What Is Invasive Cervical Cancer?

Invasive cervical cancer is a malignant tumor that occurs in the cervical epithelium. The death rate of invasive cervical cancer in China ranks seventh in the death rate of malignant tumors. The 5-year survival rate of invasive cervical cancer in the early stage is 90%, and only 10% in the late stage. The census has a positive effect on the early diagnosis and treatment of invasive cervical cancer. The incidence of invasive cancer in the cervix has gradually increased since the age of 45. The peak age of onset is 45 to 55 years, and the second peak age is 35 years. The average age of onset is 48 years.

Basic Information

English name: invasive carcinoma of cervix
Visiting department: Obstetrics and Gynecology
Multiple groups: 45 to 55 years old women

Common locations: uterus
Common causes: Early childbearing, prolific birth, premature and frequent sexual life, disorder of sexual life, unclean sex, viral infection, etc.
Common symptoms: Increased leucorrhea, vaginal bleeding, lower abdomen and lumbosacral pain, etc.

Causes of invasive cervical cancer

1. Marriage and child-related factors

The incidence of invasive cervical cancer is related to factors such as early marriage, early childbearing, prolific birth, premature and frequent sexual life, disorder of sexual life, unclean sexual life and other factors. The risk of cervical invasive cancer is related to sexual behavior. Studies have found that sperm sperm and spermidine oxidation products, tetramethylene diamine is a synergistic factor for cervical invasive cancer. The high polyamine concentration in spouse's sperm may increase the risk of cervical cancer. Because the incidence of invasive cervical cancer is closely related to sexual life, married women should be regularly screened to diagnose and treat precancerous lesions in a timely manner.

2. Infectious factors

(1) Human papilloma virus (HPV) studies have confirmed the main cause of HPV cervical invasive carcinoma. People with HPV infection have an increased risk of invasive cervical cancer. HPV infection is a sexually transmitted disease, so multiple sexual partners and sexual life disorders are susceptible to HPV infection. There are more than 60 subtypes of HPV. CIN is mainly HPV 16, 18, 6, and 11 infections. Squamous cancers are mainly 16, 18, and 31. Adenocarcinomas are mainly 18 and 16. Patients with genital warts caused by HPV infection are five times more likely to develop invasive cervical cancer than normal people.

(2) High HSV-2 antibody levels in patients with invasive cervical cancer of herpes virus (HSV) suggest that the virus is related to the incidence of invasive cervical cancer. There is no basis for the direct carcinogenic effect of HSV. Studies have suggested that HSV-2 is a synergistic factor in the development of invasive cervical cancer.

(3) Studies of other pathogens suggest that infections such as human cytomegalovirus, syphilis, trichomoniasis, chlamydia, and fungi may also be associated with the incidence of invasive cervical cancer.

3. Other

The incidence of invasive cervical cancer is also related to cervical erosion, lacerations, valgus, endocrine, foreskin, smoking, economic status of life, trauma, family tumor history, psychological factors, diet and other factors. Inadequate intake of micronutrients such as vitamin C, A, and folic acid is a risk factor for invasive cervical cancer. Smoking is a synergistic factor for the occurrence of invasive cervical cancer. People who smoke continuously for 4 years or more have a four-fold increased risk of invasive cervical cancer. Quitting smoking can reduce their risk.

Clinical manifestations of invasive cervical cancer

Early cervical invasive carcinoma may be asymptomatic. However, although some patients have obvious clinical symptoms such as increased vaginal discharge and vaginal bleeding, the clinical stage may still be early lesions. The occurrence of clinical symptoms in the early stage of the disease is the main reason for timely treatment of patients with invasive cervical cancer, and it is also one of the important reasons for the good treatment effect of invasive cervical cancer.

1. Increased vaginal discharge

80% to 90% of patients with invasive cervical cancer have varying degrees of leucorrhea. Leucorrhea is similar to the general inflammation. With the progress of tumor necrosis and secondary infection, malodorous purulent leucorrhea can appear.

Vaginal bleeding

Vaginal bleeding symptoms occur in 80% to 85% of patients. Can be manifested as contact, menstrual period, postmenopausal or irregular vaginal bleeding. The occurrence of contact vaginal bleeding in young women or vaginal bleeding after menopause are clinical symptoms that deserve special attention. Huge cauliflower-like tumors and ulcerative cavity tumors are prone to vaginal bleeding.

3. Other symptoms

Progression of tumor invasion may include pain in the lower abdomen and lumbosacral region, feeling of falling in the lower abdomen and bowel movements, blood in the stool, difficulty in defecation, frequent urination, hematuria, and edema of the lower extremities. Patients with advanced stages may also develop symptoms such as anemia and weight loss.

Examination of invasive cervical cancer

Laboratory inspection

Cervical shedding cytology showed cervical intraepithelial neoplasia. The early lesions of cervical adenocarcinoma are often located in the cervical canal, and false negatives are prone to appear by conventional material smears. Detection of tumor markers: 70% of patients have elevated serum SCC and CEA values, and their levels are related to tumor size and stage. Dynamic determination of their concentrations can help monitor the disease.

2. Imaging examination

Routine imaging examinations include X-ray chest radiographs, ultrasound examinations of the liver, kidneys, and pelvic abdomen, and radionuclide nephrograms. Depending on the condition, barium enema, intravenous pyelography, bone scan, CT, MRI scan were selected. It is very important to check for ureteral obstruction and hydronephrosis by ultrasound or radionuclide nephrogram. The accuracy of CT examination in diagnosing para-uterine violations is 60%. The detection of pelvic lymph node metastasis has high specificity but poor sensitivity. CT can also be used to mediate fine needle aspiration cytology. Lymphography: The specificity is higher than 90%, but the sensitivity is poor, and the lymph nodes and metastases above the lesion cannot be displayed.

3. Other inspections

(1) Endoscopy includes endoscopy such as colposcopy, cystoscopy, and rectoscopy. Under colposcopy, invasive cervical cancer often shows markedly uneven, cloud-like, brain-like, nodular, or lard-like images of the lesion, and abnormal images such as abnormal blood vessels can also appear.

Cystoscopy and rectoscopy are mainly used to check whether the bladder and rectum are invaded by cancer to determine the stage. The staging criteria for stage IVa of invasive cervical cancer is that the cancer invades the bladder mucosa and / or rectal mucosa. Biopsy under cystoscopy and rectoscopy is a reliable method to confirm the metastasis of the bladder and rectal mucosa. Prostate and cystoscopy should be considered in patients with stage b, , and IVa.

(2) Histopathological examination Histopathological examination is the most reliable method for the diagnosis of invasive cervical cancer. Clamping method is commonly used, and in a few cases, it is submitted for examination through cervical canal curettage or cervical cone resection. The accuracy of the biopsy positioning will affect the final diagnosis. If necessary, it is necessary to cooperate with iodine test, fluoroscopy, colposcopy and other localization biopsy. Biopsy can cause local tumor bleeding in the cervix. Cotton ball compression bleeding is a commonly used effective hemostatic method. A small amount of bleeding can be applied to the local area with silver nitrate or ferrous sulfate solution.

(3) Iodine test or fluoroscopy In addition to colposcopy, iodine test or fluoroscopy can help locate biopsies. Tumors have an affinity for fluorescein. After oral or intravenous injection of fluorescein, the fluorescence intensity of the tumor lesion area is higher than that of normal tissues. This examination can help early detection of cancer and localized biopsy.

Differential diagnosis of invasive cervical cancer

As cervical invasive carcinoma has no specific clinical symptoms, it should be distinguished from benign lesions such as infectious vaginitis, senile vaginitis, cervical erosion, cervical polyps, intramucosal fibroids, cervical submucosal fibroids, and cervical tuberculosis. .

Cervical invasive cancer treatment

Drug treatment

At present, chemotherapy alone for invasive cervical cancer cannot achieve the effect of complete cure. Chemotherapy has a certain palliative effect on patients with advanced cervical invasive carcinoma and recurrence. Chemotherapy also has a positive effect on patients with poor prognosis treated with radiotherapy or surgery alone.

(1) Cisplatin, cyclophosphamide, fluorouracil, methotrexate, doxorubicin, bleomycin, mitomycin, vinblastine, vincristine, etc. are commonly used drugs for cervical invasive cancer chemotherapy . Among the many chemotherapeutic drugs, cisplatin is a commonly used drug for the treatment of invasive cervical cancer. In recent years, new drugs that have been used for chemotherapy of cervical invasive cancer and have achieved preliminary results include ifosfamide, paclitaxel, and isovinblastine. Most studies have shown that combined chemotherapy is better than single-agent chemotherapy in treating invasive cervical cancer, and the combination chemotherapy with cisplatin is particularly effective. Cisplatin has obvious anti-cancer effects on cervical squamous cell carcinoma.

(2) Combined chemotherapy regimen for cervical squamous cell carcinoma. FAOC regimen. Fluorouracil, doxorubicin, vincristine, and cyclophosphamide are repeated every 4 weeks for 1 cycle. PBO regimen: cisplatin, bleomycin, and vincristine are repeated every 2 weeks. PF regimen cisplatin and fluorouracil are repeated 1 cycle every 3 weeks. MOBP regimen: mitomycin, vincristine, bleomycin, and cisplatin are repeated every 6 weeks. CAP regimen Cyclophosphamide, doxorubicin, cisplatin repeat 1 cycle every 4 weeks. BIP protocol: bleomycin, ifosfamide, mesna, and cisplatin are repeated every 3 weeks. BM regimen: bleomycin and mitomycin are repeated every 3 weeks.

(3) Common chemotherapy regimens for cervical adenocarcinoma MFP regimen mitomycin, fluorouracil, and cisplatin are repeated every 3 weeks for 1 cycle. PAM regimen: cisplatin, doxorubicin and methotrexate are repeated every 3 weeks.

2. Surgical treatment

Surgical treatment is the main treatment for early cervical invasive cancer. Surgical methods and options:

(1) Total hysterectomy Extrafascial hysterectomy is only suitable for the diagnosis of definite stage Ia1 cervical invasive carcinoma. The rate of pelvic lymph node metastasis in stage a1 is less than 1%, and the rate of pelvic lymph node metastasis in stage a2 may increase significantly. If the postoperative examination reveals that the lesion has exceeded stage a1, other treatments such as postoperative radiotherapy should be further supplemented according to the condition.

(2) The second wide hysterectomy is to remove the entire uterus, free ureter, remove 2-3 cm of uterine tissue, and 2-3 cm of vagina, which is suitable for the treatment of stage a cervical invasive carcinoma. Extensive hysterectomy or radiotherapy should be performed if there are scattered lesion fusions, tumor plugs in blood vessels and lymphatic vessels, and poorly differentiated cells.

(3) Extensive total hysterectomy This operation is a radical operation for invasive cervical cancer and a pelvic lymph node dissection. The scope of surgical resection usually includes: the entire uterus, part of the vagina (more than 3cm below the dome or more than 3cm below the cancerous foci), bilateral attachments or reserved ovaries, uterine sacral ligaments and main ligaments above 3cm, bladder cervical ligaments and paravaginal tissue, Pelvic lymph nodes and surrounding adipose tissue below and below the total. This is the basic surgical procedure for invasive cervical cancer and is suitable for stage b a cervical invasive cancer.

(4) Ultra-wide hysterectomy is an enlarged radical operation or pelvic organ resection such as bladder and rectum. This procedure is only used in patients with advanced cervical invasive cancer and central recurrence cancer. The surgical resection has a wide range and high complications and mortality, so it needs to be performed by an experienced doctor.

Whether patients with invasive cervical cancer are suitable for surgical treatment, in addition to clinical staging, should also be based on the patient's age, general conditions, whether there are comorbidities and contraindications to surgery.