How to diagnose cervical precancerous lesions

Early cervical precancerous lesions cannot be identified by local naked eye observation. Most of them only have varying degrees of erosion or slight contact bleeding, and some cervixes even have smooth appearance. Patients with suspected or clinically recognizable cervical precancerous lesions should undergo careful gynecological examinations and necessary full-body examinations in order to make an early diagnosis and find out the type and range of cancer growth.

(I) Gynecological examination

1. Visual inspection of the vulva: Pay attention to the presence of cancer in the vulva. Late-stage patients may occasionally have vulvar metastasis. In addition, cervical precancerous lesions and vulvar cancer may also exist at the same time.

2. Speculum examination For patients with recurrent vaginal bleeding, it is best to perform a digital examination first to understand the scope of the lesion and then gently insert the speculum for examination to avoid damaging the cancerous tissue and causing heavy bleeding. The main purpose of the speculum is to understand the morphology of the cervix. If a cancer is suspected, understand its type, size, and the scope of the cervix and vagina. If necessary, apply 3% compound iodine solution locally for auxiliary examination.

3. Digital vaginal examination: Use the index finger to touch the entire vaginal wall, cervical surface and cervical canal from the vaginal opening inward, paying attention to the texture, the extent of the tumor and whether there is blood on the finger cot.

4. In addition to understanding cervical lesions, bimanual examination can also help understand the size, texture, mobility of the uterus, and whether there are lumps, thickening, and tenderness in the bilateral adnexa and paracervix.

5. The triple diagnosis should pay attention to whether the anterior wall of the rectum is smooth, the elasticity of the posterior wall of the vagina, the thickness and hardness of the cervical canal, whether the paracervical main ligament and sacral ligament are thickened, hardened, elastic and nodular, and whether there is cancer infiltration in the pelvic wall, metastatic and enlarged lymph nodes, etc. The triple diagnosis is an indispensable step in determining the clinical staging of cervical precancerous lesions.

(II) Full body examination Full body examination is necessary for patients with cervical precancerous lesions, which can not only understand whether there are distant metastatic lesions, but also provide a basis for formulating treatment plans. When examining patients in the late stage, attention should be paid to whether the iliac fossa, inguinal and supraclavicular lymph nodes are enlarged, whether the kidneys can be touched, and whether there is percussion pain in the kidney area.

(III) Other auxiliary examinations To further understand the location and range of cancer spread and metastasis, some necessary auxiliary examinations should be carried out according to the specific situation, such as chest fluoroscopy or radiography, cystoscopy, colonoscopy, intravenous pyelography, lymphangiography and isotope renal examination. Biopsy is the most reliable basis for diagnosing cervical precancerous lesions. Whether the cancer is early or late, a biopsy must be performed to confirm the diagnosis.