What are the characteristics of cervical cancer? What are the treatments for cervical cancer?

In recent years, the incidence of cervical cancer has been showing a trend of becoming younger. The widespread use of cervical cytology screening in recent decades has enabled cervical cancer and precancerous diseases to be detected and treated at an early stage, and the incidence and mortality of cervical cancer have dropped significantly.

Explain the characteristics of cervical cancer in detail

Early cervical cancer often has no obvious symptoms and signs, and the cervix is ​​smooth or difficult to distinguish from cervical columnar epithelial ectasia. Patients with endocervical cancer are easily missed or misdiagnosed because of the normal appearance of the cervix. As the lesion develops, the following manifestations may occur:

1. Symptoms

(1) In the early stage of vaginal bleeding, it is mostly contact bleeding; in the middle and late stages, it is irregular vaginal bleeding. The amount of bleeding varies depending on the size of the lesion and the invasion of the interstitial blood vessels. If it invades large blood vessels, it can cause heavy bleeding. Young patients may also experience prolonged menstruation and increased menstrual volume; elderly patients often experience irregular vaginal bleeding after menopause. Generally, symptoms of exogenous vaginal bleeding occur earlier and the amount of bleeding is larger; this symptom occurs later in endogenous vaginal bleeding.

(2) Vaginal discharge Most patients have vaginal discharge. The liquid is white or bloody, can be thin like water or rice water, or have a fishy smell. Late-stage patients may have a large amount of rice water-like or purulent leucorrhea due to necrosis of cancerous tissue and infection.

(3) Late-stage symptoms Different secondary symptoms may appear depending on the extent of cancer involvement, such as frequent urination, urgency, constipation, lower limb swelling and pain, etc. When cancer compresses or involves the ureter, it may cause ureteral obstruction, hydronephrosis and uremia; in the late stage, systemic failure symptoms such as anemia and malignant diseases may appear.

2. Physical signs

Carcinoma in situ and small invasive carcinomas may not have obvious macroscopic lesions, and the cervix may be smooth or have only columnar epithelial ectasia. Different physical signs may appear as the disease progresses. Exophytic cervical cancer may show polyps and cauliflower pride organisms, often accompanied by infection, and the tumor is fragile and easy to bleed; endophytic cervical cancer is manifested as cervical hypertrophy, hardness, and dilatation of the cervical canal; in the late stage, cancer tissue necroses and falls off, forming ulcers or cavities with a foul odor. When the vaginal wall is involved, the pride organisms on the vaginal wall or the vaginal wall grow; when uterine tissue is involved, double diagnosis and triple diagnosis examinations can touch thickened, nodules, hardness or frozen pelvic cavity.

3. Pathological type

Common types include squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma.

(1) Squamous adenocarcinoma is divided into three histological grades: I is well-differentiated squamous cell carcinoma, II is moderately differentiated squamous cell carcinoma (non-keratinizing large cell type), and III is poorly differentiated squamous cell carcinoma (small cell type), most of which are undifferentiated small cells.

(2) Adenocarcinoma accounts for 15% to 20% of cervical cancer. There are two main tissue types. ① Mucinous adenocarcinoma: The most common type is derived from the columnar mucinous cells of the endocervical canal. It has a microscopic glandular structure, multi-layered proliferation of glandular epithelial cells, obvious abnormal proliferation, nuclear division, and cancer cell papillae entering the glandular cavity. It can be divided into high-, medium-, and low-differentiated adenocarcinomas. ② Malignant adenoma: Also known as minimally invasive adenocarcinoma, it belongs to the category of highly differentiated endocervical mucosal adenocarcinoma. There are many cancerous glands of different sizes and shapes, which are dot-like protrusions and extend to the deep layer of the cervical stroma. The glandular epithelial cells are not atypia-shaped and there is often lymph node metastasis.

(3) Adenosquamous carcinoma accounts for 3% to 5% of cervical cancer. It is formed by the differentiation and development of reserve cells into glandular cells and squamous cells at the same time. The cancer tissue contains both adenocarcinoma and squamous cell carcinoma.

4. Transfer pathway

Hematogenous metastasis is rare, and direct spread to lymph nodes is the main cause of metastasis.

(1) Direct spread is the most common, with cancer tissue infiltrating locally and spreading to adjacent organs and tissues. The vaginal wall is often affected downward, and the cervical canal rarely affects the cavity upward; cancer spreads to both sides and may affect the cervix, vaginal tissue, and even the pelvic wall; when cancer compresses or invades the ureter, it may cause ureteral obstruction and hydronephrosis. In the late stage, it may spread forward or backward, invading the bladder or rectum, and forming a vesicovaginal fistula or a rectovaginal fistula.

(2) Lymphatic metastasis: After local infiltration, the cancer lesion invades the lymphatic vessels to form tumor emboli, which are then drained into the local lymph nodes with the lymphatic fluid and spread in the lymphatic vessels. The first-level lymphatic metastasis group includes paracervical, parauterine, obturator, internal iliac, external iliac, common iliac, and presacral lymph nodes; the second-level group includes deep and superficial inguinal lymph nodes and para-aortic lymph nodes.

(3) Hematogenous metastasis is rare and may metastasize to the lungs, liver, or bones in the late stage.

Cervical cancer treatment requires choosing the right method

According to the clinical stage, patient age, fertility requirements, general condition, medical technology level and equipment conditions, we formulate appropriate personalized treatment plans. We adopt comprehensive treatment plans such as surgery, radiotherapy and chemotherapy.

1. Surgical treatment

Surgery is mainly used for patients with early-stage cervical cancer.

Commonly used surgeries include: total hysterectomy, hysterectomy and pelvic lymph node cleaning, para-aortic lymph node removal or sampling. Young patients have normal ovaries. For young patients who need to preserve fertility, cervical cone resection or radical cervical resection is feasible in the early stage. Different surgeries are selected according to the different stages of the patient.

2. Radiation therapy

Applicable to: ① patients in the middle and late stages; ② early stage patients who are not suitable for systemic surgery; ③ preoperative radiotherapy for large cervical lesions; ④ postoperative pathological examination reveals high-risk factors for adjuvant treatment.

3. Chemotherapy

It is mainly used for patients with advanced or recurrent metastasis. In recent years, new adjuvant chemotherapy (intravenous or arterial infusion chemotherapy) before surgery has also been used to reduce tumor lesions, control subclinical metastasis, and enhance radiosensitivity. Commonly used chemotherapy drugs include cisplatin, carboplatin, paclitaxel, bleomycin, ifosfamide, fluorouracil, etc.