cervical stump cancer
Introduction
Introduction to cervical stump cancer Cervical stump cancer refers to the cancerous part of the cervix that remains after subtotal hysterectomy. Cervical stump cancer can occur within a few months to 2 years after subtotal hysterectomy, and can also occur in years or longer. . basic knowledge The proportion of illness: 0.03% Susceptible people: women Mode of infection: non-infectious Complications: bacterial infection
Cause
Causes of cervical stump cancer
The sex of the first sexual intercourse is too early, and the sexual behaviors of multiple sexual partners and male partners are considered to be related to the occurrence of cervical cancer. It is believed that this is related to the cervix squamous metaplasia and the sensitivity to carcinogens.
More than 50 years ago, it was found that cervical cancer is extremely rare among nuns. Many studies have pointed out that marriage and sexual disorders, such as the first sexual intercourse, multiple sexual partners and cervical cancer are closely related, and cervical cancer was reported in the 1970s. There is a correlation between the case fatality rate and the incidence of gonorrhea. It is therefore believed that cervical cancer is mostly caused by sexually transmitted infections. Among these factors, the most constant relationship with cervical cancer is the number of sexual partners. The table shows the case control. The results of the study indicated that women with cervical cancer had more sexual partners than women in the control group, and the risk of illness was directly proportional to the number of sexual partners. The relative risk of 10 personality partners was less than 1 personality partners. More than 3 times higher, the facts show that multiple sexual partners have a significant correlation with CIN and cervical cancer, but the correlation with the former is more obvious, Slattery has calculated in one study, the number of sexual partners 10 in cervical cancer 36% of new cases, when the number of sexual partners 6 and the first sexual intercourse before the age of 15 years, the risk of cervical cancer increased by 5 to 10 times.
Epidemiological studies have also found that the first sexual intercourse is 16 years old, the relative risk is more than 20 years old, some scholars pointed out that the first marriage age is less than 18 years old, the prevalence rate is 13.3 times higher than those over 25 years old, Biswas (1997) reported that the initial sexual intercourse age was less than 12 years old and 18 years old, the OR value of 3.5, and the relationship with cervical cancer independent of other factors and independent.
The characteristics of sexual relationships may also affect the risk of cervical cancer. Some scholars have also analyzed the number of sexual partners at different ages. Brinton (1987) and Herrero (1990) did not find the number of sexual partners before the age of 20 than the lifetime partners. More significance, but Peter (1986) found that the role of lifelong partners can be attributed to the role of multiple sexual partners before the age of 20, he also found that menarche and short interval between initial sexual intercourse can increase the risk, compared to the first sexual intercourse The role of the individual alone is strong, but later generations have failed to confirm that a stable sexual partner (time 3 months), a more unstable sexual partner is more relevant to the risk of cervical cancer (Brinton, 1987; Herrero, 1990), This phenomenon suggests that the risk of sexual partners with sexually transmitted diseases may be increased in a longer period of time, and the risk increases. Herrero (1990) found that the risk of cervical cancer in anal sex was also increased. Whether it is true or not only reflects other aspects of sexual behavior on both sides, it is still unclear about sex.
Human papillomavirus infection (20%):
Human papilloma virus (HPV) infection is a major risk factor for cervical cancer. Epidemiological investigation and clinical data analysis show that there are about 30 types and sexual genital tracts in more than 80 kinds of HPV types found so far. Related to the lesion.
According to the virulence of HPV and the distribution of HPV infection in different CIN and cervical cancer tissues, HPV is divided into two categories: high-risk type and low-risk type. Low-risk type leads to low-grade cervical intraepithelial neoplasia (CINI) and Flat sputum lesions, mainly HPV 6,11,30,39,42,43 and 44, high-risk type mainly lead to the occurrence of CINII-III and cervical cancer, mainly HPV 16,18,31,33,35,45, 52, 56, etc., as shown in Table 3, compared with normal cervix and CIN, HPV 16 and 18 have the highest positive rate in cervical invasive carcinoma, followed by CIN, while HPV 6,11 is more common in CIN, HPV 16 Type 18 is more common in CINII and III, while HPV 6,11 is more common in CINI. The distribution of HPV subtypes in cervical invasive carcinoma is shown in Table 4. The most common type is 16, followed by 18 Type, 45, 31, 33 type accounted for 2% to 5%. Another study pointed out that HPV 18 is the most common type of cervical adenocarcinoma, and HPV type 16 is the most important in relation to squamous cell carcinoma.
HPV infection in the genital tract is mainly transmitted through sexual transmission. It is most common among young women with active sexual behavior. The peak age of infection is 18 to 30 years old. As a common sexually transmitted disease, HPV infection is mostly transient. Most studies report The natural clearance time of cervical HPV infection is about 7 to 12 months, and only a small number of persistent infections. Many studies have shown that persistent high-risk HPV infection is a necessary condition for cervical lesions. It is reported that the persistence of high-risk HPV Infected patients have a 100- to 300-fold increased risk of developing CINIII, whereas high-risk HPV-negative patients are less likely to develop HGSIL (including CINII and CINIII) within the next 2 years, and cytological results in follow-up are also mild or borderlined. The abnormality turned into normal.
Dalstein et al. (2003) reported a prospective study of 781 women with normal cervical cytology/ASCUS/LSIL. The authors used high-risk HPV for the 781 women using the second-generation hybrid capture method (HCII). HR-IPV), followed by a follow-up every 6 months, with an average follow-up of 22 months, the results showed that the average infection time of high-risk HPV-positive patients was 7.5 months (3 to 42 months), more than 50% of infected people were Clearance within 7.5 months, compared with high-risk HPV-negative patients, HPV transient infection and persistent infection are more likely to occur in cervical cytology ASCUS and SlL, with relative risk (RR) of 2.38 and 9.13, respectively. Patients with CIN 2/3 or higher were persistently infected with high-risk HPV. The authors also found that high-risk HPV patients with low to moderate viral load and high viral load were more likely to have cervical cytology abnormalities than those with high-risk HPV-negative. The relative risk (RR) is 1.65 and 8.66, respectively.
Schlecht et al (2001) reported the results of a prospective HPV persistent infection study of HPV and cervical cytology from 1,611 women from 1993 to 2000, once every four months in the first year. Subsequently, twice a year, the initial two consecutive HPV DNA positives were defined as persistent infection, and the results showed that the relative risk of SIL in patients with HPV 16 or 18 persistent infection was 8.68 (95% CI, 5.9~) compared with HPV-negative patients. 17.6); The relative risk of SIL for any high-risk HPV persistent infection was 10.17 compared with high-risk HPV-negative patients, and the relative risk of developing HSIL was 11.6.
The incidence of HPV infection in the reproductive tract has increased significantly in the past 30 years. The incidence of HPV infection in the Rockester area in the United States increased 8 times between 1950 and 1978, 106/10 per 100,000 in 1978 (Chuang, 1984), and between 1966 and 1984. The number of patients in the United States due to wetness has increased by 4.5 times.
The survey results of different regions in six provinces and cities in China found that the positive rate of HPV 16 DNA in cervical cancer tissues was 36%-64% by nucleic acid hybridization method, 64% in Shanxi Province in high-incidence area, and 36% in low-incidence area in Sichuan Province. There is a significant difference in the detection rate of HPV 16 between the two places (Zhang Wenhua, 1987), Si Jingwei et al. (1992). The results of the survey on Xinjiang, a high-incidence area for cervical cancer, North China, Hubei, Heilongjiang, and low-incidence areas in Guizhou The positive rate of HPV type 16 in cervical cancer was 60.4%, and the positive rate of HPV16 in cervical cancer was significantly different, and it was consistent with the mortality rate of cervical cancer in various places, such as Xinjiang, which was 77% (case fatality rate was 15.78/100,000). In Guizhou, it was 45% (case fatality rate was 4.92/100,000). Further analysis found that the positive rate of HPV 16 in rural cervical cancer in Xinjiang was 88%, which was significantly higher than that in urban areas (66%).
In several case-control studies, HPV infection was closely associated with the development of CIN and cervical cancer. A large case-control study in four Latin American countries, including 759 cervical invasive carcinomas and 1467 controls The detection of HPV6/11, 16/18 by FISH showed that there was a significant correlation between HPV 16/18 and cervical cancer. When HPV6/11 and HPV 16/18 were positive, the relative risk was the highest. It has also been observed that sexual behavior and the effects of HPV infection are independent of other factors (Reeves, 1989).
Two case-control studies in the United States (Manos, 1991; Morri-son, 1991) also showed that HPV infection has a strong correlation with CINI-III, when multiple types of HPV infections exist simultaneously. The risk is higher. After adjusting for HPV infection factors, the first sexual intercourse in the two groups is too early, and the correlation between multiple sexual partners, oral contraceptives and smoking disappears or decreases significantly. Eileen's 2003 review literature believes that the reproductive tract There are different types of HPV multiple infections in HPV infection, and the multiple infection rate can reach 39%, and multiple infections are associated with the severity of the lesion, with approximately 11.8% of cytologically normal or unidentified atypical squamous cells (ASCUS). Among women and 35.4% of women with mild to moderate dysplasia, multiple infections can be seen, and at least one of them is high-risk HPV.
Schellekens et al detected 12 HPV-DNA in 74 cervical cancer samples, HPV infection rate was 96%, 14.1% was 2 to 3 HPV infections, at least 1 of which were high-risk HPV, and multiple infections were found in glandular scales. It was more common in cancer than in squamous cell carcinoma and adenocarcinoma (P=0.014).
Morrison (1991) also pointed out that the risk of increased viral load was also increased based on the intensity of the hybridization signal, and there was a statistically significant dose-response relationship between them, Munonz et al. (1992) in case-control studies in Colombia and Spain in recent years. HPV DNA was detected by three different hybridization methods, and there was a strong correlation between HPV and cervical cancer in both countries, and the risk of cervical cancer was also observed when the viral load increased. Josefssonzai et al reported in 2000. The results of HPV 16 viral load assay were performed on 478 cases of cervical carcinoma in situ and 608 normal controls. They were divided into five groups according to the viral load from low to high. Compared with HPV 16 negative patients, cervical cervix occurred. The OR value of cancer was gradually increased from the low viral load group to the high level group, which were 2.0, 4.4, 8.1, 18.7, and 68.8, respectively. Ho et al. followed 100 women in 1999 and followed up for 6 weeks in the first 3 months. One time, followed by every 3 months for 15 months, two consecutive HPV positives were defined as persistent infection, and HPV persistent infection was associated with the persistence of SIL, with an OR of 3.91 (95% CI, 1.58). ~9.65), Persistent high viral load 0R was 4.97 (95% CI, 1.45 ~ 17.02), after adjustment for HPV factors, oral contraceptives, is still closely related to the initial low level of education and early sexual intercourse and cervical cancer.
Cohort study is an ideal method to determine the natural relationship between HPV and cervical cancer. Campion (1986) used long-term observation of 100 CIN women for 2 years, and detected HPV DNA by FISH at intervals of 8 months. As a result, HPV 16/18-positive patients developed 56%. For CINIII, HPV 6-positive patients are only 20%. Schneider (1987) has similar reports. It is interesting to note that 3 cases of cervical CINI-II with HPV 16/18 infection have been removed from their sexual partners with HPV type 16 After the infection, their lesions also disappeared. Finnish 530 cervical HPV-positive women were followed up for an average of 60 months. The cell-shaped HPV type was used as an indicator of disease progression. The results indicated that HPV16 is more likely to induce CIN than other types. Deterioration (45% deterioration of HPV type 16 and 27% of HPV type 18, 0 and 13% for HPV 6/11) (Syranen, 1990). Murthy (1990) pointed out that 63 cases progressed from CIN to CIS. In women, the positive rate of HPV 16/18 in biopsy specimens diagnosed as CIS was 68.3%, while in 44 women with progression-free CIN, the HPV 16/18 positive rate was 27.3% and the OR was 5.9 at the end of follow-up. has statistical significane.
The Institute of Oncology, Institute of Oncology, Chinese Academy of Medical Sciences, in the high incidence of cervical cancer in Jixian County, Shanxi Province, showed that high-risk HPV of genital tract infection is a major risk factor for cervical cancer and cervical intraepithelial neoplasia in local women. A study of 1997 married women aged 45 years, including 12 cases of cervical cancer, 31 cases of CIN III, 43 cases of CINII, 127 cases of CINI, infection rate of cervical invasive carcinoma and CIN III HPV were 100% (12/12, 31/31) ), CINII was 95.3% (41/43), CINI was 61.4% (78/127), and the normal population was 14.2% (253/1784). Bosch and Manos collected 1008 cervical cancer biopsy specimens from 22 countries. PCR analysis revealed that HPV DNA was detectable in 93% of tumors, and there was no significant difference between countries (Bosch FX, 1995). Recently, Manos et al. (Walboomers JM, 1999) reanalyzed HPV-negative cases in this study. In combination with the previous data, the factor of insufficient sample size was excluded, and the HPV detection rate of cervical cancer in the world was found to be 99.7%.
In summary, the etiology of HPV and cervical cancer can be summarized as follows: 1 The above groups of studies indicate that the correlation between the two is strong and consistent; 2 its correlation is mainly reflected in a few special types of viruses , that is, a high-risk virus.
Menstruation and childbirth factors (10%):
The relationship between menarche age, menopausal age and health factors and cervical cancer is rarely reported. Zhang et al. (1989) pointed out the risk of cervical cancer in women in rural China (Jing'an County) with poor hygiene (no washing of vulva, etc.) and menstrual menstruation. The other group also found that during the menstrual period, the puerperium was poorly sanitized. The RR between the case group and the control group was 2.27 (Liao Caisen, 1986), which was statistically significant. In addition, more and more facts indicated that Production and cervical cancer are closely related. Many provinces and cities in China reported the lowest prevalence of 1-3 times of delivery (110.38/100,000), 4-6 times higher (192.36/100,000), and increased significantly more than 7 times (377.52/10) Wan (Wang Dawang, 1985), Brinton (1989) survey in Latin America, after adjusting for socio-economic factors and sexual factors, found that the risk of giving birth to 12 births in cervical invasive cancer is 0 to 1 child. 4 times higher, Wang (1996) reported that the data from 1991 to 1994 in Taiwan, China showed that the risk of vaginal delivery 4 times increased by 2 times compared with 1, this correlation may be the trauma of the cervix during childbirth. And the role of endocrine and nutrition during pregnancy, in addition to High detection rate of HPV is now pregnant women, pregnancy is likely to induce immune dysfunction due to increased activity of the virus.
Male sexual behavior and related factors (10%):
Some studies have shown that male sexual behavior is closely related to cervical cancer. Some scholars compared the sexual behavior and other behavioral characteristics of cervical cancer and healthy women's spouses to study the role of men in the pathogenesis of cervical cancer. All these studies have Consistent conclusion: the number of sexual partners of cervical cancer spouses is much higher than that of the control spouses. The study also pointed out that most of the spouses of cervical cancer patients have various sexual history, including genital warts, gonorrhea, genital herpes, and spouses. Women who often use condoms have a low risk of cervical cancer. The cohort study of 415 cases of cervical cancer in Jing'an County showed that the relative risk of cervical cancer increased with the increase of the sexual intercourse of the husband and the husband before the first sexual intercourse. Also rising, the husband has two extramarital sexual partners, the relative risk of his wife's cervical cancer increased by 5 times, 306 pairs of investigations (Liao Caisen, 1986) also shows that the sexual disorder of the person and the spouse is high or low in the pairing survey. In the comparative survey of the normal population in the hair-producing area, the case group was higher than the control group, and the high-incidence area was higher than the low-incidence area.
Some scholars have further studied the relationship between the risk of cervical cancer and the type of spouse sexual behavior. Some researchers in Europe, Thailand and Taiwan have found that the high risk of cervical cancer is related to the number of spousal sputum (Buckley, 1981). ; Kjaer, 1991; Wang, 1996), Reeves and Quiroz (1987) reported that male mate spouses in Latin America can affect the prevalence of sexually transmitted diseases, so it is more important in the high-incidence area to investigate the above-mentioned sexual behavior, the most convincing The evidence is that monogamous women are directly related to the risk of cervical cancer (Buckley, 1981), and Skegg (1982) believes that the incidence of cervical cancer in women who traditionally maintain virginity before marriage (Indonesian Muslims) Very high, this is because their husbands have transmitted carcinogenic factors to these women. Male genital HPV infection is also closely related to the risk of cervical cancer in their spouses. Barrasso et al (1987) used colposcopy to examine 294 cases of cervical cancer. 480 cases of male mate with flat condyloma and 186 cases of cervical intraepithelial neoplasia, 64% of male genitalia have condyloma acuminata and papules, cervical intraepithelial neoplasia 32.8% (61 cases) of the patient's sexual partners also had penile intraepithelial neoplasia, while only 1.4% (4 cases) of sexual partners in flat warts, and 60% (36 cases) of 60 cases of penile papules. The HPV DNA sequence was detected, and HPV 16 and 33 were found in almost all penile intraepithelial neoplasia, while HPV 6, 11 and 42 were only found in genital warts. The above fact also supports cervical cancer and its precancerous lesions and its males. Sexually associated HPV infection.
There are also many reports on the influence of male penile cancer on cervical cancer in their spouses. In the retrospective survey of deaths in China in the 1970s, the geographical distribution of the two cancers was statistically significant (P <0.01, Li Bing, 1987), Creham (1979) and Smith (1980) reported that the wife of patients with penile cancer was 3 to 6 times more likely to have cervical cancer than other women, and the second wife of a woman with cervical cancer now has a wife. The risk of cervical cancer is twice as high as that of the control group.
There is no clear conclusion about the relationship between male circumcision and cervical cancer. Some scholars have concluded that the relative risk of cervical cancer in the circumcision of the circumcision is extremely low (RR 0.3).
Smoking (10%):
Smoking may be one of the factors in the pathogenesis of cervical cancer. Different epidemiological surveys have shown that the risk of invasive pre-invasive and invasive cancer is increased in smokers. After controlling various other factors, it is found that the influence of smoking still exists. In most studies, the risk of cervical cancer was increased by a factor of 2, and high-risk patients were mostly long-term smokers, suggesting that there may be an advanced effect. The effect of smoking is only expressed in patients with squamous cell carcinoma, but with adenocarcinoma or gland. Squamous cell carcinoma has nothing to do. In the detection of smoker cervical mucus, it is found that smoking has high levels of nicotine and cotinine. Studies have shown that smoking years, daily smoking and initial smoking age are related to cervical cancer, although The inhibitory effect of smoking on the body's immunity should be considered, but its biological effects should also be considered. In particular, smoking enhances the effects of infection factors including HPV. ZurHausen (1982) believes that the cancer-promoting effect of smoking on HPV needs further study.
Pathogenesis
Cervical stumps were smashed to varying degrees, and the sputum was cauliflower-like, nodular, ulcerated or hollowed, and the parametrial tissue was thickened and nodular.
Because the residual cervix after subtotal uterine resection still maintains the original lymphatic drainage, the spread of cervical stump cancer is also the same as that of general cervical cancer, which can extend to the pelvic wall tissue to cause back acid and lower abdominal discomfort. Tumors can be transferred along the paracervical lymph nodes to the pelvic and distant lymph nodes. The cancerous tumors infiltrate forward. The bladder may have frequent urination, dysuria, hematuria and other symptoms. The posterior spread of the rectum invades the rectum, resulting in poor bowel movements, heavy and heavy, falling and blood in the stool. .
Prevention
Cervical stump cancer prevention
In order to reduce the incidence of cervical stump cancer, cervical cancer must be strictly examined before deciding to perform subtotal hysterectomy or hysterectomy. After total hysterectomy, patients should participate in the census regularly, and early diagnosis, timely and appropriate The treatment is more important for stump cancer. It should be checked regularly after subtotal hysterectomy. For example, routine cervical smear examination, intrinsic fluorescence spectroscopy, colposcopy and cervical biopsy should be performed to eliminate malignant transformation. In order to avoid missed diagnosis, if the patient complains of vaginal bleeding after the second hysterectomy, the patient should be diagnosed early. After the patient is treated, regular follow-up should be performed regularly. If there is recurrence, the patient should be actively treated.
Complication
Cervical stump cancer complications Complications bacterial infection
Co-infection, adhesion of surrounding tissues, recurrence.
Symptom
Cervical stump cancer symptoms Common symptoms Squamous cell metaplasia Vaginal irregular bleeding Vaginal bleeding vesicular edema Vaginal secretions Increased cancerous ureteral stricture Cervical mucus
Domestic patients with cervical stump cancer reported by Jiangsen et al (1992), 10 cases of clinical analysis of the time from the previous surgery: 1 case in 5 years, 4 cases in 5 to 9 years, 3 cases in 10 to 15 years, 2 cases in 15 years Zhang Rong (1997) reported the treatment of 12 cases of cervical stump cancer, and analyzed the incidence of the previous operation from 3 months to 27 years; 3 cases in <3 years, 2 cases in 3 to 5 years, > 10 years 7 cases.
Clinical signs and symptoms may vary depending on clinical stage and tumor growth pattern. Early cancer cases of cervical stump cancer can sometimes be asymptomatic, accounting for about 6%. They are only found when census or other reasons are examined. Cervical stump Patients with invasive cancer can generally have irregular vaginal bleeding and increased vaginal secretions. The main symptoms are the same as cervical cancer. Some scholars have reported that patients with cervical stump cancer have vaginal bleeding from 75% to 80%, and vaginal discharge increases from 10% to 14%. If the tumor is secondary to infection, tissue necrosis, secretions may be accompanied by stench, as well as low back pain, lower abdomen and other symptoms.
1. The clinical stage of clinical stage cervical cancer has been more than 70 years old. After several revisions, it has been gradually improved. At the beginning, the tumor was infiltrated into the basin wall, that is, the "frozen pelvis" was classified as stage IV, and was revised in 1937 when the stage was revised. Phase III; when the stage was revised in 1950, it was decided to invade the palace body as a standard for staging (the original staged palace was invaded as stage II); the staged standard of 1961 defined that stage 0 cancer was carcinoma in situ, intraepithelial cancer, It is also pointed out that the stage 0 cancer case is not included in any treatment statistics. In 1970 and 1985, the concept of occult cancer (OCC) was added, and in the third stage, hydronephrosis or renal inactivity was added, and later, stage 0 and IV were added. The standard of the period was explained. At the FI-GO meeting held in Santiago (Chile) in 2003, the phase I standard was revised. The revised clinical classification standard for cervical cancer is currently used internationally. Staging criteria:
Stage 0: carcinoma in situ, intraepithelial neoplasia (this case is not included in any treatment statistics).
Stage I: The lesion is confined to the cervix (whether the uterus is affected or not).
Stage Ia: Invasive cancer identified only under the microscope, lesions visible to the naked eye, even superficial infiltration, is stage Ib; interstitial infiltration depth <5mm, width <7mm (infiltration depth from tumor site epithelium or gland) The basement membrane is <5 mm down, and the infiltration of the vein or lymphatic zone does not change the stage.
Stage Ia1: interstitial infiltration depth <3mm, width <7mm.
Stage Ia2: The interstitial infiltration depth is 3 to 5 mm and the width is <7 mm.
Stage Ib: Clinical examination of lesions is limited to cervical or preclinical lesions greater than stage Ia.
Stage Ib1: clinically visible lesions <4 cm in diameter.
Stage Ib2: clinically visible lesions > 4 cm in diameter.
Stage II: The lesion is beyond the cervix, but not to the pelvic wall. The vaginal infiltration does not reach the lower third of the vagina.
Stage IIa: no obvious parametrial infiltration.
Stage IIb: There is obvious parametrial infiltration.
Stage III: The lesion infiltrates into the pelvic wall. There is no gap between the tumor and the pelvic wall during rectal examination; the cancer involves the lower third of the vagina; there is no other reason for hydronephrosis or no function of the kidney.
Stage IIIa: The lesion did not reach the pelvic wall, but it involved the lower third of the vagina.
Stage IIIb: The lesion has reached the pelvic wall or has hydronephrosis or no function of the kidney.
Stage IV: The lesion has exceeded the true pelvis or clinically infiltrated bladder or rectal mucosa.
Stage IVa: The lesion spreads to adjacent organs.
Stage IVb: The lesion is transferred to a distant organ.
2. Staging considerations
(1) Phase 0 includes atypical cells in the entire epithelium, but no interstitial infiltration.
(2) The diagnosis of Ia (Ia1 and Ia2) must be determined according to the observation under the microscope.
(3) The diagnosis of stage III should be infiltration of the pelvic wall, no gap between the tumor and the pelvic wall, and the thickening of the nodular shape can be determined.
(4) Even if it is classified as stage I or II according to other tests, if there is a stenosis of the ureter and a hydronephrosis or no function of the kidney, it should be classified as stage III.
(5) Bladder edema can not be classified as stage IV, cysts and sulcus are seen in cystoscopy, and when the bulge or rectum can be confirmed by vaginal or rectal examination, the bulge or sulcus and tumor fixation should be regarded as submucosal submucosal Invasive, bladder irrigation fluid with malignant cells should be confirmed by pathological examination of the living tissue in the bladder wall.
According to the symptoms and signs, clinical examination and pathological diagnosis of cervical stump cancer is not difficult, the diagnosis is the same as the diagnosis of general cervical cancer. Some scholars believe that the stage of diagnosis of cervical stump cancer is better than the period of diagnosis of general cervical cancer. It is late, but some scholars believe that vaginal bleeding after subtotal hysterectomy is more likely to cause attention than patients without surgery. Therefore, early cases account for the majority, and cervical stump cancer is caused by resection of the uterus and previous surgery. Early diagnosis is especially important because anatomical changes, as well as possible complications, make treatment more difficult.
Examine
Examination of cervical stump cancer
1. Cervical scraping cytology: generally used for cervical cancer screening, must be in the cervical transition zone scraping test, mainly based on nuclear changes to determine cell malignancy.
2. Iodine test: The iodine test is non-specific for cancer. The normal cervical epithelium is rich in glycogen, which will be dyed brownish black by iodine, while the cancer epithelium is deficient in glycogen, iodine is not colored, and living tissue is not stained. Improve diagnostic accuracy.
3. Colposcopy: Observe the presence or absence of atypical epithelium or early cancer on the surface of the cervix, and select the lesion for biopsy to improve the diagnostic accuracy.
4. Cervical and cervical biopsy: is the most reliable and indispensable method for the diagnosis of cervical cancer and its precancerous lesions.
Diagnosis
Diagnosis and diagnosis of cervical stump cancer
Should be noted with the cervical, vaginal inflammatory disease.
