Invasive cervical carcinoma
Introduction
Introduction to cervical invasive cancer Cervical invasive cancer is a malignant tumor that occurs in the cervical epithelium. Invasive cervical cancer is often found in gynecological examinations and confirmed by histopathological examination of pathological biopsy. Some cervical cancer is asymptomatic and abnormal in the naked eye, which is called preclinical invasive cervical cancer. In developing countries, 90% to 95% of cervical invasive cancers are squamous cell carcinomas, and 2% to 8% are adenocarcinomas. basic knowledge The proportion of illness: 0.05% -1% Susceptible people: good for adult women Mode of infection: non-infectious complication:
Cause
1. Pathological characteristics According to the tissue source of the tumor, the main pathological types of cervical invasive carcinoma are squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma. In recent years, cervical adenocarcinoma and mucinous adenocarcinoma have an upward trend, because of the increase in conventional staining. After mucin staining, it was found that the squamous cell carcinoma tissue in the mucus-stained section was actually a poorly differentiated adenocarcinoma or adenosquamous carcinoma. Therefore, the definition of squamous cell carcinoma is no longer just a tumor like stratified squamous epithelium, but should be clearly defined as: Squamous cell carcinoma refers to a cancer that has squamous epithelial differentiation, ie, keratinization and intercellular bridges, but no glandular differentiation or mucus secretion. No glandular differentiation or mucus secretion is important, and differentiation can be excluded based on these two points. Poor adenocarcinoma and adenosquamous carcinoma, this new classification not only corrects the diagnosis of cervical cancer, histogenesis and the proportion of different pathological types of cervical cancer, more importantly, it points out the prognosis for the clinic, because poorly differentiated adenocarcinoma and adenocarcinoma Squamous cell carcinoma has a high degree of malignancy and a worse prognosis than squamous cell carcinoma, and it mostly occurs in young patients, which is the main reason for poor prognosis and rapid metastasis. About %, adenosquamous carcinoma accounts for about 10%, in addition, squamous cell carcinoma has verrucous squamous cell carcinoma, papillary squamous cell carcinoma and other subtypes, adenocarcinoma has papillary adenocarcinoma, endometrioid adenocarcinoma, clear cell carcinoma, etc. are rare in clinical practice.
Prevention
Early diagnosis, active treatment, and good follow-up.
Close and regular follow-up after treatment of invasive cervical cancer is very important for understanding the changes of the condition, giving further treatment and judging the prognosis.
1. Follow-up time
Under normal circumstances, return to the hospital for review after 1 month of treatment. If supplementary radiation therapy is needed, the interval should not be too long. Supplementary therapy should be given within 2 to 4 weeks. If the condition is stable, every 2 to 3 months within half a year. 1 examination; 3 to 6 months within one year; 1 semi-annual examination within 2 years; 1 examination at least once a year in the future. When the condition changes, the follow-up time should be flexibly controlled.
2. Follow-up content
① Systemic examination: whether there is superficial lymph node enlargement, abdominal condition, whether the lower extremity is edema, etc.
② Postoperative follow-up: mainly observe the recovery of the patient's general condition, whether the wound is completely healed, and whether there is lymphocyst formation.
Complication
Cancer infiltrates the vagina rapidly, and invades the uterus in the late stage; co-infection.
Symptom
Symptoms of Invasive Cervical Cancer Common Symptoms Persistent Pain Weight Loss Vaginal Bleeding Hematuria Increased Vaginal Discharge Backache Loss of Appetite Urgency Abdominal Pain Fever
The severity and severity of clinical symptoms are related to the early and late stages of the disease. Cervical cancer may be asymptomatic in the early stage. With the development of the disease and the different growth patterns of the tumor, the symptoms gradually appear. The main clinical symptom of invasive cervical cancer is irregular vaginal bleeding. , Vaginal discharge and pain, the severity of these symptoms, and the sooner or later of the lesions, tumor growth patterns, histopathological types and the patient's general condition are directly related.
Irregular vaginal bleeding is the main clinical symptom of cervical cancer patients, accounting for 80% to 85%. Especially postmenopausal vaginal bleeding should be paid attention to. Vaginal bleeding is often caused by rupture of tumor blood vessels, especially in cauliflower-type tumors. If the bleeding occurs frequently, excessive blood loss can lead to severe anemia. In advanced cases, vaginal bleeding can lead to shock, which is more common in erosive tumors.
Increased vaginal discharge is also the main symptom of cervical cancer patients. It usually occurs before vaginal bleeding. Initial vaginal discharge may have no odor. With the growth of cancer, the cancer tissue will become infected, necrotic, and the amount of secretion will increase. Rice watery or bloody watery samples with foul odor. When the tumor spreads upward and involves the endometrium, the secretions are blocked by cervical cancer tissue and cannot be discharged, resulting in the formation of uterine effusion or pyometra. The patient may have Lower abdominal discomfort, pain, backache, abdominal pain and fever and other symptoms.
Examine
Cystoscopy, proctoscopy, nephrogram, pyelography, chest X-ray, pelvic image, etc. In recent years, computerized tomography (CT) and magnetic resonance imaging (MRI) are increasingly used in clinical diagnosis and differential diagnosis (not As a basis for clinical staging), CT scan can help clinically understand the situation of pelvic and para-aortic lymph nodes, and MRI examination can help clinically identify the difference between cervical cancer and normal cervix. Some scholars believe that clinical MRI examination shows full-thickness cervical tissue and uterus. Among the patients with invasion of the lower segment, 94% have parametrial invasion, especially for patients with large-volume cervical cancer, radiotherapy alone can be directly selected to avoid misdiagnosis as early cancer and inappropriate treatment. The above auxiliary examinations are helpful to determine. It is necessary to choose the appropriate treatment method to improve the treatment rate and to judge the prognosis.
Diagnosis
Differential diagnosis
It should be differentiated from cervical infectious diseases. The past concept of histopathology: the standard for diagnosing invasive cancer is to see whether the basement membrane is damaged. It is not a reliable indicator for the identification of invasion, because proliferating basal cells and inflammatory cells can destroy the basement membrane, and the stromal response is currently considered an important indicator for the identification of invasive cancer.
