How to treat female cervical erosion? Complete knowledge of female cervical erosion disease

Cervical cancer is the most common gynecological malignancy. The peak age for carcinoma in situ is 30 to 35 years old, and for invasive cancer is 45 to 55 years old. In recent years, the incidence of cervical cancer has tended to be younger. The widespread use of cervical cytology screening in recent decades has enabled early detection and treatment of cervical cancer and precancerous lesions, and the incidence and mortality of cervical cancer have decreased significantly.

Detailed interpretation of the characteristics of cervical cancer

Early cervical cancer often has no obvious symptoms and signs. The cervix may be smooth or difficult to distinguish from cervical columnar epithelium ectopia. Patients with endocervical cancer are prone to missed diagnosis or misdiagnosis because of the normal appearance of the cervix. As the lesion develops, the following manifestations may occur:

1. Symptoms

(1) In the early stage of vaginal bleeding, it is mostly contact bleeding; in the middle and late stages, it is irregular vaginal bleeding. The amount of bleeding varies depending on the size of the lesion and the invasion of the interstitial blood vessels. If the large blood vessels are invaded, it may cause heavy bleeding. Young patients may also experience prolonged menstruation and increased menstrual flow; elderly patients often have irregular vaginal bleeding after menopause. Generally, the exogenous type has vaginal bleeding symptoms earlier and the amount of bleeding is heavier; the endogenous type has these symptoms later.

(2) Vaginal discharge Most patients have vaginal discharge. The liquid is white or bloody, can be thin like water or rice water, or have a fishy smell. Late-stage patients may have a large amount of rice water-like or purulent leucorrhea due to necrosis of cancerous tissue and infection.

(3) Late-stage symptoms Different secondary symptoms may appear depending on the extent of cancer involvement, such as frequent urination, urgency, constipation, lower limb swelling and pain, etc. When the cancer compresses or involves the ureter, it may cause ureteral obstruction, hydronephrosis and uremia; in the late stage, there may be symptoms of systemic failure such as anemia and cachexia.

2. Physical signs

Carcinoma in situ and microinvasive carcinoma may not have obvious macroscopic lesions, and the cervix may be smooth or only have columnar epithelial ectopia. Different signs may appear as the disease progresses. Exophytic cervical cancer can be seen with polyp-like and cauliflower-like growths, often accompanied by infection, and the tumor is fragile and easy to bleed; endophytic cervical cancer is manifested by cervical hypertrophy, hardness, and cervical canal dilatation; in the late stage, cancer tissue necroses and falls off, forming ulcers or cavities with a foul odor. When the vaginal wall is affected, growths can be seen growing on the vaginal wall or the vaginal wall becomes hard; when the paracervical tissue is affected, bimanual and triple-manual examinations can palpate thickening, nodules, hardness, or a frozen pelvic cavity of the paracervical tissue.

3. Pathological type

The three most common types are squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma.

(1) Squamous cell carcinoma is divided into three grades according to histological differentiation. Grade I is well-differentiated squamous cell carcinoma, grade II is moderately differentiated squamous cell carcinoma (non-keratinizing large cell type), and grade III is poorly differentiated squamous cell carcinoma (small cell type), most of which are undifferentiated small cells.

(2) Adenocarcinoma accounts for 15% to 20% of cervical cancer. There are two main histological types. ① Mucinous adenocarcinoma: the most common, originating from the columnar mucinous cells of the endocervical canal, with glandular structure under the microscope, multi-layered proliferation of glandular epithelial cells, obvious atypical proliferation, nuclear division images, and cancer cells protruding into the glandular cavity in a papillary manner. It can be divided into high-, medium-, and low-differentiated adenocarcinoma. ② Malignant adenoma: also known as minimally invasive adenocarcinoma, it is a highly differentiated endocervical mucosal adenocarcinoma. There are many cancerous glands of different sizes and shapes, which are dot-like protrusions extending into the deep layer of the human cervical stroma. The glandular epithelial cells have no atypia and often have lymph node metastasis.

(3) Adenosquamous carcinoma accounts for 3% to 5% of cervical cancer. It is formed by the differentiation and development of reserve cells into glandular cells and squamous cells at the same time. The cancer tissue contains both adenocarcinoma and squamous cell carcinoma.

4. Transfer pathway

It mainly spreads directly and metastasizes to the lymph nodes, while hematogenous metastasis is less common.

(1) Direct spread is the most common, with local infiltration of cancerous tissue and spread to adjacent organs and tissues. It often affects the vaginal wall downwards, and rarely affects the vaginal cavity upwards from the cervical canal; cancer foci spread to both sides and may affect the paracervical and paravaginal tissues and even the pelvic wall; when cancer foci compress or invade the ureter, it may cause ureteral obstruction and hydronephrosis. In the late stage, it may spread forward or backward to invade the bladder or rectum, forming vesicovaginal fistula or rectovaginal fistula.

(2) Lymphatic metastasis: After local infiltration, the cancer lesion invades the lymphatic vessels to form a tumor thrombus, which is then drained into the local lymph nodes with the lymphatic fluid and spreads in the lymphatic vessels. The first-level lymphatic metastasis group includes the paracervical, paracervical, obturator, internal iliac, external iliac, common iliac, and presacral lymph nodes; the second-level group includes the deep and superficial inguinal lymph nodes and para-aortic lymph nodes.

(3) Hematogenous metastasis is less common, but in the late stage it may metastasize to the lungs, liver, or bones.

Cervical cancer treatment requires the right method

An appropriate individualized treatment plan is formulated based on comprehensive considerations such as clinical stage, patient age, fertility requirements, general condition, medical technology level, and equipment conditions. A comprehensive treatment plan with surgery and radiotherapy as the main treatment and chemotherapy as the auxiliary treatment is adopted.

1. Surgical treatment

Surgery is mainly used for patients with early-stage cervical cancer.

Commonly used surgical procedures include: total hysterectomy; subradical hysterectomy and pelvic lymph node dissection; radical hysterectomy and pelvic lymph node dissection; para-aortic lymph node resection or sampling. Young patients with normal ovaries can be retained. For young patients who want to retain fertility, cervical cone resection or radical cervical resection is feasible for particularly early stages. Different surgical procedures are selected according to different stages of the patient.

2. Radiation therapy

Applicable to: ① patients in the middle and late stages; ② early patients whose general condition is not suitable for surgery; ③ preoperative radiotherapy for large cervical lesions; ④ auxiliary treatment for high-risk factors found in pathological examination after surgical treatment.

3. Chemotherapy

It is mainly used for patients with advanced or recurrent metastasis. In recent years, surgery combined with preoperative neoadjuvant chemotherapy (intravenous or arterial infusion chemotherapy) is also used to shrink tumor lesions and control subclinical metastasis. It is also used for radiosensitization. Commonly used chemotherapy drugs include cisplatin, carboplatin, paclitaxel, bleomycin, ifosfamide, fluorouracil, etc.