What Is the Relationship Between Cervical Cancer and Pregnancy?

The clinical manifestations are the same as those of non-pregnant cervical cancer. Early and occasional vaginal bleeding is common. Because it occurs during pregnancy, it is often misdiagnosed as threatened abortion, placenta previa, placental abruption, premature delivery or cervical dilatation. Misdiagnosis due to abortion avoidance of vaginal examination. Followed by the development of cancer, there can be increased vaginal discharge and endless vaginal bleeding. Late stage pain may occur at the waist or lateral thighs.

Pregnancy with cervical cancer

Cervical cancer during pregnancy refers not only to pregnancy, but patients with cervical cancer found within 1 year after delivery should also fall into this category, because these patients actually develop disease during pregnancy, only because the cancer is earlier or for other reasons Nothing was found. Because cervical cancer mostly occurs in women with reduced fertility and women over 40 years of age, it is rare to have cervical cancer during pregnancy.

Cervical cancer signs during pregnancy

The signs are the same as those of a non-pregnant person. Early stage should be distinguished from chronic cervical inflammation, cervical erosion and benign papilloma common in pregnancy. Middle and late signs are obvious and easy to diagnose.

Pregnancy with cervical cancer medication

Available data show that the prognosis of patients with cervical cancer in the same age group is similar to that of non-pregnant cervical cancer patients. If cervical cancer during pregnancy is diagnosed and treated appropriately, its prognosis is not affected by pregnancy.

1. Treatment of cervical carcinoma in situ For patients diagnosed with early-stage pregnancy with cervical carcinoma in situ, total hysterectomy or sub-extensive hysterectomy may be performed to preserve one side of the ovary. If the pregnant woman is young and requires childbirth, you can allow the pregnancy to continue with close follow-up. A full-term cesarean section will be performed at 6 to 8 weeks after delivery. If the general condition of the pregnant woman is poor, it is not appropriate to perform surgery, the pregnancy can be terminated by suction, and 6-8 weeks after the termination of pregnancy, then intracavitary radiation therapy.

2. Treatment of invasive cervical cancer The treatment of invasive cervical cancer is the same as that of non-pregnant cervical cancer. It is mainly radical hysterectomy plus bilateral pelvic lymphadenectomy, tumor chemotherapy or adjuvant chemotherapy, or lumen Internal radiotherapy plus external radiotherapy, or a combination of multiple measures. The choice of treatment plan depends on: the clinical stage of cervical cancer when diagnosed, early cervical cancer is mostly treated by surgery, and intermediate and advanced patients choose radiation therapy; the stage of pregnancy when cervical cancer is diagnosed, more early Adopt sacrifice fetal preservation mother-based treatment measures, the second trimester of pregnancy is used to do the treatment of tumor treatment plan; the desire of the fetus, the precious child can consider conserving the fetus.

3. Choice of delivery method The choice of delivery method for pregnancy with cervical cancer is still controversial. Some scholars believe that for pregnant women with small tumors a, a and early b cervical cancer, vaginal delivery can be selected. As to whether vaginal birth can promote the spread of cancer cells, there is no conclusion yet, but there is no evidence that vaginal birth can affect the survival rate of patients with pregnancy and cervical cancer. However, the fetus through the cervix during vaginal delivery may accelerate the spread of cancer and possible bleeding and infection. Therefore, most scholars advocate the use of cesarean delivery. It has been reported that the implantation of cancer cells in the perineal lateral incision of the vaginal postpartum in cervical cancer patients has been reported. Therefore, such women who have undergone perineal lateral incision should be closely followed up. Once nodules are found in the incision site, they should be immediately removed Biopsy to avoid mistakenly treating the tumor as an abscess.

Diet and health care for pregnant women with cervical cancer

1. 12 grams of astragalus, 15 grams of angelica, 9 grams of Codonopsis, 9 grams of Atractylodes, 9 grams of Asparagus, 9 grams of Poria, 9 grams of Huaishan, 6 grams of Alder, 6 grams of Ligusticum, 5 grams of licorice. Decoction, one dose per day. Indications for cervical cancer gas deficiency.

2, 30 grams of Poria, 30 grams of dandelion, 25 grams of Poria, 25 grams of Yinchen, 15 grams of Atractylodes, 9 grams of Angelica, 9 grams of Amaranth, 4.5 grams of Bupleurum, 9 grams of Alisma purpurea. Decoction, one dose per day. 60 grams of Sophora flavescens, 30 grams of snake bed, 30 grams of wild chrysanthemum, 30 grams of silver flower, 15 grams of white peony, 15 grams of calamus. Add water to fry and remove residue to soak the vagina and cervix.

3, 30 grams of raw Nanxing (fried for 2 hours), 24 grams of Poria, 30 grams of Scutellaria barbata, 30 grams of Hedyotis diffusa, 12 grams of mangosteen, 24 grams of Atractylodes, 15 grams of Rhizoma Curcuma, 12 grams of Angelica sinensis, Xiangfu 12 grams, 12 grams of tan, 12 grams of green. Decoction, one dose per day.

4, 10 grams of whole scorpion, 10 grams of hive, 10 grams of snakes. The whole scorpion was immersed in cold water for 24 hours (changed the water 2-3 times). After being taken out and dried, it was roasted on low heat, and the hive and snake rot were slightly fried. At the end of the joint research, the water pan is a pill, 2 grams each time, twice a day.

5, 30 grams of Ligustrum lucidum, 30 grams of Scutellaria barbata, 30 grams of mulberry parasitism, 30 grams of yam, 30 grams of Hedyotis diffusa, 24 grams of horse-chestnut flower, 20 grams of habitat, 15 grams of turmeric, 12 grams of Zhimu, Cork 12 g. Decoction once a day. For advanced cervical cancer.

6, 30 grams of mulberry parasitism, 15 grams of Polygonatum sibiricum, 15 grams of Radix Pseudostellariae, 15 grams of continuity, 12 grams of Coix seed, 9 grams of Atractylodes, 9 grams of dog ridge, 9 grams of tangerine peel, 3 grams of cimicaria. Decoction, one dose per day. Indications are obvious cervical depression.

7, 30 grams of Hedyotis diffusa, 15 grams of Banzhi Gong, 15 grams of Huaishan, 15 grams of Caoheche, 12 grams of habitat, 9 grams of Zhimu, 9 grams of Alisma orientalis, 15 grams of Echinacea, 9 grams of black ginseng, Cork 4.5 g. Decoction, one dose per day.

8, 50 grams of Hedyotis diffusa, 50 grams of white grass root, 50 grams of red sugar. Decoction, one dose per day, even 7-14 doses. Indications of rectal inflammation after cervical cancer radiotherapy.

9, 6 grams of Bupleurum, 6 grams of angelica, 6 grams of Chuanxiong, 6 grams of white peony, 6 grams of ripe land, 6 grams of Chinese bark, 6 grams of ginkgo. Decoction, one dose per day. Indications for advanced cervical cancer.

10, 18 grams of ginseng, 18 grams of scallion, 9 grams of pepper. A total of 7 grams per serving were studied, once a day, with warm boiled water, for 24 days as a course of treatment.

11, 6 grams of safflower, 6 grams of alum, 30 grams of Watson. Fry the water, smoke first, and then wash the vulva externally, once or twice a day, 30-60 minutes each time, and then use it after the next heating. Each dose can be used for three to four days. Attending early cervical cancer.

12, 3 grams of kelp, 3 grams of seaweed, 5 grams of incense, 5 grams of Atractylodes, 5 grams of Poria, Angelica 6 grams, 10 grams of Amaranth, 3 grams of Bupleurum, 3 grams of whole scorpion, 2 tadpoles. Decoction, to three doses of meat per week. Attending early cervical cancer.

13. 30 grams of Scutellaria barbata, 15 grams of yellow yam seeds, 15 grams of rhizome root, 30 grams of white flower Hedyotis, 30 grams of walnut twigs, 15 grams of dragon sunflower, 30 grams of astragalus 30 grams, 30 grams of epimedium, 30 grams of exams. Decoction, one dose per day. Indications for mid-term cervical cancer.

14. 30 grams of prunella vulgaris, 30 grams of mountain bean root, 15 grams of pollen, 30 grams of horse chestnut, 15 grams of madder, 15 grams of Bupleurum, 9 grams of zedoary turmeric, and 9 grams of Sanlang. Decoction, one dose per day. Indications cauliflower and erosive cervical cancer.

15, 15 grams of angelica, 15 grams of Bupleurum, 15 grams of chicken internal gold, 30 grams of Codonopsis, 9 grams of Atractylodes, 9 grams of Poria, 9 grams of Poria, 9 grams of green peel, 9 grams of licorice, 7 grams of licorice. Decoction, one dose per day. Indications cauliflower and erosive cervical cancer.

16, 30 grams of canthari, 30 grams of psyllium, 30 grams of talc, 30 grams of wood. After researching, the water is a pill, 0.1-0.12 g per serving, once a day.

17, 30 grams of houttuynia cordata, 30 grams of white grass root, 15 grams of salvia miltiorrhiza, 9 grams of angelica, 30 grams of oyster, 60 grams of white hydrangea, 9 grams of madder, 15 grams of codonopsis, 9 grams of atractylodes, 9 grams of red peony, soil Poria 9 g. Decoction, one dose per day.

18. One domestic pigeon, countless 30 grams of vinegar, 30 grams of Huaishan. After the pigeons are slaughtered, the offal is chopped and simmered with the last two flavors.

Prevention of cervical cancer during pregnancy

1. High risk factors for cervical cancer

(1) Sexual disorder refers to having more than two sexual partners.

(2) The age of first sexual intercourse is too early, and you have had sex before the age of 18.

(3) Prolific early breeding.

(4) Viral infection, human papilloma virus (HPV) is closely related to cervical cancer, especially types 18 and 16. Human cytomegalovirus (CMV) and herpes simplex virus type II (HSV-II) have been proven to be one of the causes of cervical cancer.

(5) High-risk men. All men who have had penile cancer, prostate cancer, or their ex-wife had cervical cancer are considered high-risk men. Women who have sexual contact with high-risk men are susceptible to cervical cancer.

(6) Chronic cervicitis, especially cervical erosion, is easy to form cervical cancer in the process of repeated injury and re-repair.

(7) Unhygienic period.

(8) Smoking. A large number of studies have shown that smokers have twice the risk of cervical cancer than non-smokers (Shi Yifu, 2000).

2. The preventive measures taken based on the above causes are as follows:

(1) Strengthen health education: publicize the harmfulness of cervical cancer in a targeted manner, increase women's awareness of the etiology and prognosis of cervical cancer, and do a good job of prevention.

(2) Propaganda to avoid sexual disturbances: According to surveys in 13 provinces and municipalities across the country, the prevalence of cervical cancer among women who have been married more than twice has increased significantly, with statistically significant differences; women who have sexual relations with multiple men, the incidence of There are more opportunities for cervical cancer. Jiangxi Obstetrics and Gynecology Hospital and Beijing Medical University surveyed 24,633 married women in the high-incidence area of Jing'an County, Jiangxi, and predicted the anti-cancer effect. The results showed that removing sexual confusion in the population can reduce the incidence of cervical cancer by 50.8 %; Removal of poor health factors can reduce the incidence of cervical cancer by 24.3%. They also studied and predicted that the disorder of sexual behavior was blocked from 1974 to 1985, and the incidence of cervical cancer decreased by 28.88% and 30.55% in 1985 and 1995, respectively, and the mortality rate decreased by 29.12% and 30.83%, respectively. Through obstructive ill-health, the incidence of cervical cancer decreased by 21.03% and 21.43%, respectively; the mortality rate decreased by 20.14% and 21.51%, respectively.

(3) Promotion of late marriage: The age of first sexual life is more important than the age of first marriage. The first sexual intercourse is under the age of 18, and the incidence of cervical cancer is four times higher than that of those over the age of 18.

(4) Promotion of family planning: multiple pregnancy and childbirth, stimulation or damage to the cervix, causing abnormal proliferation of cervical epithelium, which can then develop into cancer. Since the 1960s, China has vigorously publicized and implemented the family planning policy, which is suitable for cervical cancer prevention.

(5) Publicity and attention to menstrual and sexual health: actively prevent chronic cervicitis and block the development of cervical precancerous lesions. Strengthen the promotion of sexual and menstrual hygiene to avoid the occurrence of vaginal trichomoniasis, fungi, viruses and other infections. Those who have been infected should be given targeted metronidazole (metronidazole), miconazole (daconin) and antiviral drugs And Chinese medicine and other active treatment.

(6) The male penis foreskin that is too long and too tight is removed to avoid the occurrence of foreskin scales. Some studies have shown that foreskin scales are also carcinogens.

(7) Publicity to avoid smoking (Cao Zeyi, 1998).

(8) Actively treat cervical erosion: moderate and severe cervical erosion, cervical polyps, cervical genital warts, cervical leukoplakia and other diseases are closely related to precancerous lesions and cancer. Lin Qiaozhi reported that the incidence of cervical erosion was 0.73%, and that of those without erosion was 0.1%, a seven-fold difference. In the 1970s, a survey of 250,000 women in Beijing showed that the incidence of cancer in the erosion group was twice as high as that in the non-erosion group. Therefore, active treatment of cervicitis and cervical erosion is an important measure to prevent cervical cancer. In addition to topical treatment, there are various methods of electrocautery, freezing, laser and cone cutting.

(9) Active treatment of genital tract virus infections and condyloma acuminatum: Recent studies have confirmed that the occurrence of cervical cancer is closely related to female genital tract HSV-2 and HPV virus infections, especially the research on HPV has been valued. HPV infection is a sexually transmitted disease. The common lesion is condyloma acuminatum. The subclinical type of infection and the cervical neoplasia (CIN) are continuous development processes of the same disease. Therefore, active treatment of HPV infection can control CIN. Cervical cytology and colposcopy biopsy are the best ways to diagnose cervical HPV infection. For localized condyloma acuminatum, 50% trichloroacetic acid cautery, laser, freezing, microwave, or surgery can be used to remove the lesion. There are reports abroad using interferon (IFN) and CO2 laser to treat HPV infection. Bernasconi (1995) used -IFN and -IFN 3000U intramuscular injection once every other day for 4 weeks. 94 female genital genital warts were randomly divided into two groups for treatment, 76.5% of patients (72/94) The condition was partially relieved, and there was no difference in the efficacy between the two groups. The author believes that this method can replace surgical treatment, laser and other damaging treatments. However, a study by Zarcone (1997) showed that the recurrence rate of IFN alone was high. They gave 70 women with genital genital warts with intramuscular injection of -IFN 3000U once every 3 days for a total of 3 weeks, of which 30 women were in Electrocautery treatment was added after the end of this course. The results showed that the recurrence rate of patients treated with IFN alone was 37.9%, while the recurrence rate of patients treated with IFN alone was only 4.51%. Therefore, the best combination of drugs and physical therapy for genital warts .

(10) Use of condoms: Although the incidence of cervical squamous cell carcinoma has declined significantly in many countries and regions due to the health census, epidemiological surveys have shown that the incidence of cervical adenocarcinoma in young women is still increasing. The long-term use of barrier contraception (uterine caps, condoms) has a protective effect, most likely because it reduces the chance of exposure to infection (Ursin, 1996); the protective effect of the uterine cap may also have antiviral effects due to simultaneous application Spermicide (Lian Lijuan, 1996).

(11) Prophylactic cervical resection: In order to prevent cervical stump cancer, clinicians currently treat benign uterine tumors.

Pathological etiology of pregnancy with cervical cancer

The etiology is not completely clear. According to a large number of epidemiological data and related studies, it is believed to be related to the following factors:

1. The first sexual life and the number of sexual partners The early sexual life and multiple sexual partners (disorders of sexual life) are closely related to cervical cancer. The age of first sexual intercourse is 16 years old, and the relative risk of onset is twice that of those over 20 years old. Cervical cancer patients have more sexual partners than the control group, and the risk of disease is directly related to the number of sexual partners.

2. Sexual hygiene and the number of childbirths The relative risk (RR) between menstrual and puerperium dystrophy and the control group was 2.27; vaginal births 4 times were twice as likely as those 1 times.

3. Viral infection Human papillomavirus (HPV) infection is a major risk factor for cervical cancer. It has been confirmed that more than 20 subtypes of HPV are associated with female reproductive tract lesions, of which high-risk types (HPV16, 18, 31, 33, etc.) mainly cause cervical intraepithelial neoplasia (CIN) , , and cervical cancer; cervical HPV16 has the highest detection rate in squamous cell carcinoma, and HPV18 type is the most common in adenocarcinoma. The risk of HPV16 / 18 infection is increased. Herpes simplex virus type II, human cytomegalovirus, chlamydia and other infections have a strong correlation with cervical cancer. As the number of infections increases, the risk of cervical cancer increases.

4. Others Long-term oral contraceptives (8 years) have an increased risk of cervical cancer. Smoking can inhibit the body's immune function, increase the chance of infection, and have the potential to promote cancer; male partners' sexual history, increased sexual partners, and penile cancer partners can increase the incidence of cervical cancer.

In summary, the incidence of cervical cancer is related to a variety of factors, and whether there is a synergistic or antagonistic effect between these factors remains to be further studied.

Diagnosis of cervical cancer in pregnancy

It should be distinguished from various cervical lesions with clinically similar symptoms or signs, and the main basis for differential diagnosis is biopsy. include:

1. Cervical benign lesions Cervical erosion, polyps, cervical endometriosis, cervical glandular epithelium eversion and cervical tuberculous ulcers.

2. Cervical benign tumors Cervical submucosal fibroids, cervical canal fibroids, and cervical papilloma.

3. Cervical malignant tumors Primary cervical malignant melanoma, lymphangioma, and metastatic cancer (most common are endometrial cancer and vaginal cancer). It should be noted that primary cervical cancer can coexist with endometrial cancer.

Examination of pregnancy with cervical cancer

Laboratory inspection:

No related information

Other auxiliary checks:

1. Cervical Cytology Examination of cervical smears as a routine item for prenatal examinations in pregnant women can help detect and treat early cervical cancer as early as possible.

2. Colposcopy and cervical biopsy In patients with cervical smear abnormal or even cervical malignant disease, colposcopy and cervical biopsy should be performed at any stage of pregnancy. Biopsy can clearly diagnose and assist clinical staging. There is a principled difference in the treatment of carcinoma in situ and invasive cancer with pregnancy.

3. Cervicotomy. Cervical coneotomy during pregnancy can cause severe maternal and child complications such as major hemorrhage, infection, miscarriage, and premature birth. It should be avoided as much as possible. Cervical coneectomy is contraindicated for those with invasive cancer.

4. Depending on the specific situation, cystoscopy, rectoscopy, pyelography, and X-ray chest radiography can also be performed. CT or MRI can be performed if necessary to help determine the extent of the lesion, select the appropriate treatment method, and increase the treatment rate.

Complications of pregnancy with cervical cancer

Secondary symptoms appear based on the extent of lesion invasion. When the lesion affects the pelvic connective tissue, the pelvic wall, the ureter or the rectum, and the sciatic nerve, the patient complains of frequent urination, urgency, anal bulge, constipation, post-emergency weight, lower limb swelling and pain; in severe cases, ureteral obstruction and hydronephrosis, Causes uremia. Patients with end-stage disease develop symptoms of systemic failure such as cachexia.

Prognosis with cervical cancer during pregnancy

In theory, pregnancy with cervical cancer has a poor prognosis because:

1. The blood supply and output of the uterus during pregnancy are increased.

2. The increase of estrogen, progesterone and human chorionic gonadotropin (hCG) affects the body's immune status.

3. Dilation of the cervix during labor may cause the spread of tumor emboli. However, a large number of data indicate that the prognosis of cervical cancer of the same age in early pregnancy (phase Ib, II) is similar (75%), and the 5-year survival rate of cervical cancer with pregnancy in advanced (stage III, IV) is lower than that of non-pregnancy. (16% vs. 28%), so it is believed that the timely diagnosis and correct treatment of cervical cancer during pregnancy will not affect the prognosis, but it is worth noting that there is data that the metastatic pregnancy of pelvic lymph nodes is higher than that of the control group. In cervical cancer, lymph node metastasis rates were 31.8% and 9.4% in pregnant and non-pregnant women, respectively. At the same time, the development of cervical cancer in late pregnancy or postpartum is rapid. Data show that patients diagnosed in the third trimester have a progressive decline in survival.

The follow-up of pregnant women with cervical cancer after treatment is the same as that of non-pregnant women with cervical cancer.

Pathogenesis of pregnancy with cervical cancer

As in non-pregnancy, squamous cell carcinoma is the most common pathological type of pregnancy with cervical cancer, followed by adenocarcinoma, adenosquamous carcinoma, and mucinous adenocarcinoma. Cervical epithelium can change in different degrees during pregnancy, such as basal cell hyperplasia, squamous metaplasia, atypical hyperplasia, etc., which is easily confused with carcinoma in situ. At the same time during pregnancy, endometrial glandular hyperplasia, glandular epithelial hyperplasia, or adenoma-like hyperplasia can also be misdiagnosed as adenocarcinoma. So be especially vigilant before making a diagnosis. According to the degree of cancer cell invasion, it is divided into carcinoma in situ and invasive carcinoma as in non-pregnancy.

1. The impact of cervical cancer on pregnancy Early cervical cancer generally does not affect pregnancy, and intermediate and advanced patients are not conducive to pregnancy. When the two coexist, although cervical cancer has no direct effect on pregnancy and uterine development and fetal position, cervical cancer cachexia affects maternal health, and often requires abortion and radiation treatment to treat pregnant women. It also causes pregnancy to terminate prematurely, abandon the fetus, or increase the fetus. The mortality rate, if cervical cancer is associated with pregnancy and transvaginal delivery due to missed diagnosis, often cause cervical tears, major bleeding, infection, etc., affecting mother and child life.

2. The impact of pregnancy on cervical cancer There is still debate about whether pregnancy affects the growth or spread of cervical cancer. However, most scholars believe that increased blood flow and lymphatic circulation of the reproductive organs during pregnancy, coupled with the role of estrogen, pregnancy promotes the spread of cancer and the prognosis is poor. The occurrence of cervical cancer is positively related to multiple pregnancy and multiple births.