This type of cancer ranks first in incidence among gynecological malignancies, and most cases can be cured in the early stages!

Author: Wu Ming, Chief Physician, Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

In my country, cervical cancer is the most common gynecological malignancy and ranks first in incidence.

Currently, the treatment of cervical cancer is relatively mature. In addition, more than 90% of cervical cancer can be detected in the early stages, so the prognosis of cervical cancer is not the worst.

1. This type of cervical cancer is the most common!

Most cervical cancers are caused by infection with HPV, which is called human papillomavirus. It is mainly transmitted through sexual contact. It acts on the cervix for a long time and eventually leads to cervical cancer.

Figure 1 Original copyright image, no permission to reprint

Cervical cancer is a tumor that originates from the cervical epithelium and cervical glands. Tumors that occur in the cervical epithelium are called cervical squamous cell carcinomas, which account for about 90% of all cervical cancers; tumors that occur in the cervical glands are called cervical adenocarcinomas, which account for about 10% of all cervical cancers; adenocarcinomas and squamous cell carcinomas coexist, called cervical adenosquamous carcinomas, which account for a very small part; there are also some special types, such as neuroendocrine carcinomas and small cell carcinomas, which are extremely rare and have very poor prognosis.

Figure 2 Original copyright image, no permission to reprint

Squamous cell carcinoma of the cervix grows on the cervix, usually in a cauliflower-shaped shape, growing outward, with a lot of purulent secretions, accompanied by odor and bleeding, so squamous cell carcinoma is usually treated at an early stage.

Cervical adenocarcinoma grows in the cervical canal and is not easy to detect at an early stage. The typical cervical appearance of adenocarcinoma is called beer barrel-like, with a flat cervix that is thick and large, hard to the touch, and smooth on the surface. Because the tumor grows inside, the surface of the cervix looks round. Because of this, symptoms may not appear until it develops to a certain extent, so adenocarcinoma is diagnosed later than squamous cell carcinoma.

The prognosis of cervical adenocarcinoma is generally worse than that of cervical squamous cell carcinoma, because adenocarcinoma is discovered later and has already invaded and metastasized by the time it is discovered. There is no difference in the prognosis between adenocarcinoma and squamous cell carcinoma of the same degree.

2. There are many ways to screen for cervical cancer, but the final diagnosis depends on pathology!

Screening for cervical cancer generally involves cytology, also known as TCT testing, and HPV testing, which can detect precancerous lesions of the cervix.

If TCT finds any problems, the next step is to do a colposcopy. A colposcopy is a 40x magnifying glass that can carefully observe the surface of the cervix to see if there are any precancerous lesions on the surface of the cervix. A biopsy can be taken from any abnormal area for pathology, which can then confirm the diagnosis.

The basement membrane is located below the squamous cells of the cervix. Under a microscope, if the lesion is confined to the epithelium, it is called a precancerous lesion, or cervical intraepithelial neoplasia. If it breaks through the basement membrane, it is called cancer. Therefore, the difference between cancer and precancerous lesions is whether or not the basement membrane is broken. Precancerous lesions are not cancer, but a small part of them will become cancer. If treated in time, the effect is very good.

3. Is surgery or radiotherapy better for early cervical cancer?

For early-stage cervical cancer, radiation therapy and surgery have the same effects.

For young patients with early cervical cancer, radiotherapy can cause a lot of harm, including damage to the ovaries and vagina, so surgery is recommended as the first choice. Most early cervical cancers require radical surgery, which requires not only the removal of the uterus, but also the removal of 4 cm of tissue around the uterus, including part of the vagina, in order to achieve a radical cure. Cervical cancer surgery must ensure that there are no cancer cells at the cutting edge, so most patients require adjuvant radiotherapy after surgery.

Surgery is usually not recommended for elderly patients with early cervical cancer because it is done to protect the ovaries and vagina. If they have already reached menopause, their ovarian function has been lost and there is no need to worry about the effects of radiotherapy on ovarian function. However, the risk of surgical complications is significantly increased compared to younger female patients, so radiotherapy is preferred.

Therefore, for patients with early cervical cancer, whether to undergo surgery or radiotherapy requires doctors to weigh the pros and cons and make comprehensive considerations.

If cervical cancer has already metastasized, especially to distant sites, surgery is no longer suitable. Instead, radiotherapy and chemotherapy can be used to control distant metastases and radiotherapy to control local lesions. A comprehensive treatment approach can be adopted and surgery may be performed in very rare cases.

Most early-stage cervical cancers can be cured. If there is no recurrence within three years after surgery, it can basically be considered cured. Recurrence usually occurs within three years after treatment, and after three years it is basically less likely to recur.