CERVICAL CANCER

Surgery and radiotherapy for cervical cancer is the main treatment, in recent years, increasing attention to the comprehensive treatment of means.

1. Surgical treatment
In principle for early cervical cancer (0 ~ la period), according to the depth of invasion, tumor size, stage, pathologic type, age and general condition and other factors determine the scope of surgery, choose a different procedure.

Cervical cancer after treatment for the tumor has not disappeared not control, the treatment of tumors disappeared for a period of time after the original lesion in the region for a relapse. Two identification difficult, it called EC recurrence. Cervical cancer radiotherapy failure patients, nearly 60% of pelvic recurrence, 40% distant metastasis. In pelvic recurrence within 1 / 2 above pregnancy and pelvic recurrence.
[Diagnosis]
(1) Symptoms
1. Vaginal bleeding and vaginal discharge: This is the cervix, vagina and the Palace of recurrence common symptoms.
2. Pain and edema: This is the most common pelvic recurrence of the symptoms, the most affected is the lower extremity pain and edema.
(2) Signs
1. Recurrent cervical and vaginal: in the cervical or vaginal local stiffen, were nodular or even ulcers.
2. Palace of recurrence: sometimes can be increased and scheduling of the uterus.
3. Recurrent pregnancy: early pregnancy diagnosis of recurrence is extremely difficult, late pregnancy can usually nodular thickening or nodular lesions, the late, there will be frozen pelvis.
(3) auxiliary
1. Cervical, vaginal and the Palace of relapse may biopsy confirmed by histology.
2. Recurrent pregnancy can be pyelography, isotope kidney map, MRI and CT scans to assist diagnosis.
[Treatment]
Recurrence of treatment is very difficult. Right suspicious recurrence after treatment, in the absence confirmed, we must not lightly again radiotherapy, this will be the resumption of radiation injury. Recurrence is already diagnosed, the treatment should be based on the first, with the location and time of recurrence seriously consider re-treatment approach. If the first treatment for radiation therapy, in the Palace of recurrence, cervix, vagina or pregnancy (isolated nodules), surgical sites, treatment with the appropriate choice. Those deemed unsuitable for treatment, according to the tumor, treatment and the length of time between general factors such as patients decide to do radiation therapy or drug treatment. The case of a possible recurrence after surgery or radiation therapy medication, a few cases can be further surgery.
Cervical cancer recurrence radiotherapy for specific design, according to the recurrence of the location, extent determined. The case of the vagina, cervix, or Palace of the limitations of recurrence, can be considered purely intracavitary irradiation; If local recurrence of a broader scope, or associated with pregnancy and pelvic recurrence, should meet in vitro irradiation; The case of simple pregnancy or pelvic recurrence of the tumor can be located under the Wild, whose in vitro irradiation; If recurrence, according to the first radiotherapy treatment. Radiation therapy and relapse again after radiotherapy, the dose of irradiation difficult to grasp. Right from the first radiotherapy 2-3 years are to be considered under specific circumstances of giving full exposure. But first shorter recurrence after radiotherapy, the dose should be carefully decided to prevent indiscriminate irradiation, it is not a cure for cancer, the radiation would cause serious complications. The recurrence after radiotherapy for patients, tissue fibrosis, radiation sensitivity reduced through normal tissue and organ damage after a radiation exposure significantly increased complications.
[Follow-up]
1. Close follow-up after treatment, the treatment of attention to the original tumor, must also pay attention to whether a new lesions.
2. We should pay attention to the emergence of radiotherapy complications, early treatment.

(1) tumor marker

An outline
Cervical cancer occurs in the cervical cancer in women.
Women in the abdominal hysterectomy is a range between the bladder and rectum, hollow organs. The uterine cervix in the second half which is a narrow part of the cervix, cervical openings on the female vagina. Its function is to menstrual outflow channel is vaginal microorganisms and air to enter the uterus of a female barrier, and also subject to sexual intercourse can withstand the induced inflammatory response.

(1) tumor marker
1. Cervical cancer associated antigen (TA-4) and squamous cell carcinoma-related surprise move (SCC) by RIA of the patients with serum values TA-4, found 61% of the patients with positive TA-4, level 5 μ g / L or more. TA-4 SCC is the Asian ingredients, cervical cancer is the special markings. Early cervical cancer TA-4 with a marked increase in SCC can be used to predict the therapeutic effect in patients with cervical cancer and whether there are any recurrence.
2. Serum tumor-associated antigen (CA-125) in patients with cervical cancer serum CA-125 may be increased. Determination of patients with SCC and CA-125; Rose found SCC, squamous cell carcinoma of 67%, adenocarcinoma of 2.5 per thousand; CA-125 increase, squamous cell carcinoma was 26%, 75% adenocarcinoma. Therefore CA-125 can be used as a sign of cervical cancer.
3. Urine promote clips of gonadotropin (UGF) not normal mmmol / L, early cervical cancer patients positive rate of 26 per 1,000, Advanced positive rate was 67%. UGF during treatment of patients with SCC and the disease can be as dynamic observation of the signs.
4. Antigen (CEA) in patients with gynecologic malignancies 60% positive results (≥ 5 μ g / L), which was 38% of cervical carcinoma in situ and invasive carcinoma of cervical cancer was 57%. CEA and tumor stage of a certain relationship, but also of surgery and chemotherapy this effect. As surgery thorough, two weeks after the CEA to negative, as surgery is not completely or relapse, or continuing high level of CEA increased; If chemotherapy effective, CEA rapidly decreased to normal, on the contrary it increased or did not change.
(2), gynecological examinations <BR> Unless general gynecological examination requirements like genital examination, overcast gleaned for a check-up and inspection, the inspection must do triple up. Checks should pay attention to the latter part of pelvic examination and pelvic conditions.
(3), histopathological examination
1. Colposcopy exfoliated cells smears early diagnosis of cervical cancer screening rate was about 90%. To enhance the positive rate, cervical cancer should be a good site, with the squamous epithelium of the junction of epithelial biopsy smears, older women scales, column skin junction to the extension of the neck when the shift, in addition to the cervical, vaginal smears from the Department should take from cervical smears, to avoid misdiagnosis. Cervical blowing tablets of small feet or small biopsy of the tongue.
Jiang abnormal vaginal shedding non-cells are abnormal cervical cancer caused many factors, in addition to parts of the female genital cancer, inflammation of the vagina can cause. Therefore, if found abnormal Pap smear cells, for further examination.
2. Cervical living tissues of the cervix and curettage of cervical screening by cervical biopsy is the biopsy forceps on the folder from the cervix organizations sent pathological examination, the diagnosis of cervical cancer is the most reliable method. The above results can be positive or Ying cases, or cervical lesions and cervical cancer identification difficult, as should cervical biopsy.
(4) iodine test <BR> iodine solution will be manufactured in cervical smear and vaginal mucosa, Iodine staining of the situation. Coloring were not as positive in the biopsy site. When cells cervical smear abnormalities or clinical cancer can Ying colposcopy, and without the help of iodine can be found in abnormal positions. The iodine solution used two First Schiller solution, the other is Lugol solution, the solution concentration is 10 times greater than the former, fast staining.
(5) fluorescence inspection <BR> luciferase tumor and the role of parents, to patients with oral or intravenous injection, cancer tissue than in normal tissue absorb more often, cervical cancer can be diagnosed early.
1. UV fluorescence excitation of oral examination showed normal cervical purple, cervical erosion performance for the Purple brown, cancer or precancerous lesions showed yellow (positive).
2. Helium - Cd laser fluorescence spectroscopy cervical cancer and cervicitis spectral curve with the shape of the difference between the peak wavelength, half-width and area ratio is different. Early diagnosis rate of about 90%.

Current treatment of cervical cancer a single method has its shortcomings, such as surgery for the treatment of cervical cancer although one of the important methods, for most patients with early radical aims can be achieved, but if a small amount of residual cancer surgery in the organization, particularly in the presence of cervical around or distant metastasis to the subclinical lesions, after causing a local recurrence or distant metastasis; In addition, surgery may also cause local cell cultivation and blood or lymphatic spread, it is possible recurrence or distant metastasis. Cervical cancer radiation therapy is the main treatment, but also for some reason the treatment is not satisfactory, such as: partial or pelvic lymph node tumors in radiation therapy or when the dose was not omitted; Some pathological types of cancer is not sensitive to radiation; Radiotherapy for pre-clinical distance metastases; due to serious radiation reaction, such as the bladder, rectum and other organs of serious reactions, resulting in radiation therapy

Cervical cancer and cervical cancer is the most common nutritional female genital cancer, multiple in 20 to 60 years. And like its etiology of early marriage, early motherhood, infertility and chronic cervicitis more relevant. Recent studies have found that malnutrition and its relationship to a certain extent.

(1) of vitamin malnutrition. Cervical cancer was observed in patients with B-carotene than the control group, B-carotene intake low risk factors for cervical cancer. In addition, vitamin C and also the incidence of cervical cancer, our survey shows that vitamin C intake increased, decreased risk of cervical cancer.

As a cervical cancer, once diagnosed correctly, it should develop the most appropriate treatment programs, which are generally dominated early surgical treatment, advanced radiation therapy or by surgery and radiotherapy combination of comprehensive therapy can be combined with chemotherapy treatment and Chinese medicine. TCM treatment of cervical cancer have significant effects, especially in the early cervical cancer treatment, and advanced with surgery and radiotherapy and chemotherapy have better results.

(1) Radiation Therapy

Cervical cancer is moderately sensitive to radiation, applicable to all cervical carcinoma in situ and invasive cervical cancer treatment, especially in Phase Ib cervical lesions greater than 3 cm or II-IV patients.

Surgical treatment of uterine sarcoma is the main method of treatment. Although prospective study has not yet sure adjuvant chemotherapy and radiotherapy, but due to uterine sarcoma high rate of recurrence (stage 5-year survival rate 50%, other phases only 0% to 20%), most scholars still advocate for adjuvant chemotherapy or radiotherapy. Collaboration Gynecologic Oncology Group (GOG) non-randomized study, in the uterus of MMMTs Ⅰ, Ⅱ patients with pelvic radiotherapy, radiotherapy can significantly reduce the recurrence, but the survival rate did not change significantly. Another non-randomized study results showed that mixed mullerian duct cancer in vitro after irradiation plus intracavitary irradiation can improve survival in patients with lower local failure rate. Radiotherapy for endometrial stromal sarcoma effective, Peters, a non-randomized controlled study results showed that doxorubicin and cisplatin combination chemotherapy effective program. GOG Phase II clinical trial results showed that uterine sarcoma Ⅲ chemotherapy with ifosfamide efficient: uterine sarcoma mesodermal to 32.2%, endometrial stromal sarcoma 33%, 17.2% of leiomyosarcoma. GOG randomized controlled study of ifosfamide, or plus cisplatin regimen can be used in the treatment of mixed mesodermal tumor recurrence in patients with advanced and the first line of chemotherapy drugs. High-dose progesterone cell differentiation good for uterine stromal sarcoma have some therapeutic effect.

Clinical symptoms】 【
No obvious symptoms of early cervical cancer, a common symptom is irregular vaginal bleeding or contact (sexual intercourse) bleeding and Leucorrhea increased; Advanced symptoms appeared oppression and pain, often for invading tumor and surrounding tissue caused by pelvic, Leucorrhea with evil smell, and that cervical erosion, ulcers, nodules or cauliflower-like, touch the easy bleeding. Development of advanced patients frequently have lower abdomen, buttocks, sacral pain and urinary tract, gastrointestinal discomfort realistic models, resulting in systemic symptoms, such as fever, weight loss, swelling and body.

[Method]
1, colposcopy;
2, cervical scratch-staining;
3, biopsy;
4, B-;
5, pathological examination;
6, cervical cytology screening.