is a symptom of advanced cervical cancer. The main cause of pain is that the pelvic nerves are infiltrated or compressed by cancer. If the obturator nerve, sacral nerve, large blood vessels or pelvic wall are affected, it will cause severe pain, sometimes radiating to the lower extremities. Other causes of pain are: the cervical canal is blocked by cancer, the drainage of intrauterine secretions is poor or intrauterine pus is formed, and lower abdominal pain; cancer invades the paracervical tissue, compresses or penetrates, which can cause ureteral or renal pelvic ureteral water, swelling or spasm, severe pain on one or both sides of the lower abdomen; when cancer compresses the iliac lymph and iliac blood vessels to block reflux, the lower extremities swell and pain.

(4) When advanced cervical cancer invades the bladder, other symptoms may lead to frequent urination, painful urination or hematuria, and even vesico-vaginal fistula. If the ureters on both sides are compressed and blocked, it will lead to urinary retention and uremia, which is one of the main causes of death. When the cancer spreads backward and compresses or invades the rectum, it often causes urgency, blood or difficulty in defecation, and even forms a recto-vaginal fistula. Advanced cancer may lead to malignant diseases due to long-term consumption.

2. Early cervical cancer cannot be identified by local naked eye observation and examination. Most cases only have varying degrees of erosion or slight contact bleeding, and some even have smooth cervical appearances. For patients with suspected or clinically identifiable cervical cancer, a careful gynecological examination and necessary systemic examination should be performed to diagnose and identify the type and extent of cancer growth as soon as possible.

(I) Gynecological examination

1. Visual inspection of the vulva: Pay attention to whether there is cancer in the vulva. Late-stage patients occasionally have vulvar metastasis. In addition, cervical cancer and vulvar cancer can also exist at the same time.

2. For people with recurrent vaginal bleeding, it is best to perform digital examination first to get a preliminary understanding of the extent of the lesion, and then gently insert a speculum to check if the cancerous tissue causes heavy bleeding.

The main purpose of the inspection is to understand the morphology of the cervix. If cancer is suspected, its type, size, and extent of involvement of the cervix and vagina should be understood. If necessary, 3% compound iodine solution can be applied locally for auxiliary examination.

In the early stage of cervical cancer, local changes are not obvious, and cervical smear cytology should be performed. Two auxiliary examination test methods have been proposed: ① Use a 2mm diameter probe to gently press the suspicious area of ​​the cervix and slowly slide it on the surface of the cervix. If the cervical tissue can be inserted when gently pressed, it means that the tissue here is very brittle and may be cancer tissue, which can be confirmed by biopsy; ② Tissue elasticity test: Because the elasticity of cancer tissue decreases or disappears, when the tongue plate or long tweezers are used to gently press the surface of the cervix, the cancer tissue feels hard, brittle, and easy to bleed. Normal tissue has good elasticity and quickly returns to its original shape and color after pressure.

3. Digital vaginal examination refers to touching all vaginal walls, cervical surface and cervical canal from the vaginal opening with the index finger, paying attention to the texture, extent of cancer and whether the finger cot contains blood.

4. In addition to understanding cervical lesions, bimanual examination can also understand the size, texture, and activity of the uterus, as well as whether there are lumps, thickening, and tenderness in the bilateral adnexa and paracervix.

5. The triple diagnosis should pay attention to whether the anterior wall of the rectum is smooth, the elasticity of the posterior wall of the vagina, the thickness and hardness of the cervical canal, whether the paracervical main ligament and sacral ligament are thickened, hardened, elastic and nodular, and whether there is cancer infiltration in the pelvic wall, metastatic and swollen lymph nodes, etc. The triple diagnosis is an indispensable step in determining the clinical stage of cervical cancer.

(2) Systemic examination A systemic examination is required for patients with cervical cancer. This can not only help determine whether there are distant metastatic lesions, but also provide a basis for formulating a treatment plan. Advanced patients should pay attention to whether the iliac fossa, inguinal, and clavicular lymph nodes are swollen, whether the kidneys can be touched, and whether there is percussion pain in the kidney area.

(3) In order to further understand the location and scope of cancer spread and metastasis, some necessary auxiliary examinations should be performed according to the specific situation, such as chest fluoroscopy or photography, cystoscopy, colonoscopy, intravenous pyelography, lymphangiography and isotope renal examination. Biopsy is the most reliable basis for diagnosing cervical cancer, and cancer must be confirmed by biopsy. Because some cervical lesions are similar to amoebic cervicitis, it is difficult to diagnose without biopsy. In addition, tissue section examination can also obtain the type and degree of differentiation of cancer.