pregnancy with cervical cancer
Introduction
Introduction to pregnancy with cervical cancer Pregnancy with cervical cancer refers not only to pregnancy, but also to cervical cancer patients found within 1 year after delivery. These patients are actually already ill during pregnancy, only because the cancer is early or for other reasons. Not found. basic knowledge The proportion of sickness: 0.0001% - 0.0002% Susceptible people: women Mode of infection: non-infectious Complications: constipation uremia
Cause
Pregnancy with cervical cancer
Sexual life (25%):
Premature sexual intercourse and multiple sexual partners (sexual life disorders) are closely related to cervical cancer. The first sexual intercourse is 16 years old, and the relative risk of the disease is 2 times higher than that of those over 20 years old. Cervical cancer patients have more than the control group. The risk of multiple sexual partners is directly related to the number of sexual partners.
Virus infection (30%):
Human papillomavirus (HPV) infection is a major risk factor for cervical cancer. It has been confirmed that more than 20 subtypes of HPV are associated with female genital tract lesions, and high-risk types (HPV16, 18, 31, 33, etc.) mainly cause cervical intraepithelial lesions. Tumor-like lesions (CIN) II, III and cervical cancer occur; cervical squamous cell carcinoma has the highest detection rate of HPV16, adenocarcinoma is HPV18 type most common, HPV16/18 type infection has increased risk of disease progression, herpes simplex virus type II Human cytomegalovirus, chlamydia and other infections have a strong correlation with cervical cancer, and with the increase of infection types, the risk of cervical cancer is increased.
Sexual hygiene and delivery times (15%):
The relative risk (RR) between the poor and the control group during the menstrual period and the puerperium was 2.27; the risk of vaginal delivery 4 times increased by 2 times compared with 1 time.
Other (10%):
Long-term oral contraceptives (8 years) increase the risk of cervical cancer, smoking can inhibit the body's immune function, increase the chance of infection, and promote cancer; male spouse history, increased sexual partners and penile cancer spouse can increase the cervix Cancer incidence.
Pathogenesis
As in non-pregnancy, the pathological type of pregnancy with cervical cancer is most common in squamous cell carcinoma, followed by adenocarcinoma, adenosquamous carcinoma and mucinous adenocarcinoma. Cervical epithelium can be changed to varying degrees during pregnancy, such as basal cell proliferation. Squamous metaplasia, atypical hyperplasia, etc., easily confused with carcinoma in situ, and endometrial glandular hyperplasia, glandular epithelial hyperplasia or adenomatoid hyperplasia during pregnancy can also be misdiagnosed as adenocarcinoma, so Be especially vigilant before making a diagnosis. According to the degree of infiltration of cancer cells, it is divided into carcinoma in situ and invasive carcinoma in the same way as non-pregnancy.
1, the impact of cervical cancer on pregnancy early cervical cancer generally does not affect pregnancy, middle and late patients are not conducive to pregnancy, when the two coexist, although cervical cancer has no direct effect on the development of the uterus, but the cervical cancer cachexia affects maternal health, In order to treat pregnant women, it is often necessary to perform artificial abortion and radiation therapy. It also prematurely terminates the pregnancy, gives up the fetus or increases the mortality rate of the fetus. If cervical cancer is combined with vaginal delivery due to missed diagnosis, it often causes cervical tear, major bleeding, infection. And so on affect the mother and child life.
2, the impact of pregnancy on cervical cancer Whether pregnancy affects the growth or spread of cervical cancer is still controversial, but most scholars believe that genital blood supply and lymph circulation increased during pregnancy, combined with the role of estrogen, pregnancy promotes the spread of cancer and The prognosis is poor, and the occurrence of cervical cancer is positively correlated with multiple pregnancies and multiple births.
Prevention
Pregnancy with cervical cancer prevention
prevention:
The precautions taken according to the cause are as follows:
1. Strengthen health education: Target the publicity of the harmfulness of cervical cancer, improve women's understanding of the etiology and prognosis of cervical cancer, and do a good job of prevention.
2, propaganda to avoid sexual disorders.
3. Promote late marriage: The age of the first-time life is more important than the first marriage age. The age of first sexual intercourse is under 18 years old, and the incidence of cervical cancer is 4 times higher than that of those over 18 years old.
4, publicity family planning: multiple pregnancy and childbirth, stimulation or damage to the cervix, resulting in abnormal proliferation of the cervical epithelium, and then can develop into cancer. Since the 1960s, China has vigorously promoted the implementation of the family planning policy, which is suitable for cervical cancer prevention.
5. Publicize the hygiene of menstruation and sexual life.
6. Excision of the male penile foreskin that is too long and too tight to avoid smegma. Studies have shown that smegma is also a carcinogen.
7. Promote avoidance of smoking.
8, active treatment of cervical erosion: cervical, severe erosion, cervical polyps, cervical genital warts, cervical leukoplakia and other diseases and precancerous lesions and cancer have a close internal relationship.
9. Active treatment of genital tract infections and condyloma acuminata.
10. Use a condom.
11, preventive cervical resection.
High risk factors for cervical cancer
1. Sexual disorder means that there are more than 2 sexual partners.
2, the first sexual intercourse age is too early, before the age of 18 have sex.
3, early breeding and prolific.
4, viral infection, human papillomavirus (HPV) and cervical cancer are closely related, especially 18,16 type, human cytomegalovirus (CMV) and herpes simplex virus type II (HSV-II) is one of the causes of cervical cancer Has been confirmed.
5. High-risk men, men who have had penile cancer, prostate cancer or their ex-wife's cervical cancer are considered high-risk men, and women who have sexual contact with high-risk men are susceptible to cervical cancer.
6, chronic cervicitis, especially cervical erosion, in the repeated damage, re-repair process is easy to form cervical cancer.
7, menstrual period is not hygienic.
8. Smoking, a large number of studies have shown that smokers are twice as likely to have cervical cancer as non-smokers.
Complication
Pregnancy with complications of cervical cancer Complications constipation uremia
According to the scope of lesion invasion, secondary symptoms, lesions affect the pelvic connective tissue, pelvic wall, compression of the ureter or rectum, sciatic nerve, patients complain of frequent urination, urgency, anal bulge, constipation, urgency, weight, lower limbs, swelling, etc.; When it causes ureteral obstruction, hydronephrosis, and finally uremia, patients with end-stage disease have symptoms of systemic failure such as cachexia.
Symptom
Pregnancy with cervical cancer symptoms Common symptoms Cervical erosion vaginal bleeding squamous cell birthplace placental abruption decidual response cervical dilation acute cervicitis urine pregnancy test positive
Same as non-gestational cervical cancer, early common sporadic or vaginal bleeding after sexual intercourse, due to pregnancy, often misdiagnosed as threatened abortion, placenta previa, placental abruption, premature delivery or cervical dilatation, because of fear Abortion avoids vaginal examination and leads to misdiagnosis. Following the development of cancer, there may be an increase in vaginal secretions, incomplete vaginal bleeding, and pain in the lower part of the lower back or thigh.
Signs and non-pregnant people, early should be associated with chronic cervical inflammation, cervical erosion and benign papilloma, early and late signs are more obvious, easy to diagnose.
Examine
Pregnancy with cervical cancer
1. Cervical cytology examination Cervical cell smear examination is a routine item for prenatal examination of pregnant women, which can help early detection and treatment of early cervical cancer.
2, colposcopy and cervical biopsy Where the cervical smear is not normal or even cervical malignant disease, colposcopy and cervical biopsy should be performed at any stage of pregnancy, biopsy can confirm the diagnosis and assist clinical stage, in situ cancer and invasive cancer combined There are principle differences in the treatment of pregnancy.
3, cervical conization, cervical conization during pregnancy can lead to major bleeding, infection, abortion, premature delivery and other serious maternal and child complications, should avoid cone cutting as much as possible, invasive cancer has been forbidden cervical conization.
4, depending on the specific circumstances can also be cystoscopy, proctoscopy, pyelography, X-ray chest X-ray examination, if necessary, CT or MRI examination, help determine the extent of the lesion, choose the appropriate treatment, improve treatment rate.
Diagnosis
Diagnosis and diagnosis of pregnancy with cervical cancer
Diagnostic criteria
1, adenomatous hyperplasia lesions increased, may be very similar to the structure of adenocarcinoma, and was mistaken for malignant.
2, reserve cell proliferation or squamous cell metaplasia, can be mistaken for cancer cell proliferation and active.
3. The decidual reaction with mosaic arrangement can be infiltrated as squamous epithelial cells in the interstitial and misdiagnosed as cancer.
Differential diagnosis
It should be differentiated from various cervical lesions with clinically similar symptoms or signs. The main differential diagnosis is biopsy, including:
1, cervical benign lesions of cervical erosion, polyps, cervical ectopic ectopic, cervical glandular epithelial valgus and cervical tuberculous ulcers.
2, cervical benign tumors of the submucosal fibroids, cervical canal fibroids, cervical papilloma.
3, cervical cancer primary cervical malignant melanoma, lymphangioma, metastatic cancer (endometrial cancer, vaginal cancer more common), should pay attention to primary cervical cancer can coexist with endometrial cancer.
