Cervical cancer in adolescents and young sons
Introduction
Introduction to cervical cancer in adolescents and younger sons Cervical tumors in adolescents and younger sons are generally more benign than malignant. Cervical cancers that occur are all adenocarcinomas. Cervical squamous cell carcinoma is rare. Cervical atypical hyperplasia is converted to carcinoma in situ and is seen before the age of 20. Most people think that the incidence of cervical cancer is related to early marriage, premature sexual life, smegma, polyeducation, prolificacy, cervical erosion, cervical laceration, cervical valgus, sexual hormone imbalance and viral infection. Viral and other pathogens infected with human papillomavirus (HPV), herpesvirus (HSV) type II, human cytomegalovirus (CMV) and STD infection can cause an increase in the incidence of cervical cancer. Women who have been infected with chlamydia It is prone to cervical cancer. In women with AIDS-related cancer, the standardized incidence of invasive cervical cancer is increased by 9.1, and the relative risk after AIDS is 6.5. Human papillomavirus is the main risk factor for cervical cancer, and HPV has been identified. It has reached more than 100 types, among which HPV16 has the closest relationship with cervical cancer, and there are more than 10 related types. The virus infection is a sexually transmitted disease. If the husband or wife or one of the sexes is unclean or has too many sexual partners, It is possible to infect the woman with these viruses or pathogens. The mother has the above-mentioned infection factors and does not pay attention to her daughter's sexual hygiene. It can also cause cross-infection between mother and daughter. Cervical cancer may occur in the future. The above pathogen infection can reduce the immune function of the sexual organs. Therefore, the cervical cells are unable to resist the invasion of external adverse factors, and are susceptible to cancer. basic knowledge The proportion of illness: 0.003% Susceptible people: young women Mode of infection: non-infectious Complications: diarrhea, cervical lymph node metastasis
Cause
The cause of cervical cancer in adolescents and younger sons
(1) Causes of the disease
Cervical cancer of adolescents and younger sons comes from Gartner duct or deputy middle kidney tube. The cause of this disease is still inconclusive. Most authors believe that the incidence of cervical cancer is early marriage, sexual life is too early, smegma , multi-education, prolific, cervical erosion, cervical laceration, cervical valgus, sexual hormone disorders and viral infections, the possible factors for cervical cancer in adolescents are as follows:
1. Estrogenic effects During the embryonic period, if the mother has been exposed to estrogen, the incidence of cervical adenosis in the offspring is increased. Some authors believe that the development of cervical adenosis is rare, but cervical adenosis and squamous metaplasia exist simultaneously. If stimulated by a certain cancer-promoting factor, the squamous cell structure is abnormal, and 0% to 5% can be converted into carcinoma in situ.
2. Cervical valgus The normal cervix is anatomically divided into two parts: the vaginal part and the cervical canal. The former is covered by squamous epithelium and has no gland; the latter is covered by columnar epithelium, with glands, histologically divided into vagina Department, transition zone and cervical canal, the transition zone is between the vaginal and cervical canal, consists of the endometrial stroma and glands of the cervix, overlying squamous epithelial cells, and the newborn is affected by maternal estrogen in the body. Cervical columnar epithelial hyperplasia, and growth to the external cervix, the influence of maternal hormone disappeared after birth, vaginal acidity changes, the squamous epithelium of the vaginal sac is covered along the columnar epithelium, called squamous metaplasia, this physiological transition zone If it is intensified by carcinogenic factors, it can eventually lead to cancer.
3. Sexual behaviors First sexual intercourse early, early marriage and early childbirth, multiple sexual partners are closely related to cervical cancer, epidemiological studies show that: sexual life begins early cervical cancer, the incidence of cervical cancer is 18 years old, the first cervical cancer The prevalence rate is 13.3 to 25 times higher than that of those after 20 years of age. Because the development of cervical epithelium is not mature in adolescence, the ability to resist disease is poor, and the immune system of adolescent girls is relatively unsensitized and susceptible to carcinogenic factors. With the development of age and sexual experience, the female reproductive tract system is sensitized and matured, thus having normal disease resistance, early marriage, premarital sex, frequent sexual life, and promote the carcinogenic effect of smegma. The incidence of cervical laceration, valgus and erosion increases, and the incidence of cancer increases. In addition, the risk of cervical cancer is directly proportional to the number of sexual partners. >10 personality partners are more than 1 personality partners Relative risk is more than 3 times higher, sexual partners are >6, and the risk of cervical cancer is more than 10 times higher than the first sexual intercourse before the age of 15.
4. Mothers with factors of childbearing age, if they are stimulated by certain physical or chemical factors in their daily life, and germ cells are distorted, their offspring are often susceptible to cancer after birth, if women take birth control pills or use females during pregnancy. Hormones, the girls born to them are likely to have cervical adenocarcinoma in the future. In addition, the mother's age, parity, multiple pregnancy, pre-eclampsia may also be related to the occurrence of offspring cervical cancer.
5. Virus and other pathogens infected with human papillomavirus (HPV), herpesvirus (HSV) type II, human cytomegalovirus (CMV) and STD infection, etc., can lead to increased incidence of cervical cancer, once infected with chlamydia Women are prone to cervical cancer. In women with AIDS-related cancer, the standardized incidence of invasive cervical cancer increases by 9.1, and the relative risk after AIDS is 6.5. Human papillomavirus is a major risk factor for cervical cancer and has been identified. The HPV has reached more than 100 types, of which HPV 16 is most closely related to the incidence of cervical cancer, and there are more than 10 related types. The virus infection is a sexually transmitted disease. If the husband or wife or the sex life is unclean or the sexual partner is too More, it may cause the woman to infect these viruses or pathogens. The mother has the above-mentioned infection factors and does not pay attention to her daughter's sexual hygiene. It can also cause cross-infection between mother and daughter. Cervical cancer may occur in the future. The above pathogen infection can reduce the sexual organs. The immune function, so that the cervical cells can not resist the invasion of external adverse factors, and is prone to cancer.
6. Other adolescent females with low immune function, smoking and spouse sexual behavior and other behavioral characteristics (number of spouses, HPV infection, genital warts and pimples, penile cancer, prostate cancer or their previous spouse have had cervical cervix Cancer patients) may be related to the occurrence of cervical cancer, smokers are twice as likely to have cervical cancer than non-smokers.
(two) pathogenesis
The occurrence and development of most cervical cancer is a slow process: normal epithelium simple hyperplasia dysplasia carcinoma in situ invasive carcinoma, a small number of invasive carcinomas directly under the stage of carcinoma in situ, gross specimens and mirrors The lower structure is similar to that of an adult.
1. Local general view often shows erosion or granules in the early stage, showing superficial ulcers, hard quality, easy bleeding, and further development of the tumor. According to its growth direction and shape, it can be divided into 4 types:
(1) erosive type: generally erosive or shallow ulcer-like, the tumor may not be visible to the naked eye, and can not be distinguished from the general cervical erosion, it can also be grainy rough and uneven, the texture is hard, the bleeding is easy to touch, more common in early infiltration cancer.
(2) Nodular type: the tumor grows to the surface, showing obvious protrusions, unevenness, brittleness and easy bleeding. It can form a mass of nodules on the surface of the cervix, often accompanied by ulceration of varying depths. The texture is hard or hard. The bleeding was obvious at the time of palpation.
(3) Cauliflower type: cauliflower-like, scorpion-like or papillary hyperplasia, generally referred to as exogenous in the classification, large tumor, rich in blood vessels, crisp in texture, obvious in blood contact, often accompanied by infection and necrosis .
(4) Ulcer type: It is an endogenous tumor. The lesion invades into the cervical canal and grows erosively. It forms ulcers and even voids. For example, volcanic vents are prone to secondary infection and massive bleeding. Sometimes the entire cervix and vaginal vault tissue festers. Complete disappearance, irregular edges, tissue necrosis, hard texture, and stench of secretions. The above four classifications are related to prognosis.
2. Juvenile cervical cancer with cervical adenocarcinoma is more common than squamous cell carcinoma, lymphatic metastasis rate is higher than squamous cell carcinoma, not sensitive to radiation therapy, can be divided into high, medium, poorly differentiated grade 3, cervical Endometrial adenocarcinoma is the most common adenocarcinoma in the adenocarcinoma. The lesion begins in the cervical canal and comes from the cervical glandular epithelium. The tissue morphology is various, usually glandular, followed by mucinous type. Most of the glands are visible under the microscope. Body structure, highly differentiated adenocarcinoma is sometimes difficult to distinguish from adenomatous hyperplasia, easy to be missed; and poorly differentiated adenocarcinoma sometimes resembles poorly differentiated squamous cell carcinoma, which must be identified.
In addition, sometimes some glandular or glandular epithelium is squamous metaplasia, such as adenocarcinoma containing squamous metaplasia without metastasis, called adenadosal carcinoma, such as severe squamous epithelium, called gland Squamous cell carcinoma or mixed cancer is classified into 5 types according to the histogenesis and prognosis of adenocarcinoma: differentiated type, undifferentiated type, adenosquamous carcinoma, adenoma and adenoma.
Cervical in situ adenocarcinoma is rare and can exist alone or in combination with invasive adenocarcinoma or squamous cell carcinoma. The histological features of the lesion are that the ductal mucosa of the cervical canal and the glandular epithelium of the gland are covered by glandular epithelial cells with malignant morphology. Substitution, but the lesion is still confined to the epithelial layer, does not penetrate the basement membrane, but the nucleus becomes obvious, the polarity disappears, and it has malignant characteristics.
In addition, when performing pathological examination, there are sometimes three special tissue types of clear cell carcinoma, middle kidney cancer and malignant yolk sac tumor (endodermal sinus tumor), which are originated from a special tissue and are basically adenocarcinoma-like structures. Cancers, which originate from completely different tissue components, are sometimes very similar in organizational form and difficult to distinguish, sometimes confused with each other in diagnosis.
Prevention
Juvenile and younger son cervical cancer prevention
When patients with cervical cancer are discharged from the hospital after treatment, especially young patients, it is necessary to explain the importance of follow-up, and check the communication site. The follow-up time is usually in the first year after discharge, and the first three months are followed up once a month. It will be reviewed once every 2 months. It will be reviewed once every 3 months in the second year after discharge, and once every six months after discharge from the third to fifth year, and once every year from the sixth year. Follow-up content In addition to clinical examination, chest X-ray and blood routine examination should be performed regularly.
Complication
Juvenile and younger son cervical cancer complications Complications, diarrhea, cervical lymph node metastasis
The most common complication of cervical cancer is the "reproductive system deficiency syndrome" after resection of reproductive tumors during surgery. It is a series of clinical symptoms caused by the lack of reproductive system. The concurrency rate is about 20-30%. The specific symptoms are: stubbornness. Sexual diarrhea, bloating, nausea, vomiting, anaerobic and other symptoms of dyspepsia and general malaise, pale, tired and other symptoms of malnutrition, at present, there is no effective treatment for such complications.
Uterine empyema is also one of the common complications of cervical cancer. Most of the cancer is caused by blockage of the neck tube, accompanied by systemic fever and vaginal discharge. Sometimes pelvic inflammatory disease will also cause invasion of the human body along with cervical cancer, and more abdominal pain.
Symptom
Cervical cancer symptoms of adolescents and younger sons Common symptoms Vaginal bleeding persistent pain hematuria Irregular vaginal irregularities Urinary pain Frequent urination sensation Pain leucorrhea
1. Mainly for irregular vaginal bleeding, and there is a typical water-washing leucorrhea puberty or irregular vaginal bleeding before puberty, often mistaken for menstrual disorders, unmarried girls often lack vigilance, generally not used to do vaginal examination Easy to miss diagnosis, Dalley reported that 2 patients (10 years old and 15 years old) had irregular vaginal bleeding, but were misdiagnosed as menstrual disorders until the vaginal discharge of debris tissue, confirmed by pathological examination as cancer.
2. Compression symptoms of cancer invading the para-uterine tissue began to only have a sense of bloating, after the dull pain, involving the peritoneum is severe pain, such as the spread of pelvic tissue can oppress or invade the nerve trunk, from intermittent low back pain to persistent pain, and When the lower extremity radiates, oppresses or invades the ureter and causes hydronephrosis, it will cause dull pain in the waist. When it is oppressed or invaded the bladder, it often shows frequent urination, hematuria and dysuria. In severe cases, urinary closure or urinary fistula may occur, and even uremia may occur. For the late stage of cervical cancer.
3. The symptoms of metastasis vary according to the location of the metastasis. The symptoms are different except for the lymphatic system. Chest pain, cough, hemoptysis, etc., chest X-ray examination can show the shadow of metastatic cancer, and those with bone metastases may appear accordingly. Persistent pain in the area, bone destruction can be seen on the X-ray film.
4. The clinical stage of cervical cancer in adolescents and younger sons is also important for treatment and prognosis. The clinical staging criteria are the same as those for adults.
At the FIGO meeting in San Diego (Chile) in 2003, the revised clinical staging criteria for cervical cancer is the current international standard for staging:
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.
Staging precautions: Stage 10 includes atypical cells in the whole epithelium, but without interstitial infiltration, 2Ia (Ia1 and Ia2) diagnosis must be determined according to the observation under the microscope, and the diagnosis of stage 3III should be paraventricular infiltration. Wall, there is no gap between the tumor and the pelvic wall, and when the thickening is nodular, it can be determined. 4 Even if it is determined according to other tests, it is stage I or II, but there is cancerous ureteral stricture and hydronephrosis or kidney function. At the same time, it should be classified as stage III, 5 bladder edema can not be classified as stage IV, cystoscopy can see bulge and sulcus, and when the vaginal or rectum can confirm the bulge or sulcus and tumor fixation, Should be considered as submucosal invasion of the bladder, bladder cells have malignant cells, should be confirmed in the pathological examination of the bladder wall.
Examine
Examination of cervical cancer in adolescents and younger sons
1. Vaginal cytology smear examination
It is of great significance for the early detection of cervical cancer. In addition to the continued use of the Pap 5 classification, the FIGO recommendation is to promote the use of Bethesda (TBS) classification and CCT, PEPNET diagnostic devices.
2. Iodine test
When the cervical smear is abnormal or the clinical is suspicious and there is no colposcopy, the abnormal part can be found by the iodine test. At present, the commonly used iodine solution is Lugol solution or 2% iodine solution, and the cells are not colored and the iodine test is positive.
3. Colposcopy
Colposcopy and vaginal microscopy, early detection of cervical cancer, determine the location of the lesion, improve the positive rate of biopsy has an important role, colposcopy can enlarge the lesion 6 to 40 times, direct observation of cervical epithelium with binoculars under strong light source And the fine-morphological changes of blood vessels, mainly used to check cervical cancer and precancerous lesions. The main observation of vascular morphology, capillary spacing, epithelial surface, lesion boundary, etc. during colposcopy, can significantly improve the diagnosis by positioning biopsy at abnormal sites. The accuracy.
4. Cervical biopsy and endocervical scraping
This is the most reliable and indispensable method for the diagnosis of cervical cancer and precancerous lesions. Generally, 4 points biopsy is taken at 3, 6, 9 and 12 points at the junction of the cervical squamous column epithelium, or in iodine test, colposcopy. The suspicious part observed under the pathological examination is taken for pathological examination. The tissue to be taken includes epithelial tissue and interstitial tissue. If the cervical smear is smear of grade III or above, and the cervical biopsy is negative, apply a small curette Cervical canal, scraping out for pathological examination.
5. Cervical conization
When the cervical smear is positive for multiple examinations, and the cervical biopsy is negative or the biopsy is carcinoma in situ, but the clinical inability to exclude invasive cancer, cervical conization can be performed to confirm the diagnosis.
6. Other inspections
According to the patient's specific conditions to determine the clinical stage of cervical cancer patients, sometimes the following auxiliary examinations, that is, chest X-ray, ultrasound, intravenous pyelography, kidney map, cystoscopy and proctoscopy, may be helpful in diagnosis.
Diagnosis
Diagnostic identification of cervical cancer in adolescents and younger sons
diagnosis
The diagnosis of cervical cancer in adolescents depends on the detailed medical history and the possibility of having cervical cancer. The pathological examination can confirm the diagnosis.
1. Clinical manifestations of irregular vaginal bleeding before puberty or puberty, often mistaken for menstrual disorders, such as with leucorrhea abnormalities, should be alert to the possibility of cervical cancer.
2. General examination of the lymphatic system is the main route of cervical cancer metastasis. The left supraclavicular lymph node is a common site for distant metastasis and should be checked.
3. Gynecological examination should pay attention to the labia, urethra and vaginal opening with or without tumor, check the vaginal infiltration range, the depth of the iliac crest, the nature and color of the secretion, the presence or absence of new growth and other lesions in the cervix, uterine position, size, hardness and activity , pay attention to the attachments on both sides and the parametrial tissue with or without lumps, thickening, nodules and tenderness, etc. The triad diagnosis reveals the posterior pelvic and pelvic wall conditions, such as the invagination of the paravaginal, paracervical and paraventricular tissues. Relationship with the basin wall, etc.
(1) The genitals of adolescents and children are not yet mature. Especially the genitalia of children are located in the deep pelvic cavity. It is difficult to perform gynecological examination. Generally, abdominal and anal examinations are routinely performed. When anal examination is performed on children, it is best to use the little finger to reach the rectum. If the condition is needed, a vaginal examination should still be performed.
(2) indications for vaginal examination: genital bleeding, infection, suspected genital foreign body, tumor, trauma, etc. are the absolute indications for vaginal examination, and must be checked immediately to avoid delay in diagnosis.
(3) vaginal examination equipment: check the vaginal and cervix of children generally use vaginal speculum (vagino-scope), you can also use otolaryngoscope, etc., according to the size of the hymen hole, choose the corresponding diameter of the vaginal speculum, the average baby Small vaginal speculum, smaller children with medium size, larger children with large size, in addition, the use of cotton swabs should not be applied when taking the upper part of the vagina secretion, so as to avoid the cotton may fall off and leave in the vagina when taking out, preferably with no Replace with a glass suction tube or a plastic tube.
(4) vaginal examination method: Before performing vaginal speculum examination, first of all, you need to obtain the consent of the family members and get cooperation. Generally, there is no need for anesthesia, but if the sick child can not cooperate well and the hymen hole is too small, under general anesthesia Carrying, taking the supine position, the assistant fixes the hip and knee joints of the sick child, so that the two legs are flexed, the abdominal wall is slack, and the vaginal speculum is slowly placed. The operation must be gentle to avoid bleeding due to injury. It must be noted that the vagina during childhood Immature, limited capacity, relatively short and narrow, Qianlong has not yet formed, the average length of vagina in early childhood is only 4.5 ~ 5.5cm, the vaginal wall is thin, easy to damage; in late childhood, the length of the vagina is 7.5cm, the cervix is flat, Button-like protrusions, until the menarche, the shape of the cervix is like the shape of an adult.
Differential diagnosis
Must be identified with the following diseases:
Cervical polyp
For pedicles, oblate scorpion creatures, smooth surface, rosy, soft, polyps often come from the cervix, protruding beyond the cervix, should be removed for pathological examination.
2. Cervical tuberculosis
The appearance of the cervix can be normal, but it can also be hypertrophy, erosion, ulcer, papillary or polypoid manifestations. Cervical tuberculosis occurs in young people, and there are many menstrual abnormalities, infertility and tuberculosis history. Biopsy can be identified.
3. Cervical papilloma
Generally, it is limited, showing papillary growth, no infiltration, and often requires biopsy to confirm the diagnosis.
4. Cervical clear cell carcinoma
The growth form is like nodular or polypoid, hard and protruding, some tumors are flat, slightly protruding from the cervix, some penetrate deeper, and some are located on the surface.
