cervical precancer
Introduction
Introduction to cervical precancerous lesions Cervical precancerous lesions refer to lesions that occur in this area before the onset of cancer and thus cause cancer. Cervical precancerous lesions are cervix dysplasia. The occurrence and development of cervical cancer has a gradual evolution process, which can take several years to several decades. It is generally believed that this evolution has gone through several stages: hyperplasia, dysplasia, carcinoma in situ, early infiltration, and invasive carcinoma. Patients with cervical precancerous lesions generally do not show obvious symptoms, or only the symptoms of general cervicitis, such as increased vaginal discharge. There are also complaints of leucorrhea with blood or a small amount of vaginal bleeding after sexual contact. Gynecological examination shows that the cervix is smooth, no obvious inflammation, or cervical congestion or erosion, the degree of erosion varies, the range is also different, sometimes it is easy to bleed, and there is no obvious difference with general chronic cervicitis. Therefore, the clinical manifestations of CIN are not specific. Symptoms and signs are undiagnosable, and are mainly diagnosed based on histological examination. basic knowledge The proportion of illness: 0.3% Susceptible people: good for adult women Mode of infection: non-infectious Complications: renal failure
Cause
Causes of cervical precancerous lesions
Cervical cancer is currently the only gynecological malignancy with a clear cause and is associated with persistent infection with high-risk human papillomavirus (HPV). The HPV virus is a double-stranded DNA virus with a spherical shell with a diameter of 55 nm, which mainly infects the mucous membrane of the skin and causes different lesions. More than 200 HPV viruses have been identified and at least 30 are associated with genital mucosal infections. HPV women are infected with HPV 80% of their lives, usually cleared naturally within 8-10 months, and only a few (5%) of women are persistently infected.
High risk factor
Other high risk factors associated with cervical cancer are:
1, sexual behavior: start sexual life too early, multiple sexual partners.
2, menstruation and childbirth factors: poor menstrual period, prolonged menstruation, early marriage, early childbearing, prolific and so on.
3. Long-term stimulation of the cervix caused by cervical inflammation caused by sexually transmitted diseases.
4, smoking: intake of nicotine reduces the body's immunity, affecting the clearance of HPV infection, leading to increased risk of cervical cancer, especially squamous cell carcinoma.
5. Long-term use of oral contraceptives: The risk of cervical cancer, especially adenocarcinoma, is more than doubled after taking oral contraceptives for more than 8 years.
6. Immune Deficiency and Inhibition: HIV infection leads to immunodeficiency and long-term use of immunosuppressive drugs after organ transplantation leads to an increase in the incidence of cervical cancer.
7, other viral infections: herpesvirus type II (HSV-II) and the cause of cervical cancer can not be ruled out.
Prevention
Cervical precancerous lesion prevention
1. Strengthen health education, raise awareness of prevention, avoid premature sexual life, and prevent sexual life chaos.
2. Regular gynecological examinations, married women recommend at least once every two years to do cervical cytology examination, and found that the problem should be further pathological examination.
3. For those patients with cervical lesions and reproductive system infections, especially HPV-infected human papillomavirus, active measures should be taken to prevent the occurrence and development of cervical cancer.
Complication
Cervical precancerous lesions Complications, renal failure
Cervical precancerous lesions can be complicated by renal failure. Pathological condition in which some or all of the kidney function is lost. According to the rapid onset of the attack, it is divided into acute and chronic. Acute renal failure is caused by a variety of diseases, causing the two kidneys to lose excretory function in a short time, referred to as acute renal failure. Chronic renal failure is a syndrome that consists of a group of clinical symptoms that arise from the development of chronic kidney disease caused by various causes to the advanced stage.
Symptom
Cervical precancerous lesions common symptoms vaginal discharge increased cervical erosion urinary frequency with urgency and dysuria vaginal irregular bleeding vaginal discharge increased pus and leucorrhea
Patients with cervical precancerous lesions generally do not show obvious symptoms, or only the symptoms of general cervicitis, such as increased vaginal discharge. There are also complaints of leucorrhea with blood or a small amount of vaginal bleeding after sexual contact. Gynecological examination shows that the cervix is smooth, no obvious inflammation, or cervical congestion or erosion, the degree of erosion varies, the range is also different, sometimes it is easy to bleed, and there is no obvious difference with general chronic cervicitis. Therefore, the clinical manifestations of CIN are not specific. Symptoms and signs are undiagnosable, and are mainly diagnosed based on histological examination.
Cervical dysplasia is a precancerous lesion, which is reversible, that is, a part of the lesion can disappear naturally, but it is also progressive, that is, the lesion can develop, and even cancer. Its reversibility and development are related to the extent and extent of the lesion. The possibility of mild dysplasia disappearing naturally is significantly greater than that of moderate to severe. The possibility of developing severe dysplasia as cancer is significantly greater than that of mild to moderate. Some scholars believe that mild dysplasia of the cervix is a benign abnormal proliferation, which can naturally turn into normal.
General symptoms
1. Vaginal bleeding: irregular vaginal bleeding, especially contact bleeding (ie, after sexual life or bleeding after gynecological examination) and postmenopausal vaginal bleeding are the main symptoms of cervical cancer patients. Cauliflower-like cervical cancer has earlier bleeding and more bleeding.
2. Increased vaginal secretions: white thin, watery, rice-like or bloody, with a stench. When the cancer tissue is broken and infected, the secretion may be purulent with malodor.
Early symptoms
First, vaginal bleeding.
Irregular vaginal bleeding is the main symptom of patients with cervical cancer, especially postmenopausal vaginal bleeding should pay attention. Vaginal bleeding can be more or less, vaginal bleeding is often caused by tumor rupture, especially in the case of vegetable-type tumors with early bleeding, the amount is also more, if bleeding frequently, blood loss can lead to severe anemia.
Second, increased vaginal secretions.
This is the main symptom of patients with cervical cancer. Most occur before vaginal bleeding. Initially, the vaginal secretions can be free of any odor. As the cancer grows, the secondary infection and necrosis of the cancerous tumor increase the amount of secretions, such as water-like water or mixed blood, with a foul smell. When the tumor spreads to the endometrium, the secretion is blocked by the cervical cancer tissue and cannot be discharged. It can form uterine effusion or uterine empyema. The patient may have symptoms such as lower abdominal discomfort, abdominal pain, low back pain and fever.
Third, frequent urination, urgency, dysuria.
When the cancer spreads forward, it can invade the bladder. Patients with falling and frequent urination, urgency, dysuria, hematuria are often misdiagnosed as urinary tract infections and delayed diagnosis. Severe can form bladder-vaginal fistula. The spread of cancer can invade the rectum, and there are symptoms such as falling, difficulty in defecation, urgency, and blood in the stool. Further development may occur in the vagina. Distant metastasis can occur in the late stage of the lesion. The location of the metastasis is different, and the symptoms appear different. The more common is the metastasis of the supraclavicular lymph nodes, where nodules or masses appear. Carcinoma infiltration can spread to distant organs through the blood vessels or lymphatic system and the corresponding sites of metastases, and their corresponding symptoms.
Fourth, pain.
This is a symptom of advanced cervical cancer. The cancer extends along the adjacent tissue, invades the pelvic wall, and compresses the peripheral nerve. The clinical manifestation is persistent pain of the sciatic nerve or one side of the ankle and ankle. Tumor compression or erosion of the ureter, narrowing of the pipeline, obstruction leading to hydronephrosis, manifested as a side of low back pain, and even severe pain, further developed into renal failure, resulting in uremia. Invasion of the lymphatic system leads to obstruction of the lymphatic vessels, obstruction of reflux and symptoms of lower extremity edema and pain.
Four major symptoms
One is bleeding after sex. 70%-80% of cervical cancer patients have this symptom.
The second is cervical erosion. Young women have long-term cure for cervical erosion, or cervical erosion after menopause, which should be taken seriously.
Third, contact bleeding, bleeding after sex, or uterine bleeding after gynecological internal examination, are signs of cervical precancerous lesions.
Fourth, leucorrhea mixed blood, in addition to the upper ring caused by uterine bleeding, women with long-term vaginal mixed blood should be promptly checked.
80% of cervical precancerous lesions can be cured by early detection and early treatment.
Examine
Examination of cervical precancerous lesions
The first step: TCT thin layer liquid-based cytology test
First, using modern state-of-the-art thin-layer liquid-based cytology (TCT), the cervical cells were observed under a microscope to see if the cervical cells were abnormal. Because cervical cancer is the first to start from the changes in cervical cells.
In addition, HPV testing can be performed if economic conditions permit, so the accuracy will be higher.
Second step: electronic colposcopy
After TCT thin layer liquid-based cytology, if cervical cells are found to be abnormal, a colposcopy is required. Under the high magnification of 40 times of electronic colposcopy, observing the subtle changes in the surface of precancerous lesions of cervical precancerous lesions is of great value for the early detection and early diagnosis of cervical cancer and precancerous lesions.
Third step: histopathological examination
If an abnormality is found in a colposcopy, a biopsy should be taken under the guidance of a special stain. At the prompt of vaginal microscopy, multiple biopsies of suspected lesions were examined by histopathology to confirm cervical lesions.
After the above three steps of examination, you can determine the cervical lesions, find early cervical cancer, prevent problems before they occur.
Diagnosis
Diagnosis and diagnosis of cervical precancerous lesions
diagnosis
Diagnosis can be performed based on clinical manifestations, examinations, and the like.
Differential diagnosis
According to the symptoms and signs, it is not difficult to distinguish with other tumors of the uterus such as uterine fibroids and uterine body cancer.
Uterine fibroids:
1, menorrhagia and bleeding during menstruation: especially submucosal uterine tumors.
2, pain: general pain is only a vague pain, unless the uterus itself to discharge submucosal uterine fibroids, resulting in uterine contractions.
3, compression symptoms: uterine fibroids can be compressed into the bladder, ureters, blood vessels, nerves and intestines, and produce a variety of operations that affect these organs.
4, infertility: uterine fibroids can affect the structure of the uterine cavity and the operation of the endometrium, making the implantation difficult. However, patients with uterine fibroids can also be normally conceived and normally produced.
Uterine body cancer:
1, vaginal bleeding: vaginal persistent or irregular bleeding after menopause; menopausal may have menorrhagia or irregular bleeding.
2, vaginal discharge: a small number of patients in the early stage of the disease with watery or bloody drainage increased, late necrosis infection, there may be stench and pus and blood secretions.
3, pain: generally only occurs in the advanced stage, when the cervical canal is blocked by the cancer tissue leading to uterine hemorrhage or empyema, there may be pain in the lower abdomen or cancer to stimulate the contractions, causing pain when the advanced cancer infiltrates the pelvic wall There may be low back pain.
