Difficulty urinating? Don't forget to check your cervix

This is the 4151th article of Da Yi Xiao Hu

Many people may think that only mature women can get cervical cancer, or that complicated sex life can lead to the disease, but that is not true! A 23-year-old female patient in a certain city who lived a simple life came to the hospital for treatment due to urination difficulties. She originally thought it was a common urinary tract infection, but after examination, she was found to have the most advanced stage of cervical cancer (stage IV). The news of the disease not only shocked the patient and her family, but also because it was discovered too late, after more than a year of full treatment, she was still unable to recover.

The patient's attending obstetrician and gynecologist pointed out that cervical cancer is a very common cancer among women. Although more than 90% of cervical cancers are closely related to the human papillomavirus (HPV) and are related to sexual behavior, the emergence of this case reminds everyone that even women with simple lives may still get sick and should not take it lightly.

Diagram of cervical cancer Normal cervix Cervical erosion

What is human papillomavirus?

According to research, women have a 50% chance of being infected with human papillomavirus (HPV) in their lifetime, which is usually transmitted through sexual intercourse. Some women infected with HPV are able to eliminate the virus on their own, but some infected people cannot eliminate the virus or are repeatedly infected due to personal physical factors or poor immune function, causing the virus to become persistently infected. Over time, the cervical cells will further become diseased, thus forming cervical cancer.

Human Papillomavirus

Transmission through contact

In fact, more than 120 types of HPV have been identified, of which about 40 are mainly transmitted through sexual contact. Among them, 13 types may cause cervical cancer, and the most notorious are types 16 and 18, which account for about 70% of cervical cancers.

Non-oncogenic HPV types can also cause lesions on the skin or mucous membranes, such as genital warts, which are mainly caused by types 6 and 11, accounting for about 90%. In addition to causing cervical cancer, human papillomavirus is also the culprit of many other cancers, such as vaginal cancer, vulvar cancer, penile cancer and anal cancer.

Cervical cancer

90% of cases are caused by HPV infection

According to surveys, 90% of cervical cancer causes are caused by HPV infection; smoking, eating less fruits and vegetables, being overweight, and heredity are also risk factors. The current prevention methods are cervical screening and HPV vaccination.

Basically, patients with early-stage cervical cancer may have the opportunity to retain their uterus and maintain their fertility, but hysterectomy is still the best option in clinical practice. If it is in the late stage, the cancer cells have spread and the effect of surgery is limited, so radiation or chemotherapy must be used. Usually, the 5-year survival rate of early-stage treatment can reach 80% to 90%, while in the late stage it may be less than 10%.

Gynecological Cancer Warning

Sudden vaginal bleeding

The more common gynecological cancers include uterine cancer, cervical cancer and ovarian cancer. However, uterine cancer is further divided into endometrial cancer and uterine sarcoma. Endometrial cancer accounts for more than 90%, while uterine sarcoma is less common in clinical practice and is difficult to distinguish from uterine fibroids, making it easy to be misdiagnosed and missed.

Because ovarian cancer tumors grow in the pelvic cavity, they are usually discovered in the late stages. Therefore, women are reminded that sudden abnormal vaginal bleeding is an abnormal sign and must seek medical attention as soon as possible. Clinically, many women who came to the hospital for treatment after suffering abnormal bleeding for more than a year were diagnosed with endometrial cancer. Therefore, the public is reminded that early detection of abnormalities is the best way to treat them.

Double protection

Smear test + vaccine

Taking this 23-year-old young woman as an example, there is a clear trend of younger people suffering from cancer in China, so it is not enough to wait until you are over 30 to do a cervical smear test.

Generally speaking, the best time to get the cervical cancer vaccine is between the ages of 9 and 14. The younger you are, the better the effect of producing antibodies. Even men can get the cervical cancer vaccine to prevent diseases caused by viral infections. And all women who have had sexual intercourse, whether they are over 30 years old or not, should undergo regular cervical smear screening once a year.

Cervical adenocarcinoma

Double protection required

Cervical cancer is mainly divided into two types: squamous cell carcinoma and adenocarcinoma. Among them, the incidence of cervical adenocarcinoma has been increasing year by year. The reason is that cervical glands are usually located in the deeper cervical tissue and are more difficult to detect through traditional smear methods. Therefore, in addition to regular smear tests, cervical vaccination should be injected to achieve a double protection effect.

Currently, HPV vaccines are available in 9-valent, 4-valent, and 2-valent types. The difference between the three is that the 9-valent vaccine can prevent HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52, and 58, and the 4-valent vaccine is for 4 types of HPV, namely 16, 18, 6, and 11. As for the 2-valent vaccine, in addition to HPV16 and 18, it also has a protective function for HPV31, 33, and 45, and its antibody amount and protection time are higher than those of the 4-valent vaccine. For those with normal smear tests, the vaccine can provide 93% protection against cervical cancer. For those with abnormal smear tests, the vaccine can still provide a very ideal protection effect after receiving treatment and injecting the vaccine.

According to statistics from the Ministry of Health, if a woman never has a smear test in her lifetime, her chance of developing cervical cancer is about 3%. However, if she has a smear test every year, the chance of cancer can be reduced to 0.1%, and the cure rate for cervical cancer can reach more than 80% if it is discovered early.

Traditional smear examination is to find abnormal cervical cells under a microscope. The accuracy rate of this method is 70%, and the false negative rate is still as high as 30%. However, if regular examinations are performed for three consecutive years and the test results are normal, the accuracy rate can be increased to 97%. Therefore, it is recommended that postpartum women must have regular smear cytology examinations. In January 2016, the American College of Obstetricians and Gy necologists (ACOG) released the latest practical guidelines for cervical cancer screening and prevention. Women aged 21 to 29 should undergo cervical cytology examinations once every three years. Combined screening is not recommended for women under 30 years old. For women aged 30 to 65, combined cytology and HPV screening is recommended once every five years; cytology screening can also be performed once every three years. Foreign studies have shown that large-scale smear cytology screening can reduce the incidence and mortality of cervical cancer by 60-90%. The purpose of cervical smear cytology is to identify precancerous lesions and provide appropriate treatment to prevent the occurrence of cancer. Early detection of cervical cancer can lead to early treatment, reducing the chance of disease progression.

Things to note before cytology examination

Cervical smear cytology is the best way to prevent cervical cancer. Before the smear test, you should be careful not to douche the vagina, avoid taking a bath, do not put in suppositories, do not have sex the night before, and avoid menstruation. Since the cervical smear is to scrape the cervical epithelial cells and observe whether there are any abnormalities under a microscope, if the test results are abnormal, further examination is still required to confirm the diagnosis and whether treatment is needed. There are different treatment methods for different test results:

Normal TCT result : at least once every 3 years

Squamous cell changes on TCT with unclear significance : Repeat Pap smear or HPV test within 3 to 6 months

TCT has mild precancerous lesions : colposcopy or smear within 3 to 6 months

TCT shows severe precancerous changes and glandular cell changes of unknown significance : colposcopy + biopsy

TCT has cancer : cervical biopsy, further treatment

In short, through preventive injection of HPV vaccine and timely and effective cervical cancer screening, we can definitely keep our female compatriots away from cervical cancer and enjoy a happy family life!

Author: Shanxi Cancer Hospital

Yan LijunChief Physician