The treatment principles of cervical cancer are based on the stage of cervical cancer. The staging of cervical cancer is partly based on pathological results, and partly determined by a doctor\’s physical examination. This is different from ovarian cancer, endometrial cancer, etc., which are completely staged through surgical and pathological diagnosis.
Doctors recommend that precancerous lesions detected through general screening, such as cervical intraepithelial neoplasia (CIN), are not actually cancer. Even if CIN III is indistinguishable from carcinoma in situ, carcinoma in situ is not included in the statistics of cervical cancer. The reason is simple: the treatment effect of cervical precancerous lesions and carcinoma in situ is so good that it is no different from benign diseases. This is not to comfort everyone, it is indeed the case. Therefore, if anyone is unfortunately shot during a cervical cancer screening and is diagnosed with mild intraepithelial neoplasia (CIN I), don’t take it too seriously. In this case, in about 2/3 of the patients, the lesions will disappear automatically. In only 1/3 of the patients, the lesions will become moderate intraepithelial neoplasia and require removal of this part of the cervix, which is the so-called cervical cone. shape resection. After the removal, you will not be able to have sex for about 8 weeks. After the scars have healed, you can do whatever you need to do, and it will basically have no impact on your body. Those who are not pregnant can get pregnant, and those who are not married can get married immediately. Of course, annual review is still required.
Severe cervical intraepithelial neoplasia and carcinoma in situ are difficult to differentiate under a microscope. Most experts now diagnose and treat these two diseases together. In fact, there are some differences between the two. The former is slightly lighter and the latter is slightly heavier, but this difference is really not necessary. Once the diagnosis is established, cervical conization should be performed as treatment. Some people regard cervical conization as a great misfortune in life, but it is actually unnecessary. Even if it reaches the stage of minimally invasive cancer (the so-called stage Ia1), if If you have fertility requirements, you can also retain the uterus and undergo cervical resection. Of course, this has to be borne1%The risk of recurrence. If there is no requirement for childbearing, hysterectomy is recommended. In fact, for such people who have two or more options, the most difficult thing to do is to do it for the doctor. For example, for minimally invasive cancer, although the uterine body has been theoretically preserved, many people cannot have normal children. How much of the cervix should be preserved is sometimes difficult to control. By cutting more points on the cervix, the chance of cancer recurrence will be reduced. However, the chance of childbirth also decreases, thus losing the significance of retaining the cervix; retaining more of the cervix increases the chance of childbirth, but both doctors and patients are afraid of cancer recurrence.
For stage Ia2-IIa cervical cancer, the most recommended surgery now is the classic radical hysterectomy plus pelvic lymphadenectomy. The scope of resection not only includes the uterus, but also requires removal of part of the vaginal tissue according to the type of tumor. and ligaments on the uterus. From the perspective of preventing cancer recurrence, the more cuts the better. As for whether to use traditional methods or minimally invasive methods such as laparoscopy or robots, there is actually not much difference. Postoperative recovery time varies.
Cervical cancer in later stages, such as cervical cancer stage IIb, stage III, etc., are not suitable for surgery and should be treated with radiotherapy or radiotherapy plus Chemotherapy. In advanced cervical cancer, radiotherapy is actually more effective than surgery. Even for early-stage cervical cancer, if radiotherapy is chosen, the effect is the same as surgery. However, during radiotherapy, while the rays kill tumor cells, they also destroy them. The surrounding tissues, such as ovaries, intestines, bladder, urethra, etc., can cause some unbearable complications, such as premature ovarian failure, radiation proctitis, radiation cystitis, etc. Some patients will feel very painful. If the radiation causes rectal Vaginal fistula, vesicovaginal fistula or even vesico-vaginal-rectal fistula will greatly reduce the quality of life. Tissue and organ fistulas caused by radiation are difficult to repair with surgery. Patients live in the immersion of urine and feces all day, and some people even lose their Confidence in life.
People often ask whether they should do chemotherapy or radiotherapy? This question is even more difficult to answer in a few simple words. For example, some early cervical cancer surgeries Later, if it is found that there is vascular invasion, poor differentiation, or cancer cells at the resection margin, or there are more than three positive lymph nodes, etc., these all require chemotherapy or supplementary radiotherapy. Sometimes, whether chemotherapy or radiotherapy is needed is not determined by one or two experts. The decision should be made by medical oncologists, radiotherapy experts and gynecological surgeons to sit down and discuss it carefully. With the development of medical technology, the era when an expert decides life and death is gone forever. Only multidisciplinary collaboration can Only then will the patient be given the best treatment plan. Maximizing the patient\’s interests and minimizing the trauma of treatment are also the goals pursued by every doctor.