cervical cancer recurrence
Introduction
Introduction to cervical recurrence cancer Cervical recurrence cancer refers to tumor recurrence after radical treatment of cervical cancer. Cervical recurrence cancer occurs mostly after treatment of advanced cervical cancer (including local advanced stage), and about 35% recurrence after invasive cervical cancer treatment is also reported. Recurrent cervical cancer is difficult to treat and has a poor prognosis. It is the most important cause of cervical cancer death. basic knowledge Proportion of disease: 1% of the disease in a specific female population Susceptible people: no specific population Mode of infection: non-infectious Complications: renal failure
Cause
Cervical recurrence cancer etiology
Causes:
In addition to treatment, there are many factors affecting recurrence. The data of uterine eradication are complete. IbIIa, 702 patients who have been tracking for more than 5 years, list 10 factors for individual analysis, and use the computer score Mantel-Cox test. The recurrence rate of individual factors gives each factor a score. The more scores, the higher the risk. Make a prediction before and after surgery, evaluate the recurrence rate after surgery and consider adjuvant treatment to reduce the recurrence rate. These 10 factors include Patient age, FIGO stage, histological classification, cell differentiation, uterine invasion, parauterine invasion, vaginal invasion, tumor emboli, marginal tumor margin and lymphatic invasion.
Some studies have investigated the lymphatic invasion. After deep uterine eradication surgery, the lymphatic invasion rate of FIGOIbIIa is 20.8% (288/1383), while the lymphatic invasion rate of IIb patients is 41.6% (96/231). The recurrence rate of invasion was 63.8% (106/288), and the recurrence rate without lymphatic invasion was 11.0% (120/1095). The number of lymphatic invasions was calculated from 288 patients with lymphatic invasion, and the number of lymphatic invasions was found to be 2. The recurrence rate was 26.6% (43/164), while the recurrence rate was 3 (50/8%) (P<0.0001), 66 for aortic lymphadenectomy, and 83.3% (55). /66), 16.6% (11/66) of the violations, in addition, the aortic lymph was not enlarged during surgery, and microscopic metastasis was found to be 4.6% (1/22) after surgery. The swollen rate of invasion was 22.2% (8/36). Patients with aortic lymphatic invasion had more than one metastasis of the pelvic lymph.
This discussion shows that the number of lymphatic invasions is particularly high in more than three cases. The adjuvant therapy should be considered. The aortic lymph, especially without augmentation, may not be considered for removal. It should reduce the intestinal obstruction after surgery and Other comorbidities.
Pathogenesis:
In addition to the extent of surgical resection affecting the recurrence rate, especially the location of recurrence, in fact, the larger surgery can only make a maximum resection of the tumor confined in the uterus or even the pelvic cavity, from the spread of cervical cancer, lymph, Blood and direct spread are possible, so the chance of recurrence is inevitable. Some scholars have analyzed the presence of cancer cells in the blood of 84 patients with Ib-IIb before surgery. The peripheral blood squamous cell carcinoma (SCC) was measured by PCR (Feverse transeriptase-PCR). The cancer index cytokeratin 19, found to be 21.4% (18/84) positive, compared with 5.7% (2/35) in the benign cervical disease group and 0% (28) in the normal cervical group, meaningfully The difference is that the cancer cells of patients with cervical cancer have long appeared in the peripheral blood. It is possible to exist through blood diffusion and metastasis, but the patients with positive reaction, combined with all risk factors including pelvic lymphatic metastasis, but Insignificant, perhaps indicating that these free cervical cancer cells are not living soon, it is not easy to find a chance to survive, but this discovery from From a distance, perhaps in the future may reduce or extinguish the distal metastasis via the trail.
Prevention
Cervical recurrence prevention
Follow-up work after treatment of cervical cancer, early detection of recurrent cancer, timely treatment and continue to follow up.
(1) Promote late marriage and less birth, eugenics. Delaying the starting age of sexual life and reducing the number of births can all reduce the chance of cervical cancer.
(2) Actively prevent and treat cervical colitis and chronic cervicitis. Care should be taken to avoid cervical laceration if there is a laceration during childbirth.
(3) Attentional hygiene and menstrual hygiene. Appropriate moderation of life, menstrual period and puerperium should not be sexual intercourse, pay attention to the cleanliness of the reproductive organs of both sides, it is best to wear condoms during sexual intercourse, reduce and eliminate multiple sexual partners.
(4) If the man has a phimosis or a prepuce, it should be treated with local cleaning. It is best to do circumcision. This will not only reduce the risk of cervical cancer, but also prevent the occurrence of penile cancer.
(5) For people at high risk of cervical cancer, including women who are prematurely sexually active, excessively premature, too premature, too much, too dense, women who have promiscuity, promiscuity, multiple sexual partners and unclean sexual life, health Women with poor conditions, lack of sexual health knowledge, women with cervical erosion, tears, chronic inflammation and vaginal infections, women with spouses with too long prepuce or phimosis should pay special attention to regular censuses. Patients with conditions can try cervical cancer thrombus for preventive treatment.
Complication
Cervical recurrence cancer complications Complications, renal failure
Patients with advanced recurrent cancer have symptoms of systemic wasting syndrome such as loss of appetite, weight loss, cachexia, and renal failure.
Symptom
Cervical recurrence of cancer symptoms Common symptoms of vaginal discharge increased weight loss of appetite decreased vaginal irregular bleeding bone metastasis lower extremity edema liver metastasis lymphadenopathy back pain pelvic mass
With the recurrence site and the degree of disease, the corresponding clinical symptoms and signs appear. The early stage can be asymptomatic, and the clinical manifestation is gradually progressing. The main symptoms and signs of patients with cervical recurrence cancer often show weight loss.
1. Central recurrence: The most common symptoms are irregular vaginal bleeding and/or increased vaginal discharge.
2. Recurrence of the parametrial (or pelvic wall): There may be discomfort in the lower abdomen in the early stage. As the lesion develops, there may be pain in the lower limb of the affected side, edema, pain in the ankle (or hip), low back pain, lower abdominal pain, difficulty in urinating and defecation, sometimes Lower abdomen or pelvic mass can be found.
(1) Recurrence site: mainly pelvic cavity, accounting for more than 60%.
1 Cervical cancer recurrence: the upper part of the vagina and the original uterus is the most common, accounting for 1/4 (Graham et al., 1962). Domestic scholars have reported a local recurrence rate of 59.8%, and distant metastasis accounted for 40.2%, of which lung ( 16.9%), supraclavicular lymph nodes (12.0%) and bone, liver more common.
2 recurrence after radiotherapy: most reports of pelvic recurrence more than extra-basal metastasis, Graham et al (1962) reported that 43% occurred in the uterine (including the pelvic wall, 27% in the cervix, uterus or vaginal upper segment, 6% in the vagina 2 /3,16% in the distance, 8% unknown), the Chinese Academy of Medical Sciences Cancer Hospital made a series of reports, in the cases of cervical cancer after traditional radiotherapy failure, pelvic recurrence accounted for 70%, distant metastasis accounted for 30%, Pulmonary metastasis was more common in extra-basal organ metastasis, accounting for 2.4%, supraclavicular lymph node metastasis rate was 1.62%, bone metastasis was 0.88%, foreign reports were 1.3%-8.9% (lung), and 2.97% (supreme supraclavicular lymph node metastasis). ) and 5.0% (bone metastasis), with the rapid development of radiotherapy equipment and technology in the 1980s, Manetta et al (1992) believed that central recurrence has decreased, Sun Jianheng (1993) reported recurrence of pelvic recurrence after endoluminal radiotherapy To 41%, distant metastasis accounted for 59%. Zhang Xiaochun et al (1995) reported that the rate of pelvic recurrence after cervical cancer treatment was only 19.7%, including pelvic wall recurrence was 53.3%, central recurrence accounted for 46.7%.
(2) Recurrence time: Most reports at home and abroad occurred in more than 60% within 2 years. According to the statistics of the Cancer Hospital of Chinese Academy of Medical Sciences, in 95 cases of recurrence after cervical cancer radiotherapy, it occurred in 42.1% in the first year and 60% in 2 years. %, 10.5% after 5 years, 6.3% after 10 years, Zhang Xiaochun et al (1995) reported that 60.8% occurred within 2 years, Li Mengda et al (1992) reported recurrence of cervical cancer after surgery, accounting for 36.9% within 1 year, within 2 years It accounts for 61.9%, accounting for 72.8% in 3 years and 93% in 5 years.
3. Recurrence and metastasis in distant areas: such as cough, chest pain and/or back pain, cough, sputum with blood or hemoptysis, etc., bone metastases often have fixed focal pain, liver metastases often have liver area Discomfort or pain, liver enlargement, swelling of the supraclavicular lymph nodes.
4. Patients with advanced cachexia may have systemic wasting syndromes: such as loss of appetite, rapid decline in weight or weight loss in the short term, and even cachexia.
Examine
Cervical recurrence cancer examination
1. Tumor markers: The current tumor markers that are useful for the monitoring of advanced and recurrent cervical cancer are squamous cell carcinoma antigens (SCC), and Pectasides et al. (1994) report an increase in SCC in 92% of patients with recurrence or progression.
2. Vaginal exfoliative cytology: After radiotherapy, vaginal exfoliated cells are often difficult to estimate for cancer cells. From a radiobiological perspective, viable cells refer to cells with sustained growth, and non-viable cells refer to loss of proliferation. The ability of the cells, but it still has metabolic activity. After radiotherapy, the cancer cells can last for several months like normal cells, but biologically these cells are not viable, so the vaginal exfoliated cell smears can still find cancer cells after radiotherapy. It is mistaken that the tumor continues to spread, and the naked eye observation is difficult to identify due to the radiation reaction. This is called the radiation effect. Therefore, the diagnosis of recurrent cancer must rely on pathological examination, and the slice should be at least 3 months after the end of treatment. get on.
3. Colposcopy: After radiotherapy, colposcopy can also see non-viable cancer cells, mistaken for cancer recurrence, must pay attention to, therefore, after radiation therapy, due to the impact of radiation reactions is not easy to diagnose correctly.
4. Cervical biopsy and cervical tube scraping: taking tissue for pathological examination is a commonly used method for definitive diagnosis. Acupuncture biopsy is an effective method for obtaining tissue, which can directly puncture the lesion, or in fluoroscopy Under or under the guidance of B-ultrasound.
5. Intravenous pyelography, lymphography, and tomography will help diagnose the deep recurrence.
Diagnosis
Diagnosis and diagnosis of cervical recurrent cancer
Diagnostic criteria:
The diagnosis of cervical recurrence cancer must be combined with clinical, pelvic examination and a variety of auxiliary examinations, comprehensive evaluation and analysis of early diagnosis.
After the treatment of cervical cancer for a period of time, the above symptoms and signs should be alert to the possibility of recurrence. The final diagnosis still needs to be based on histopathological examination. The central recurrence can be diagnosed by clinical, cytological and histological examinations, and para-uterine and distant metastasis. The diagnosis depends mainly on medical history, pelvic examination and auxiliary examination. It is generally considered that the early diagnosis of pelvic recurrence after radiotherapy is difficult. The reasons may be: 1 some symptoms of recurrence are similar to side effects after radiotherapy; 2 para-uterine (or pelvic wall) Recurrence often lacks clear objective indicators; 3 after cervical radiotherapy, cervical atrophy, parauterine fibrosis and other effects of examination and sampling; 4 radioactive changes in exfoliated cells after radiotherapy are often mistaken for uncontrolled or recurrent tumors, so cytology found cancer It is difficult to assess the actual clinical significance of cells.
Differential diagnosis:
1. Systemic examination to pay attention to the presence of suspicious lesions in the whole body, superficial lymph nodes, especially the left supraclavicular lymph nodes and lower extremity edema and other signs.
2. Pelvic examination Most recurrent lesions are found after follow-up treatment after treatment. After surgery, puncture the vaginal stump with bleeding or vaginal submucosal thickening and infiltrating foci (especially adenocarcinoma), or pelvic fistula and The mass can be diagnosed as postoperative recurrence, the latter should be differentiated from postoperative lymphocystosis, and the diagnosis of recurrence after radiotherapy should be noted in the following pelvic examinations:
(1) After the radiotherapy, the cervix or vagina has been cured, and the vulva has congestion, erosive or granulomatous lesions should not be ignored. Further examination is required. Zhang Wenhua et al (1990) of the Cancer Hospital of Chinese Academy of Medical Sciences reported 85.7 cases of central recurrence. % has this type of performance.
(2) After cervical atrophy or tissue healing after radiotherapy, cervical enlargement, nodules, unevenness and even ulcer necrosis occur. At this time, recurrence should be highly suspected, but it should be differentiated from radioactive necrosis. The latter has uniform cervix texture and vaginal washing. After local anti-inflammatory treatment, it will gradually improve.
3. Uterine enlargement after radiotherapy should be distinguished from uterine effusion, empyema and other malignant tumors of the uterus. The endometrium should be taken for diagnosis to confirm the diagnosis. B-ultrasound, CT or MRI can also assist diagnosis. .
4. The thickening of the uterus should pay attention to uniform flaky thickening or nodular thickening, combined with clinical dynamic observation to distinguish recurrence or radioactive fibrosis.
