What should I do in the late stage of cervical cancer?

Cervical cancer refers to malignant tumors that occur in uterus, vagina and cervical canal. The metastasis of cervical cancer can spread directly to adjacent tissues and organs, downward to vaginal vault and vaginal wall, upward to uterine body, laterally to pelvic tissue, forward to bladder and backward to rectum. It can also metastasize to cervical lymph nodes, internal iliac lymph nodes, external iliac lymph nodes, inguinal lymph nodes, and even to systemic lymph nodes such as clavicle in the later stage. Hematogenous metastasis is rare, and the common metastatic sites are lung, liver and bone. When the symptoms of cervical cancer appear three months later, two-thirds of the patients have advanced cancer. The most common symptoms of cervical cancer are increased leucorrhea and vaginal bleeding. Leucorrhea can be rice soup or pink, and it smells fishy. Vaginal bleeding begins after sexual intercourse, defecation or gynecological examination, especially after menopause.

diagnose

For patients with cervical cancer or suspected cervical cancer, endoscopic examination should be performed first, and then digital examination, vaginal digital examination, double examination of vagina and abdominal wall, and triple examination of rectum, vagina and abdominal wall should be performed to understand the hardness and elasticity of the lesion area and determine the situation and scope of parauterine infiltration. Colposcopy and vaginal microscope can be used for biopsy to improve the diagnostic rate. Vaginal smear plays an important role in early detection of cervical cancer. In addition, it can also be used as HCD1ca17; +07; CTH、HCD 1ca 12； B-ultrasound, isotope examination, etc. Help to determine the scope of infringement.

treat cordially

Surgical treatment is the main treatment for early cervical cancer. Advanced cervical cancer is mainly treated by radiotherapy or the combination of radiotherapy and surgery.

prevent

In order to prevent cervical cancer, the following people should have gynecological cancer prevention examination every 2 ~ 3 years:/kloc-people who have had sex and got married before the age of 8; Sexual dysfunction, frequent sexual intercourse and sexually transmitted diseases; Early marriage and multiple births; Those with cervical inflammation and erosion; Vaginal bleeding after sexual intercourse, postmenopausal vaginal discharge, especially bloody discharge; People over the age of 45 who have no symptoms should also have regular routine examinations. Self-prevention methods of cervical cancer are:

(1) not promiscuous.

(2) Advocate late marriage and late childbearing and family planning to avoid damaging the cervix.

③ Pay attention to hygiene and keep the lower body clean.

(4) Male foreskin should be circumcised if it is too long, and the skin scale should be removed with water frequently to keep the genitals clean.

⑤ If hysterectomy is performed for other reasons, curettage should be performed before operation.

⑥ Actively treat chronic inflammation and deal with precancerous lesions.

In addition, to prevent cervical cancer, we should avoid alcohol and tobacco and avoid cold and greasy food.

The etiology of cervical cancer is still unclear, and a large number of data at home and abroad confirm that the prevalence rate of women with early marriage and childbearing, prolificacy and sexual dysfunction is high. At present, it is also believed that cholesterol in skin scales can be transformed into carcinogens after bacterial action. It is also an important cause of cervical cancer.

In recent years, it has also been found that cervical cancer is related to some viruses transmitted during sexual intercourse, such as: ① Human Scar Virus Type II (HSV-2), because HSV-2 antibody detection is 80% ~ 100% positive in patients with invasive cervical cancer; (2) The detection of human papillomavirus (HPV) and HPV-specific antigens in various cervical cancer tissues showed that the incidence of cervical cancer was related to HPV infection; ③ Human cytomegalovirus. It has been reported at home and abroad that patients with atypical hyperplasia of cervical precancerous lesions have high serum CMV antibody titer; Animal experiments prove that CMV-DNA has the ability of malignant transformation. Therefore, viral infection has become one of the important topics in the study of the etiology of cervical cancer in recent years.

2. Etiology

1), marriage factors Most patients with cervical cancer are married women. Premature sexual intercourse and too many sexual partners are closely related to cervical cancer. The more sexual partners, the higher the relative risk of cervical cancer, and the incidence of prostitutes is four times that of normal people. Therefore, sexual life and marriage are closely related to cervical cancer.

2) Birth factors lead to early primiparity and high incidence of cervical cancer.

3) Pathogenic factors Many pathogens are closely related to cervical cancer, especially human papillomavirus (HPV) and herpes simplex virus type II (HSVII).

4) Other factors Some studies believe that penis scales, trichomonas vaginalis infection, syphilis and gonorrhea are all related to the occurrence of cervical cancer.

3. Dissemination and transfer

Metastasis route: Because the epithelial layer of the cervix lacks lymphatic vessels and blood vessels, the basement membrane is a histological barrier, which can prevent the infiltration of cancer cells, so the cancer in situ will not metastasize. When carcinoma in situ turns into invasive carcinoma, the cancer will spread. The main transfer routes are as follows:

1) Direct transmission: spread to vagina. Exogenous cervical cancer lesions often spread downward, first infiltrating the vaginal vault, and then spreading to the middle and lower segments of the vagina. The lesions in the cervical canal make the cervical canal expand, thicken and harden, and spread upward, involving the uterine cavity, penetrating the uterine wall, and spreading in the abdominal cavity. It spreads to the tissues beside uterus and invades bilateral main ligaments and sacral ligaments, and the whole pelvic cavity can form a hard cancer focus, which is characterized by "frozen pelvis". Cancer infiltrating the uterus will also compress one or both ureters, leading to ureteral obstruction. When it invades the bladder and rectum, it will cause hematuria and the feeling of "internal urgency before weight".

2) Lymphatic metastasis: Infiltration of cervical cancer into stroma can invade lymphatic vessels to form tumor thrombus, which will flow with lymph to adjacent lymph nodes and spread in lymphatic vessels. The metastasis routes are: ① Basal lymphatic vessels of cervical cancer focus → Parauterine lymph nodes-obturator lymph nodes → Internal and external iliac lymph nodes → Common iliac lymph nodes → Abdominal paraaortic lymph nodes → Supraclavicular fossa lymph nodes. ② Lymphatic vessels of cervical cancer focus → presacral lymph nodes → subaortic lymph nodes.

3) Blood metastasis: In patients with advanced or poorly differentiated diseases, it can spread to lung, liver, kidney, bone, brain, skin and other parts.

4. Experts talk

The highest incidence rate in the world is South Africa, followed by Asia. The number of new cases in China exceeds10.3 million every year, accounting for 73-93% of the incidence of malignant tumors in female reproductive system. In developed countries, the incidence of cervical precancerous lesions has obviously decreased, which is largely attributed to the early diagnosis and treatment of cervical precancerous lesions. In developing countries, the incidence of cervical cancer in China is six times higher than that in developed countries due to the imperfection of cervical screening and the neglect of cervical diseases by women.

There are 500,000 new cases in the world every year, with China accounting for 1/4. It is particularly noteworthy that due to environmental pollution and bad hygiene habits in life, cervical cancer, which used to occur mostly in women around 50 years old, is now aimed at young women.

Clinical stage

Stage 0: carcinoma in situ, which is confined to cervical epithelium without local invasion.

Stage I: Cancer is confined to the cervix (whether the uterus is invaded or not).

The second stage: the cancer has exceeded the cervix, but the infiltration has not yet reached the pelvic wall. Cancer has involved the vagina, but it has not reached the next third.

Stage III: the tumor has infiltrated into the pelvic wall, and there is no gap between the tumor and the pelvic wall during rectal examination; The tumor involved the vagina1/3; Except for hydronephrosis or renal failure caused by other reasons, all patients with hydronephrosis or renal failure belong to stage ⅲ.

Stage 4: The cancer has spread beyond the real pelvis, or has invaded the bladder or rectal mucosa clinically.

Clinical manifestations of cervical cancer

In developed countries, the incidence of cervical cancer has greatly decreased, which is largely due to the early diagnosis and treatment of precancerous lesions. In developing countries, the incidence of cervical cancer is six times that of developed countries because of the imperfect cervical screening work. According to the screening results of tens of thousands of patients with cervical lesions by experts from Beijing Friendship Hospital, 607 cases were found abnormal, and 345 cases of cervical precancerous lesions and 9 cases of cervical cancer were finally diagnosed. The youngest cervical precancerous lesion is 23 years old, and the patients with cervical cancer are 34-48 years old, of which 33.3% are under 40 years old and 66.6% are 40-48 years old. Cervical cancer has seriously threatened the health and life of young and middle-aged women.

Cervical cancer has no symptoms in the early stage. As the disease progresses, the patient may have abnormal vaginal bleeding. Because young women are sexually active, their estrogen level and frequency of sexual intercourse are high, so it is easier to take sexual intercourse bleeding as the first symptom. In addition, the increase of leucorrhea is also a common symptom of cervical cancer, and about 80% of cervical cancer patients have this symptom.

Clinical follow-up observation shows that it takes about 10 years to develop from general cervical precancerous lesions to cervical cancer. From this point of view, cervical cancer is not terrible, it is a preventable and treatable disease. The key to prevention and treatment lies in: regular gynecological examination, timely detection and treatment of cervical precancerous lesions, and termination of its development to cervical cancer. If preventive measures can be implemented, the cure rate of cervical cancer is very high.

There are no symptoms in the early stage, which is no obvious difference from chronic cervicitis, and sometimes even the cervix is smooth, especially for elderly women whose cervix has shrunk.

The main symptoms are:

Vaginal bleeding: Young patients often show contact bleeding, which mostly occurs in sexual life, gynecological examination and bleeding after defecation. The amount of bleeding can be more or less, which generally depends on the size of the lesion and the invasion of interstitial blood vessels. The amount of bleeding in the early stage is small, and the large lesion in the late stage is characterized by massive bleeding. Once the larger blood vessels are eroded, it may cause fatal massive bleeding. Young patients can also show prolonged menstrual period, shortened cycle and increased menstrual flow. Elderly patients often complain about irregular vaginal bleeding after menopause.

Vaginal drainage: patients often complain of increased vaginal drainage, which is white or bloody, as thin as water sample or rice soup, and has a foul smell. In the late stage, a large number of purulent or rice-soup-like malodorous leucorrhea is discharged due to cancer tissue ulceration, tissue necrosis and secondary infection.

Symptoms of advanced cancer: Secondary symptoms appear according to the degree of lesion invasion. When the lesion spreads to pelvic connective tissue, pelvic wall, compression of ureter or rectum, sciatic nerve, frequent urination, urgency of urination, anal distension, constipation, acute diarrhea, swelling and pain of lower limbs, etc. In severe cases, it can lead to ureteral obstruction, hydronephrosis and uremia. At the end of the disease, patients may have emaciation, anemia, fever and general failure.

The diagnosis of cervical cancer is mainly based on the history and clinical manifestations, especially those with contact bleeding, which requires detailed general examination and gynecological triple diagnosis, as well as cervical smear cytology, iodine test, nitrogen laser tumor intrinsic fluorescence diagnosis, colposcopy, cervical biopsy and cervical conization. After the diagnosis of cervical cancer, chest X-ray, lymphography, cystoscopy and proctoscopy should be done according to the specific situation to determine its clinical stage.

5. Difficulties and countermeasures

At present, the single method of treating cervical cancer has its shortcomings. For example, although surgical treatment is one of the important methods to treat cervical cancer, it can achieve the goal of radical cure for most early patients, but if a small amount of cancer tissue remains during the operation, especially subclinical lesions around the cervix or distant metastasis, it may lead to local recurrence or distant metastasis after operation; In addition, surgery may also cause local cancer cell implantation and blood or lymphatic spread, so it may cause local recurrence or distant metastasis. Radiotherapy for cervical cancer is also the main treatment method, but it will also make the treatment effect unsatisfactory for some reasons, such as: some tumors or pelvic lymph nodes are missed or the radiation dose is not enough; Some pathological types of cancer tissues are not sensitive to radiation; There was subclinical distant metastasis before radiotherapy; Due to serious radiation reaction, such as the serious reaction of bladder, rectum and other organs, the radiotherapy is terminated or the radical dose cannot be achieved.

One of the difficulties: how to improve the cure rate of cervical cancer

1), combined surgery and radiotherapy for cervical cancer preoperative radiotherapy: preoperative radiotherapy for cervical cancer can reduce local recurrence and metastasis and improve the cure rate of patients, which is an important progress in the treatment of cervical cancer in the past 40 years.

2) Comprehensive treatment of surgery and anticancer drugs Most of the causes of death after cervical cancer surgery are cancer recurrence and metastasis. Recurrence is due to incomplete surgery, cancer cells remain in the primary site, and later develop into detectable tumors. Metastasis refers to the fact that cancer cells have left the primary focus before or during the operation and migrated to other parts for planting through tissue gaps, lymphatic vessels and blood vessels.

3) Comprehensive treatment of radiotherapy and anticancer drugs Radiotherapy is the main method to treat cervical cancer at present, and the radiotherapy technology is also improving. However, radiotherapy, like surgical treatment, is a local treatment, and the recurrence and metastasis of cancer is still a difficult problem.

The second difficulty: how to improve the long-term curative effect of cervical cancer

Western medicine has a certain effect on cervical cancer, especially in situ cancer and early cases. But in the middle and late cases, the treatment effect is not ideal. If Chinese medicine is combined with treatment, the curative effect can be greatly improved.

1), Chinese medicine combined surgery After simple Chinese medicine treatment, some cancer cells remaining in the deep and cervical canal can be treated by surgery. From some surgical specimens after TCM treatment, we can further study and discuss the therapeutic effect and function of TCM.

2) Combination of traditional Chinese medicine and radiotherapy

3) Chinese medicine combined with chemotherapy at the same time, if the disease stage is late or the tumor is large, local injection, intravenous injection or arterial infusion of chemotherapy drugs can be combined, which can improve the curative effect and surgical resection rate.

6. Experience and experience

1). Understanding the pathogenic factors of cervical cancer, taking corresponding measures, advocating late marriage and family planning, actively preventing and treating women's diseases such as cervicitis, and insisting on tumor screening can greatly reduce the incidence of cervical cancer. Because tumor screening can find precancerous lesions and carcinoma in situ early, the cure rate is greatly improved after effective treatment, which plays a great role in reducing cervical infiltration and advanced cancer.

2). Chinese medicine has a good effect on cervical cancer, especially for early cervical cancer, which is mainly based on local use of Chinese medicine, supplemented by oral Chinese medicine based on syndrome differentiation.

3). Even for advanced cervical cancer, TCM can treat it according to syndrome differentiation, that is, measures such as strengthening the body resistance and eliminating pathogens, attacking and reinforcing both the symptoms and root causes can be taken according to the pathogenic factors, physical condition, clinical manifestations and changes in the external environment, which can alleviate the symptoms of patients with cervical cancer and prolong their lives.

4) Radiotherapy for cervical cancer is the main treatment method. In vivo and in vitro radiotherapy is seriously harmful to human body, and many patients stop treatment because of radiotherapy reaction. Therefore, in many units, traditional Chinese medicine is combined with treatment to reduce side effects, and it may have sensitization effect on radiotherapy, so it can not only successfully complete treatment, but also improve the cure rate and survival rate.

Don't be afraid!

Go to a regular hospital.