If HPV is negative, do we not need to consider cervical cancer?

This is the 4362nd article of Da Yi Xiao Hu

Although Ms. Li is already 59, she still has smooth skin and a slim figure, and looks quite "young". However, she has been a little annoyed recently because her period, which has not come for 5 years, has come again? Is she really getting younger again? !

She immediately went to the local hospital for a checkup and, at the doctor's suggestion, underwent a vaginal ultrasound and other related tests. The results were indeed a little off:

Vaginal ultrasound revealed that the endometrium was only 0.17 mm thick, which could temporarily rule out bleeding caused by endometrial lesions.

A mass measuring 2.7*1.7*3.0cm was found on the anterior lip of the cervix, which was not good!

Based on the results of the ultrasound examination, the doctor highly suspected that the abnormal uterine bleeding during menopause was secondary to malignant lesions of the cervix and recommended that she undergo further examinations such as a colposcopy.

Ms. Li was unwilling to believe it, because she attached great importance to her health and had regular physical examinations every year. She had just completed her annual physical examination half a year ago. In the HPV test and TBS test for cervical cancer screening, she had always been "clean" with no abnormalities.

Everyone says that HPV-positive people are more likely to get cervical cancer. How can you get cervical cancer if you have never been infected with HPV?

Finally, Ms. Li underwent an advanced examination for cervical cancer screening - colposcopy cervical biopsy - at the doctor's suggestion.

The report clearly states: The pathology of the cervical biopsy at 10-4 o'clock indicates: adenocarcinoma.

Ms. Li was extremely confused: her HPV test results were clearly negative before her annual physical examinations, so how could she develop cervical cancer, which is highly correlated with HPV? Finally, the patient found Director Qiu Jin, a gynecological oncologist at Tongren Hospital.

Director Qiu answered her doubts: "Not all cervical cancers are related to HPV. Cervical squamous cell carcinoma is highly related to HPV infection, but there are also some cervical cancers that are not related to HPV, among which adenocarcinoma is the most common."

Although most adenocarcinomas are also accompanied by HPV infection, a small number of other cervical adenocarcinomas will show HPV-negative, more insidious HPV-unrelated cervical adenocarcinoma (NHPVA). For this group of people, due to rapid onset and late detection, the 5-year survival rate is only 10-20% of cervical squamous cell carcinoma.

As cervical cancer prevention and treatment are gradually gaining popularity and the dangers of HPV have become well known to people, NHPVA should arouse people's vigilance!

After detailed imaging and laboratory tests, Director Qiu made a comprehensive analysis and determined that Ms. Li is now in stage IB2 cervical adenocarcinoma, and the lesion is still confined to the cervix. As long as the principle of no tumor is strictly followed during the operation, the long-term health after the operation should be relatively ideal.

After careful preparation, Ms. Li underwent a scheduled transabdominal extensive hysterectomy + bilateral adnexectomy + para-aortic lymph node dissection + pelvic lymph node dissection. The operation went very smoothly, and postoperative pathology showed that the tumor was completely removed!

This case tells us a truth: symptoms are the most important. When abnormal symptoms occur, we cannot just "take it for granted" based on our limited medical and health knowledge. We should still find a specialist for the corresponding investigation. If the disease is delayed for another year or two, I am afraid the ending of the story will not be so happy!

Important points for all girls:

01Pay attention to HPV vaccination.

Persistent infection with high-risk HPV is still the main cause of 70% or even more than 90% of cervical cancer. No matter which type of cervical vaccine is administered, it can effectively reduce the incidence of cervical cancer.

02After vaccination, regular cervical cancer screening is still required.

There are many subtypes of HPV, and vaccines cannot completely prevent infection from all subtypes, so HPV testing and TCT examinations every two years or even once a year are very necessary.

03 Pay attention to your physical health . Take abnormal vaginal bleeding or other signals from your body seriously and seek medical attention as soon as possible.

Author: Department of Obstetrics and Gynecology, Shanghai Tongren Hospital

Zhang Liang, Qiu Jin, Dai Yun