Problem description:

Is cervical cancer dangerous? Can it be cured? I'm just not sick yet. Oh! ! ! ! ! ! ! ! ! ! I'm only twenty-one years old. Oh, 55555555555555

Analysis:

Cervical cancer-incidence and high risk factors (1) incidence 1. Cervical cancer is the most common gynecological malignant tumor. 2. The incidence has obvious racial and regional differences. The highest incidence rate in the world is Colombia, and the lowest is Israel. China's high-incidence areas include Guanyu District of Hubei, Wufeng County and Jing 'an County of Jiangxi. The low-incidence areas are Beijing and Shanghai. There are more rural areas than cities, and more mountainous areas than plains. (2) The high risk factor is 1. Human papillomavirus (HPV) infection is the main risk factor for cervical cancer. According to literature reports, about 95% of cervical cancer patients can detect high-risk human papillomavirus. HPV 16 mainly causes squamous cell carcinoma, and HPV 18 mainly causes adenocarcinoma. 2. Premature sexual life and sexual dysfunction. 3. Get married and have children. Early marriage, early childbearing, prolificacy and secret childbirth. 4. Male factor. If the husband has cancer, prostate cancer or his ex-wife has cervical cancer, the incidence rate is high. Human papillomavirus infection in male genitals is closely related to the risk of cervical cancer in spouses. Histogenesis, Development and Pathological Changes of Cervical Cancer (I) Physiological Changes of Normal Cervical Epithelium Composition of Cervical Squamous Epithelium * * Original Cervical Squamous-columnar Junction * * Physiological Squamous-columnar Junction Transition Zone: During the formation of the regional transition zone between the original squamous-columnar junction and the physiological squamous-columnar junction, the columnar epithelium covered on its surface is gradually replaced by squamous epithelium, and the replacement mechanism. (2) Squamous epithelialization Squamous epithelium grows directly between columnar epithelium and basement membrane, so that columnar epithelium falls off completely and is replaced by squamous epithelium. (2) Cervical intraepithelial neoplasia (CIN) 1. Cervical atypical hyperplasia-cervical epithelial cells are partially or mostly replaced by different atypical cells. According to the degree of atypical cells and epithelial involvement, it is divided into three levels: mild, moderate and severe. (1) Mild atypical hyperplasia (CINⅰ Ⅰ grade)-The cell atypia is light, and the atypia only accounts for 1/3 in the subcortical layer. (2) Moderate atypical hyperplasia (CINⅱ Ⅱ grade)-the cells have obvious atypia, and the atypia cells are confined to the lower 2/3 of the epithelial layer. (3) Severe atypical hyperplasia (CINⅲ Ⅲ grade)-the cells have obvious atypia, and the atypia cells almost or completely involve the epithelial layer. 2. The polarity of the whole epithelium of cervical carcinoma in situ disappeared, the cell atypia was obvious, and there was mitotic stage; The basic feature is that cancer cells are confined to epithelium, the basement membrane is intact and there is no interstitial infiltration. Cervical carcinoma in situ involves glands-atypical cells can enter the transitional cervical glands along the opening of the cervical gland cavity, so that the original columnar epithelial cells of the glands are replaced by multiple layers of atypical squamous cells, but the basement membrane of the glands remains intact. (3) Cervical invasive carcinoma 1. Squamous cell carcinoma: 90%-95% of cervical cancer (1), early invasive carcinoma: Microscopically, it was found that the cancer cells passed through the basement membrane in a teardrop shape with interstitial infiltration, but the depth was 4/hp.2. Adenocarcinoma: 5%- 10%, originated from the columnar epithelium of the cervical canal, and its appearance was similar to that of others. Microscopically, there are three types: (1) mucinous adenocarcinoma: columnar mucinous cells from cervical mucosa, the most common. (2) Cervical malignant adenoma (also known as minimal deviation adenocarcinoma) (3) Adenosquamous carcinoma: rare in columnar cells of cervical mucosa. The main ways of metastasis are direct dissemination and lymphatic metastasis, and hematogenous metastasis is rare. (1) The lesions directly spread to the upper part of uterine cavity and cervical canal, infiltrated into the lateral main ligament, adjacent tissues and pelvic wall, and then moved to the front of bladder and the back of rectum. (2) Lymphatic metastasis group: parauterine, obturator, internal iliac and external iliac lymph nodes. Secondary metastasis group: common iliac artery, deep inguinal vein, superficial inguinal vein and paraaortic lymph node dissection group. (3) Blood metastasis occurs in the late stage, which can reach the lung, kidney and spine. 4. Clinical manifestations and clinical staging (1) Symptoms: Early cervical cancer has no symptoms and no obvious signs, which is no obvious difference from chronic cervicitis. Once the symptoms appear, they are: 1. * * * Bleeding, contact bleeding or irregular bleeding, and cancer focus erodes large blood vessels, which can cause fatal massive bleeding. 2. The liquid discharged by * * * is white, bloody and thin, like water or rice, and has a foul smell. If accompanied by infection, there may be a lot of purulent or fishy leucorrhea like rice soup. 3. Advanced carcinoid pain, urinary tract symptoms and rectal compression symptoms, cachexia. (2) Signs Early cervical cancer and cervicitis are difficult to distinguish with naked eyes. In the late stage, according to different types, the local signs are different: exogenous, there are polypoid, mastoid and cauliflower-like vegetation on the cervix, which is brittle and easy to bleed when touched. Endogenous type, cervical hypertrophy, hard quality, barrel-shaped cervical enlargement, smooth cervical surface or superficial ulcer. Ulcer type, cancer tissue necrosis and shedding to form concave ulcer. The appearance of the cervix is hollow, covered with gray necrotic tissue, and has a foul smell. Gynecological examination can palpate the thickening and mass around the uterus and infiltrate into the pelvic wall to form a frozen pelvic cavity. Diagnosis and differential diagnosis of early cervical cancer and chronic cervicitis have similar symptoms and signs, while advanced cervical cancer may have the same manifestations as cervical tuberculosis, cervical adenomatosis and cervical endometriosis. The most reliable diagnostic method is to do cervical and cervical canal biopsy and make pathological diagnosis. Auxiliary examination methods are: 1. Cervical cytology II. Iodine test 3. * * * Microscopic examination 4. Cervical fluoroscopy 5. Cervical biopsy 6. Cervical conization 6. The principle of treatment is to determine the treatment measures according to clinical stages, patients' age, general situation, equipment and medical technology level. The main methods are surgery, radiotherapy and chemotherapy. First of all, according to the examination, the clinical stages were carried out and the treatment plan was decided: stage ⅰ: the lesion was confined to the cervix. Stage Ⅱ A: The focus exceeded the cervix and involved * * *, but it did not reach 65,438+0/3 below * *, and there was no obvious parauterine infiltration. Stage Ⅱ B: The focus exceeded the cervix and involved the uterus, but did not reach the pelvic wall, with no obvious infiltration. Ⅲ a stage: the lesion involved * * * da 1/3. Stage Ⅲ b: The focus infiltrates the pelvic wall beside uterus, or there is hydronephrosis or renal insufficiency. Stage Ⅳ: The lesion spread outside the true pelvic cavity or infiltrated the bladder mucosa and rectal mucosa. 1. CIN Ⅰ of cervical intraepithelial neoplasia was treated according to inflammation, and CIN Ⅱ was followed up for 3 ~ 6 months after curettage, electric ironing, freezing, laser or cervical conization, and every 3 ~ 6 months after operation 1 time. Can level total hysterectomy, if you want children, you can do cervical conization and follow up regularly after operation. 2. Surgical treatment of invasive cervical cancer (1) (patients in stage Ⅰ a ~ Ⅱ a) Ⅰ a1stage: abdominal hysterectomy can preserve the ovary. Stage Ⅰ A2: Radical hysterectomy with ovarian preservation. Stage ⅰ b ~ ⅱ a: radical hysterectomy and pelvic lymph node dissection can preserve ovaries. (2) Radiotherapy is effective in all stages of invasive cancer, and early cases are mainly intracavitary radiotherapy, supplemented by external irradiation. External irradiation was the main treatment in the later stage, supplemented by intracavitary radiotherapy. Intracavitary radiotherapy is used to control local lesions, and external irradiation is used to treat pelvic lymph nodes and para-uterine tissues. (3) Surgery combined with radiotherapy (4) Chemotherapy is mainly used for patients with advanced or recurrent metastasis. Prognosis and follow-up prognosis are related to clinical stages, pathological types and treatment methods. The five-year survival rate reached 93.4% in the first stage, 82.7% in the second stage and 26.6% in the third stage. The main causes of late death are uremia, massive hemorrhage, infection and cachexia. Follow-up time: 1 time in the first year after discharge, every 2-3 months after discharge, every 3-6 months in the second year, every 6 months from the third year to the fifth year, and every year from the sixth year. Eight defenses 1. Popularize cancer prevention knowledge, advocate late marriage and fewer children, and carry out sexual health education. 2. Establish a women's health care network, regularly carry out cervical cancer screening and treatment, and all women over the age of 30 who go to gynecological clinics should undergo routine cervical smear examination. 3. Actively treat moderate and severe cervical erosion, timely treat cervical intraepithelial neoplasia, and block the occurrence of cervical cancer.