[Patient Story] Pay Attention to Abnormal Findings, Prevent and Treat Cervical Cancer Early!

News
2023-10-08

Cervical cancer has the highest incidence rate among the three major gynecological malignancies and is a significant cause of cancer-related deaths in women. Therefore, the prevention, early diagnosis, and treatment of cervical cancer are crucial.

Patient Story

Ms. Lin, a 39-year-old woman, was found to have an HPV infection and abnormal TCT results during a health screening earlier this year, but she did not take it seriously. Six months later, Ms. Lin suddenly remembered the doctor's advice to undergo further examination. She went to the hospital for a colposcopy and a cervical biopsy. Unfortunately, she was diagnosed with cervical cancer.
To further clarify the condition and receive timely treatment, Ms. Lin was referred by a friend to the gynecology outpatient department of our hospital. She was seen by Professor Chen Jianguo, Director of the Department of Gynecology (formerly Deputy Director of the Department of Obstetrics and Gynecology at Guangdong Provincial People's Hospital). Considering it to be early-stage cervical cancer, Professor Chen recommended immediate hospitalization for treatment.
After admission, doctors completed a full workup for Ms. Lin, and the clinical diagnosis was cervical cancer stage IA2. During the ward round, Director Chen Jianguo clearly stated that the patient was considered to have moderately differentiated squamous cell carcinoma of the cervix, stage IA2. Ms. Lin could choose between open surgery or laparoscopic radical hysterectomy for cervical cancer.
Ms. Lin wished to undergo laparoscopic surgery but was concerned about the risk of recurrence. Director Chen Jianguo patiently communicated with Ms. Lin: indeed, not all cervical cancers are suitable for laparoscopy, but for appropriately selected surgical cases, laparoscopy does not increase the recurrence or mortality rate of cervical cancer and is beneficial for postoperative recovery. Ms. Lin's condition was just suitable.
After understanding this, Ms. Lin and her family ultimately chose laparoscopic surgery as desired. Fortunately, Ms. Lin's cancer was in an early stage, the postoperative outcome was good, and she was discharged one week later.

Cervical Cancer Does Not Always Require Abdominal Hysterectomy

There are many treatment options for cervical cancer, and the specific plan depends on factors such as the severity of the disease, the patient's age, and overall health status. Common methods include surgical resection, radiotherapy, chemotherapy, and targeted therapy. In addition, adjuvant therapies such as immunotherapy and hormone therapy can be used to enhance treatment outcomes.

Among these, surgical treatment is the most ideal approach for early-stage cervical cancer, including total hysterectomy, cervical conization, and others. In these surgeries, an abdominal incision is not always necessary; resection can also be performed via laparoscopy. Compared to open surgery, laparoscopic surgery involves smaller incisions, which can reduce postoperative pain, hospital stay, and the risk of complications, while offering faster recovery and smaller scars.

However, laparoscopic surgery is not suitable for all cases and may not be applicable for patients with more complex conditions or larger lesions. Furthermore, the surgery requires specialized equipment, which may increase the cost and duration of the procedure. It also demands a high level of technical skill from the surgeon; otherwise, it may lead to surgical failure or complications.

Other treatment modalities, such as radiotherapy, use radiation to kill cancer cells and shrink or eliminate tumors. It is typically performed after surgery to reduce the risk of recurrence.

Chemotherapy involves using chemical drugs administered intravenously or orally to kill cancer cells. Chemotherapy is often used in conjunction with radiotherapy to enhance treatment efficacy.

Targeted therapy is a treatment method that targets specific molecular targets to inhibit the growth and spread of cancer cells. Targeted therapy is typically used for patients with advanced-stage cervical cancer.

It is important to note that each treatment method has its own advantages, disadvantages, and indications. Patients should cooperate with their doctors and choose an appropriate treatment plan based on their specific condition.

Three Levels of Prevention for Cervical Cancer

Cervical cancer is preventable. Women of appropriate age can receive the HPV vaccine. It is also recommended that all sexually active women undergo regular cervical cancer screening to detect precancerous lesions early and prevent the progression to cervical cancer.

Primary Prevention: Avoid HPV Infection

Avoid early initiation of sexual activity, delay the age of first childbirth, implement protective measures during sexual activity, quit smoking, and boost immunity, among other measures.

HPV vaccination is a cost-effective and efficient measure for the prevention and control of cervical and related diseases, significantly reducing the incidence of cervical cancer. It should be noted that regular screening is still necessary after receiving the HPV vaccine.

Secondary Prevention: Regular Screening

Regardless of whether they have received the HPV vaccine, all sexually active women should undergo regular cervical cancer screening for early detection, early diagnosis, and early treatment.

Based on the age characteristics of cervical cancer incidence in China, the recommended starting age for screening is 25-30 years old. For women who have been sexually active for more than 3 years, an annual cervical cytology (TCT) screening is recommended, and combined HPV testing is advisable if conditions permit. If screening results are negative for three consecutive years, combined testing can be performed every 2-3 years.

For women aged 65 and older, if they have had three consecutive negative cytology results at three-year intervals or two consecutive negative HPV tests at five-year intervals within the past 10 years, no further screening is required.

Those with abnormal vaginal bleeding should undergo screening as advised by their doctor, with colposcopic biopsy if necessary. For pregnant women, screening should generally be postponed until after delivery unless there are special circumstances.

Director Chen Jianguo (second from right) and Director Yang Xiaomei (second from left) performing laparoscopic surgery (not the case described in this article)

Tertiary Prevention: Early Detection and Early Treatment

When a pathological diagnosis confirms high-grade cervical precancerous lesions, active management is required. Generally, a cervical conization can remove the lesion and halt disease progression. For low-grade lesions, physical therapy or topical anti-HPV medication may be chosen. If a biopsy indicates cervical cancer, comprehensive treatment such as surgery, radiotherapy, or chemotherapy should be undertaken based on the clinical stage and pathological type to prevent disease progression and irreversible consequences.

However, a diagnosis of cervical cancer should not cause excessive worry. If detected early, the vast majority of cases can be cured through surgery. With the increasing maturity of laparoscopic techniques, early-stage cervical cancer confined to the cervix with a tumor smaller than 2 cm (excluding special pathological types) can be treated with laparoscopic radical hysterectomy.