Hello, Sina netizens!
Host: Famous doctors gather to talk about people's health. Good afternoon, all Sina netizens. Welcome to the famous doctor hall broadcast live by Sina Health and Medical Forum. I'm Cui Yinmo. While broadcasting the program, you can communicate with experts through our interactive platform. Today we are going to talk about cervical cancer. Cervical cancer is one of the most common malignant tumors in the female reproductive system. Its incidence is only lower than breast cancer, and cervical cancer is not obvious in the early stage. Therefore, female friends are required to pay more attention to life details in order to learn more about related topics, This program specially invites Professor Wang Jianliu, the director of the Department of Obstetrics and Gynecology of Peking University and the deputy director of the Department of Obstetrics and Gynecology of Peking University People's Hospital, to talk with us about the prevention and treatment of cervical cancer. Hello, Professor Wang!
Wang Jianliu: Hello! Hello, netizens, it's a great pleasure to come here and talk with you about the topic of cervical cancer and cervical lesions.
Host: Professor Wang, let's take a look at a case first. There was a college student named Jing Jing. In recent months, she found that her underpants always had a lot of secretions, and the odor of the secretions was very strong, even there was leucorrhea with blood and contact bleeding. She went to the hospital to check, and found that it was cervical cancer. After a detailed inquiry, the doctor learned that the 20-year-old female college student, due to her lack of sexual knowledge and lack of attention to her personal life, had done four curettages for her three boyfriends. Without telling her family that they were young, she went to the small outpatient clinic to get things done. She felt that she should not have asked questions, but did not expect such serious consequences. We were sad to see her case. When we talked about cancer, we thought it was an old thing. Why did such a young girl, who was only 20 years old, also suffer from cancer? And it's cervical cancer. Is it not related to age?
Wang Jianliu: This case is very interesting. She has several characteristics. One is only 20 years old. Cancer patients, especially cancer patients with malignant tumors, are often old and have low resistance to tumors. So why does 20 years old young people have cervical cancer? Cervical cancer is different from other tumors. The occurrence of the first cervical cancer is related to the infection of a virus called HPV. This virus infection is easy to cause cervical cancer. What is the relationship between this virus infection and? It spreads the virus mainly through sexual intercourse.
Just in the middle of this case, she had multiple sexual partners at the age of 20 and had many abortions. It is estimated that she contracted the virus through sexual transmission. And there is also a high-risk factor. In addition to multiple sexual partners, the occurrence of cervical cancer is also related to multiple sexual injuries. She has had several abortions.
This virus is caused by sexual transmission. Generally, young women are more active in sexual life, so her infection rate of this virus is high, and the incidence of cervical cancer and cervical lesions is relatively high. The incidence of cervical cancer is generally dominated by young women, about 30-40 years old.
The case of 20 years old is relatively rare, but in our country, with the reform and opening up, the lifestyle of some young women has changed, and cervical cancer has become younger.
Host: So many young people should pay more attention to it. They always think that cancer is far away from them. It may be possible from the age of 20.
Wang Jianliu: Especially cervical diseases such as cervical cancer.
Host: So we should pay more attention to life. We also heard a statement that after the age of 40, women who often take contraceptives are also prone to cervical cancer. Is this statement scientific?
Wang Jianliu: There is no conclusive conclusion on this issue in the academic circles of the medical community. The contraceptive pill is mainly progesterone, and the progesterone based contraceptive pill contains a small amount of estrogen. Some studies say that estrogen has a relationship with the occurrence of cervical cancer, while some studies say that the relationship is not obvious and there is no conclusive conclusion.
According to my personal opinion, if young women need oral contraception, although oral contraception is used, its relationship with cervical cancer is not clear. It is not allowed to use the contraceptive pill because there is no clear conclusion or such a view. There is no clear conclusion.
Compere: It is inconclusive whether the birth control pill can induce the injury of abortion curettage.
Wang Jianliu: Physical damage is related.
Host: In addition to the physical damage just mentioned, what other factors are related to cervical cancer?
Wang Jianliu: According to years of observation and clinical experience, the main cause of cervical cancer is HPV infection. There is a saying that there is no cervical cancer without HPV infection. HPV infection is an essential factor in the academic world, which is the most important reason.
Of course, there are other factors. What we just mentioned is the prematurity of sexual life. We usually have sex before we are 16 years old, which is called prematurity. There are many sexual partners, and many abortions. These are high-risk factors for cervical cancer.
There are also special circumstances. For example, this individual has low immune function and is prone to cervical cancer. At present, the relatively clear factors related to the incidence of cervical cancer have just mentioned these points.
Compere: Is it also because of physical damage that sex is too early?
Wang Jianliu: Premature sexual life has little to do with physical damage. Premature sexual life is also related to HPV infection. If she has prematurely sexual life, she may be infected with HPV too early. The virus continues to infect, and may cause cervical lesions for a long time.
Moderator: She may not occur before the age of 20, but may accumulate to the age of 3 or 40.
Wang Jianliu: According to the research, after HPV infection, quite a few people will disappear by themselves, but only a few people will continue to exist. It may take several years or even more to cause cervical lesions. It is not that she will not cause cervical lesions so quickly once infected with the virus.
Host: Since you said that cervical cancer and HPV, namely human papillomavirus, HPV virus, we think that the virus is infectious. Cervical cancer is also caused by this virus. Is it infectious?
Wang Jianliu: The main cause of cervical cancer is the infection of HPV virus. The HPV virus itself is infectious, and its transmission route is mainly through sexual behavior. But cervical cancer itself is a malignant tumor, and it is not infectious. So after some patients have cervical cancer, we can clearly tell the patient that your disease is not infectious, but the cause of the disease is infectious.
Host: In fact, we also pay special attention to one topic, that is, many of these diseases are hereditary. Is cervical cancer also hereditary?
Wang Jianliu: According to the current research, cervical cancer itself is not hereditary. But there are some special cases, which may have a certain family nature, which may have a certain relationship with living habits and other cultural habits. From the perspective of genetics, no genetic factors have been found.
Host: In fact, we may be able to detect many diseases early before their onset, and then prevent or treat them early. But just now we also mentioned that the early symptoms of cervical cancer may not be obvious, but can we be more careful to find its early symptoms?
Wang Jianliu: This is a very good question. We often say that cervical cancer is a disease that can be completely prevented. At the same time, we also say that if it is found in time, it is a malignant tumor that can be completely cured. Why do you say that? First, why can cervical cancer be prevented? Avoid it. Because we already know that the main cause of disease is virus infection. If we detect the virus infection at an early stage and find that it is closely tracked, it will be a long process for virus infection to cause cervical cancer. In the process, we need regular inspection to find out that it causes some early lesions and timely treatment, so it can be prevented. If we can't prevent it, we can find it early, find it early, treat it in time, and even cure such a cervical cancer. So cervical cancer can be found early, treated in time, or even completely cured.
In addition, from a clinical point of view, we can pass gynecological examination. Cervical gynecological examination can be intuitive with the naked eye. Now there is a very good method to take exfoliated cells from the surface of the cervix for testing. Virus infection can cause cervical cancer, but before it causes canceration, it will first cause changes in the cells on the surface of the cervix, Then take them for corresponding tests to see if the cells have changed. If the cell has changed, it has no cancer, which is called precancerous lesions. At this stage, we actively intervene to avoid cervical cancer.
Cervical cancer can be detected by HPV virus and cervical exfoliative cytology. The two main methods can detect cervical cancer early, even in the precancerous stage, so as to block it and prevent it from developing to the cancer stage.
Host: Do I have to go through constant physical examination to see if I have this problem? We can't actually observe the details of life?
Wang Jianliu: Yes. Early stage cervical cancer, or early stage cervical cancer lesions, generally she has no symptoms, or some patients will have a symptom that leucorrhea has more secretions, or has a smell, but this is not a typical symptom, leucorrhea has more smell, sometimes cervicitis vaginitis will also have this symptom.
However, there is one thing that we often give science lectures. The typical symptom of cervical cancer is contact bleeding, in other words, bleeding during sexual intercourse. There is physical stimulation and bleeding after sexual intercourse. If there is bleeding during sexual intercourse, it is very intuitive for cervical cancer. If female friends have such symptoms, they should go to the hospital as early as possible.
Compere: You can't take it lightly. It may be a very serious problem of cervical cancer. Cervical erosion, a common female disease, has developed into severe cervical erosion. What is the relationship between severe erosion and cervical cancer?
Wang Jianliu: This issue has always been debated in our academia. In the past, cervical erosion was regarded as a disease treatment. Cervical erosion was divided into mild erosion, moderate erosion, and severe erosion. Through exfoliative cytology, there was no precancerous lesions and no cancer. The method of electric ironing, light excitation, and microwave made it smooth.
In recent years, the academic community has unified a view that cervical erosion itself is not a disease, it is a physiological change, because there are two kinds of cells on the cervix, one is called squamous cells, and the other is columnar cells. The squamous cell is composed of several layers of cells. It looks gray and smooth, while the columnar cell is monolayer. You can see the blood vessels under the monolayer cells, which look red and like erosion. If the columnar cells run to the outside of the cervix, they look red and like erosion. In fact, they are not. We call it columnar cell exocytosis, which is called a physiological phenomenon. It is not a disease.
According to this new concept, it can be explained that you just raised the question of cervical erosion and cervical cancer. Since cervical erosion is a physiological state, it is not a disease, it is not a pathological phenomenon, then it has no relationship with cervical cancer. But in some early cases of cervical cancer, its performance can be shown in the form of cervical erosion, which indicates that cervical erosion is not a disease, and cervical erosion has no relationship with cervical cancer. But cervical cancer can show cervical erosion, so how to distinguish it? So we can go to the hospital to find a doctor. For example, we can do HPV virus testing. For example, we can take some exfoliative cytology testing. If the virus is negative, exfoliative cytology testing is normal, and it is found that it is erosion. If the patient has no symptoms and does not treat, follow up observation. If there are many leucorrhea and contact bleeding, after screening, cervical lesions can be excluded, and anti-inflammatory local treatment can be used. If she is cervical cancer, which is manifested in the form of erosion, it can be detected early through systematic detection of virus detection.
Host: As you said, cervical erosion may be an early manifestation of cervical cancer. What's the probability? How many patients with cervical erosion may develop cervical cancer?
Wang Jianliu: If the cervix shows a severe erosion, the probability of cervical cancer is very small. Because cervical cancer just mentioned that cervical cancer can appear in the form of cervical erosion, but most cervical cancer grows a tumor, like eating vegetables in the middle of life, and a tumor like cauliflower grows out of the surface of the cervix. Through the inspection of the hospital doctor, the cervical cancer has a papilloid cauliflower like tumor, in this form, and a small part of it shows cervical erosion. Cervical erosion is not directly related to cervical cancer, and the probability of cervical cancer is relatively low. However, if it is severe cervical erosion, it is necessary to screen for cervical lesions.
Host: Which female friends may need more screening for cervical cancer? Speaking of screening, how many screening methods can be screened out?
Wang Jianliu: There is a consensus at home and abroad that married women should be routinely screened for cervical lesions. Now it has changed. As long as women have sex, they should be screened for cervical lesions and cervical cancer. If she has sex, she may be infected with a virus. If she is infected with a virus, she may develop cervical cancer, which is the probability.
Therefore, for women who have sex life, it is recommended to carry out routine cervical cancer screening.
Moderator: How often is screening conducted?
Wang Jianliu: It is generally advocated that the screening should be conducted once a year. If the screening is normal for three consecutive years, it should be conducted once every other year. When is it said that screening can be conducted after having sex, and when is it terminated? It is generally advocated to be over 70 years old. So from the beginning of sexual life to the age of 70, it is necessary to conduct routine screening for cervical cancer.
Compere: Does having sex require cervical cancer screening regardless of whether her sexual partner is the only one?
Wang Jianliu: We require screening when having sex. If multiple sexual partners are a high-risk factor for cervical cancer, screening should be more strict. There are two methods that are really used in clinical practice, one is virus detection, human papillomavirus HPV detection, but the cost of detecting this virus is relatively expensive, and there is no complete routine screening method in China. In addition, cytology of cervical exfoliation, we take some cells from the cervix for testing. This method has been applied for decades and is economical and simple, and can also find early lesions of cervical cancer. Early cervical lesions can be detected by virus detection or exfoliative cytology, or a combination of the two methods.
Compere: Many people may use cells to detect HPV first if they combine the two methods, and then screen for HPV if there is danger. We have heard many people say that HPV screening is a particularly revolutionary step in the history of cervical cancer screening. However, the presence of a positive result in many reports will bring a lot of psychological pressure to the infected person. When she fails to achieve the result of canceration, how should she understand if she really sees a positive result in the report sheet?
Wang Jianliu: These should be two problems.
As I mentioned earlier, HPV infection is a very common phenomenon. Some domestic scholars have conducted a sample survey among ordinary women in pregnancy in Beijing, and found that the HPV infection rate among ordinary people is 10% or even as high as 12% in the urban and suburban areas of Beijing. That means that one out of 10 female friends may be infected with HPV.
So how high is the incidence of cervical cancer for such a high infection rate? It is estimated that the majority of HPV infection will not cause cervical cancer, and will not reach this stage.
Moderator: 1 in 10000.
Wang Jianliu: What should we do once the HPV virus infects us? Are we just waiting? In fact, research has found that the HPV virus will disappear by itself within one year after more than 80% of the infection. The immune resistance of the body will eliminate the virus. Less than 20% of patients are likely to have a persistent virus. The virus has been infected for more than a year. Only when the virus is continuously infected can it cause cervical lesions.
So if it is suspected that the HPV virus is positive, you can follow it up and test it after 10-12 months. Maybe it will become negative. If it is negative, don't worry about it. Check again the next year. If it continues to be positive, we will see if there is any change in cytology. If there is any change in cytology, we will take corresponding treatment measures according to the degree of cytology change. If there is no change in cytology, we can follow up without treatment. Some female friends may say that there are many anti HPV drugs introduced by many media or some popular science knowledge, and these drugs are also used clinically, for example, interferon, which is an antiviral drug to enhance resistance. There are also some other medicines of our traditional Chinese medicine and traditional Chinese medicine, which may also have some antiviral effects. But whether we say interferon, antiviral injection, or we use antiviral traditional Chinese medicine, their antiviral efficacy is not very accurate. If a female friend is infected with HPV, it means that it is OK to use a little medicine, but its effectiveness is not accurate, and it is OK not to use follow-up, if you are worried about using a little antiviral medicine, it is OK. If she turns negative, she may use medicine to turn negative, or turn negative naturally. If she does not turn negative, there is no need to be nervous. We can follow up.
Host: HPV virus may have an incubation period, which may last for more than ten years.
Wang Jianliu: But it is a slow process.
Host: But everyone must have this anxiety. As long as there is this virus in the body, there is the possibility of pathological changes. If you want to eliminate the virus from the body before it becomes diseased, is there no such method now?
Wang Jianliu: There is no effective way to control virus infection. A delegation from the Department of Obstetrics and Gynecology of the United States called People to People decades ago. I asked an American expert if there was any way to fight the virus and eliminate the virus if a woman detected HPV infection in the United States. He said there was no way. What shall I do? Just follow up. There is no very good way. Why do we use drugs again? The effect is not very good. It also wastes medical resources and increases our psychological panic. Therefore, since HPV infection is very common, most of it may disappear. It is enough for us to follow up closely.
Compere: So these women detect positive in time, relax and closely observe their changes.
Wang Jianliu: As long as there is no cytological change, it is a virus infection. We will follow up and observe it.
Compere: Many patients with cervical cancer may finally face the consequences of hysterectomy. It is hard for women to bear the consequences of hysterectomy. Besides this operation, is there any other treatment?
Wang Jianliu: This involves the treatment of cervical cancer. At present, surgery is our first choice for the treatment of early cervical cancer. For advanced cervical cancer, we only consider other treatment methods when surgery is unavailable. The most common treatment is radiotherapy. Others, such as chemotherapy, are commonly used to treat tumors, but in cervical cancer, it is used as an auxiliary treatment for surgery and radiotherapy, not as the main treatment method.
So for some early cervical cancer, extensive hysterectomy and lymph node resection can be used to know whether the tumor has spread or metastasized. If she is really an early stage, she can be cured after the operation is completed. Even thorough surgery can cure early cervical cancer without adjuvant radiotherapy and chemotherapy.
However, for advanced cervical cancer, it is impossible to operate, because the scope of cervical cancer surgery is relatively large, the tumor has spread to the outside of the cervix, and the surgery cannot be completely removed, then radiotherapy is required. Radiotherapy is relatively sensitive to cervical cancer, and the effect is relatively certain. So cervical cancer is mainly divided into two categories from the medical point of view, one is called squamous cell carcinoma and the other is adenocarcinoma. Radiotherapy for squamous cell carcinoma is very sensitive. We have a saying that radiotherapy can be used for any stage of cervical cancer, whether early or late. If adenocarcinoma is less sensitive to radiotherapy, surgery is preferred for adenocarcinoma cases. The two types of cervical cancer have different treatment focus and methods. According to her type of cervical cancer, according to her own stage sooner or later, choose the appropriate treatment.
Moderator: Now some netizens have asked questions through the interactive platform.
Netizen: 76 years old, stage II cervical cancer. What is the effective treatment for this condition? Can chemotherapy be used at this age? How about the effect?
Wang Jianliu: Just now we talked about early cervical cancer surgery, while the late stage is radiotherapy. The early and late stages are defined as Phase II A and Phase II B. If it is stage II A, it means that the cervical cancer has invaded the vagina, and it does not go beyond the side of the cervix. If it is stage II A, surgery can be considered.
If it is stage II B, it means that the tumor has gone from the cervix to the side of the cervix, but has not yet reached the pelvic wall. This situation is called stage II B. This situation is not suitable for surgery, and radiotherapy should be used.
In addition, this female friend is 76 years old, and she is relatively old. If there are some medical complications such as hypertension, diabetes, or poor physical condition, she does not advocate surgery. Because of the large trauma of surgery, radiation therapy is also recommended. Therefore, if there are no special circumstances, such as this situation, the advanced stage II cervical cancer mainly relies on radiotherapy.
Netizen: Late stage of cervical cancer, irregular vaginal bleeding started in June 2011, and in October 2012, I went to the tumor hospital for treatment. The effect was good. What should I pay attention to? Do I need to take medicine?
Wang Jianliu: Cervical cancer surgery usually involves chemotherapy and radiotherapy. Generally, there is no oral medicine to treat cervical cancer. She has already done chemotherapy and radiotherapy in the tumor hospital. Regular follow-up is OK later. There is no special treatment. If you want to do some more treatment, I personally suggest that you can find a Chinese medicine to take some Chinese medicine to recuperate your body. I often tell my patients that after the tumor treatment, they say that they are not sure about following up in this way. Do you want to suggest that we take some medicine? I suggest you go to the Chinese medicine hospital to find the Chinese medicine doctor in the Chinese medicine hospital and prescribe some medicine. Those who prescribe medicine should not focus on active recuperation, recuperate well, eat well, sleep well, and enhance immunity is helpful for disease recovery.
Some patients said that it would be better to find Chinese medicine to prescribe anti-tumor drugs. I don't know much about Chinese medicine. I personally think that the anti-tumor effect of Chinese medicine is limited. I generally advocate that cancer patients should use traditional Chinese medicine to regulate their body conditions and enhance their immunity to fight cancer.
Netizen: What should be paid attention to in the diet of patients with cervical cancer?
Moderator: Maybe there is any diet that is more beneficial to her recovery for her illness?
Wang Jianliu: From the perspective of the causes of cervical cancer, the incidence of cervical cancer is not directly related to diet. Therefore, if you want to prevent cervical cancer, it is unreasonable from the diet. When we often give science lectures, people will also ask about this. I said what you want to eat, and what you like to eat, you can eat, because it has nothing to do with cervical cancer.
But if you are a patient with cervical cancer, she said that what problems should be paid attention to in my diet, and whether I would eat something inappropriate, which would affect my condition. I said that this question should be asked by Chinese medicine, because his theory of Chinese medicine may be spicy, sour, cold, etc., whether it has an impact on the body's yin and yang, virtual and real, Consult traditional Chinese medicine and they will tell you what is appropriate and what is not. Western medicine says there is no clear requirement.
Netizen: How long does it take for cervical cancer to develop from precancerous lesions to cancer?
Wang Jianliu: This is a very important and good question. That is to say, after virus infection, sometimes the precancerous lesions are not cancer. How long does it take to cause precancerous lesions to cancer? According to the statistics of a large number of clinical cases, it should be about 5-15 years. So this is also a slow process. I mentioned just now that cervical cancer is completely preventable. We follow up and observe the virus infection. It may be congenital cervical disease. When cervical disease occurs, we treat cervical disease and block it to avoid cervical cancer, because the time period from cervical disease to cervical cancer needs to be calculated on an annual basis, In this period, as long as we follow up regularly and check regularly, we can find this stage of precancerous lesions without causing cervical cancer or even advanced stage.
Netizen: The cervical cancer has been partially removed. It has been more than three months since this operation was performed. Would you like to ask if you can have a roommate now? If the roommate pays attention to what?
Wang Jianliu: Generally speaking, patients with cervical cancer undergoing surgery are told to have outpatient reexamination four to six weeks after the surgery. The vaginal wound should grow well four to six weeks after the surgery. If it grows well, when will they start having sex. It is generally recommended that three months later. It has been three months since her operation. If she goes to the clinic for inspection, the doctor says that the wound heals well and there is no problem. She can have sex.
Host: In fact, we can see that in the gynecological tumor ward, common patients with cervical cancer after surgery have urine bags hanging on their bodies and beside their beds. Many patients practice holding their urine before pulling out the urine bags, causing a lot of inconvenience to her life. After she finishes this operation, will there be any impact on her urination? Is there any other way to solve it?
Wang Jianliu: This is a very good problem. It is also a problem that puzzles me. The surgery for cervical cancer is relatively large. The cancer is in the cervix. The fist is the uterus, the arm is the cervix, the front is the bladder and the back is the intestines. If the uterus is extensively resected, because the lesion is in this area, we need to cut off the surrounding tissue more than three centimeters around the cervical cancer, so as to ensure the thoroughness of tumor removal, and remove the vagina more than three centimeters. With such a wide range of resection, the front is the bladder and the back is the rectum, which will cut off the nerves of the bladder and rectum. Urination of the bladder is innervated by nerves. If the nerves innervating the bladder are cut off, the bladder urination function will be affected. Basically, all patients will have short-term urination dysfunction after extensive cervical cancer resection. Just as you mentioned, they are carrying urine bags.
The cervical cancer cases I did in our ward basically took one month or even two months. In some cases, it took longer to pull out the catheter. In a short time, she could not urinate by herself, and then she urinated by pressing abdominal muscles.
On the one hand, the tumor should be completely removed, and on the other hand, these nerves should be destroyed. If these nerves are not removed, the scope of surgery is not enough, and the tumor treatment is not complete. This is a contradiction. How can we solve this problem? Do we have a way to remove the tumor completely, but also preserve the nerves, and not cut off the nerves that dominate the bladder.
Recently, some doctors at home and abroad have been studying this problem, and I have also discussed this problem. I went to the United States in 11 years to see American doctors perform nerve sparing surgery, and we also communicated with domestic experts about nerve sparing surgery. In fact, this method is feasible, but it is not suitable for all cases. It is only suitable for young patients with early disease. We can try to preserve nerves, and some cases are not suitable for nerve preservation surgery. Therefore, for patients with cervical cancer, there is no better way to solve the problem of urine retention after surgery, and urine bag.
Host: This is a necessary stage for recovery after surgery. We also heard that uterine vein thrombosis is easy to occur after surgery. How should we prevent this problem?
Wang Jianliu: General cases of malignant tumors are often in an advanced age, which is easy to form thrombus. In addition, just mentioned that the operation of cervical cancer is relatively large, and the operation time is relatively long, which usually takes 2-4 hours. So the patient's position is static for a long time, which will also affect the blood circulation. Because he is not moving, the venous blood flow of lower limbs is slow, and the bed rest activity is reduced, these factors are high-risk factors for thrombosis.
Therefore, after cervical cancer surgery, if you do not actively prevent thrombus, it is easy to have thrombosis. There are different situations of thrombosis, some are intramuscular thrombus, some are large vein thrombus, and few active thrombus forms on the vein wall. Once you move down the ground, these thrombus will fall off, flow back to the heart along the vein, and the heart will contract to the lungs, Sudden death will occur after the embolism of the pulmonary artery. This is the case report at home and abroad. After the operation, the patient did not actively prevent thrombosis. When the patient went down to the ground or even went to the toilet, the thrombus fell off and caused sudden death.
We recommend active treatment after cervical cancer surgery. If there is not much bleeding after surgery, anticoagulants are often used 12 hours and 24 hours after surgery. At this time, anticoagulants are used, and some measures are taken to prevent thrombosis. We let patients wear elastic stockings to prevent thrombosis, which have a certain elasticity, to help lower limb venous blood flow recover and return to the heart.
And now hospitals use devices such as lower limb massage to promote venous return and prevent thrombosis. In recent years, few cases of thrombosis after cervical cancer surgery have occurred in our hospital.
Host: In short, the patient should not be kept completely still after surgery. No matter active or passive, massage or wearing elastic socks requires blood circulation.
Wang Jianliu: Avoid thrombosis.
Compere: The operation is very difficult. It takes 4-6 hours. It is not all right to finish it. Maybe the thrombosis and other problems are after the operation.
Wang Jianliu: Urine retention, etc.
Host: Is there anything the patient needs to pay attention to after the operation, which was just mentioned about urine retention and thrombosis?
Wang Jianliu: After the surgery for cervical cancer, we can prevent thrombosis and wait for the bladder to recover after a period of time. Because the operation takes a long time and the surgical trauma is large, we should use antibiotics to prevent infection after the operation. In addition, some patients have some problems. Cervical cancer surgery requires the removal of bladder lymph nodes, or even abdominal lymph nodes. There are many surgical injuries, especially the treatment of lymph nodes and lymphatic vessels. If the treatment is not thorough, the surgery may form lymph cysts. Therefore, the operation is to prevent infection, bleeding and thrombosis. After the operation, regular B-ultrasound examination is also required to see if there is a lymphocyst. For some patients, there may be lymphedema, thigh edema and lymphatic reflux obstacles.
The lymph of the lower limb flows back to the abdominal cavity through the pelvic cavity to form lymphatic circulation. We cut off the lymph nodes of the pelvic cavity, and the lymph flow of the lower limb is not smooth, resulting in lymphedema, which is a common complication after our surgery.
Compere: Radiotherapy is a very important surgical method. Radiotherapy often causes acute radiation inflammation. Is there any way we can prevent this problem?
Wang Jianliu: Just mentioned that radiotherapy is one of the most important means for the treatment of cervical cancer. It is very sensitive to the cervix. Many patients with cervical sensitivity take radiotherapy, which is different from chemotherapy and surgery. After surgery, her problems can be seen in Lima, and the side effects can be seen soon after chemotherapy. The radiation dose is accumulated every day to reach the maximum tolerance of the body. Once the maximum tolerable dose is reached, its side effects gradually appear, including short-term radiation reaction and long-term radiation reaction. Just now, you mentioned radioactive cystitis, radioactive proctitis, and patients with hematuria and hematochezia. Radioactive cystitis is very troublesome in clinic. Radiation has already irradiated the body and damaged the body. It is difficult to eliminate such a reaction.
At present, from the perspective of prevention and improvement from the perspective of radiation technology, there is a word in the implementation of intensity modulated medicine. Select the important areas with higher doses, and the unimportant areas with lower doses, rather than the same amount of regional radiation. We call for strengthening to avoid the occurrence of radiation inflammation of the bladder. If we can't prevent it, we have limited means to treat radiation cystitis proctitis in western medicine. We turn to traditional Chinese medicine, retention enema of traditional Chinese medicine and other means to treat radiation cystitis proctitis. The clinical management of complications caused by radiotherapy is very difficult.
Host: Can we use interventional treatment for cervical cancer? Generally speaking, what kind of situations should interventional therapy apply to?
Wang Jianliu: This is also a means of treating tumors that has been used more frequently in recent years. Especially for patients with cervical cancer, we take interventional chemotherapy to treat some cervical cancer. What is intervention? We insert a tube catheter through the femoral artery to the uterine artery that innervates the cervix. We can insert a tube into the uterine artery to innervate the blood vessels of the uterus, and direct the chemotherapy drugs to this part. This is the local part of the cervix, resulting in high concentrations of chemotherapy drugs, which can shrink the tumor of the cervix. Its purpose is to take some medicine for some cervical tumors that are large, inconvenient or inoperable, and then let them shrink before surgery.
Therefore, this method is suitable for patients with advanced cervical cancer and local lesions larger than 4 cm. In this case, we will take some medicine to make it smaller. In clinical observation, it is better than intravenous chemotherapy, because it is the artery where drugs directly hit the uterus, and the effect of drugs directly acting on the cervix is better than that of veins. This is our clinical treatment method for some cases. Not all cases use this method.
Compere: We heard of a Lipper knife operation.
Wang Jianliu: Lippo knife is a kind of electric ring resection. Like steel wire, it cuts off the cervical lesions by heating and electrifying. We call it Lippo electric ring resection, which is mainly used for the treatment of cervical precancerous lesions. And it is not used for all cases of cervical precancerous lesions. Here is a concept. Cervical precancerous lesions are divided into one level, two levels and three levels. Cervical precancerous lesions are one level. Most of them can return to normal without treatment or simple drug treatment.
For Grade II cervical precancerous lesions, we propose to apply Lippo surgery, remove some lesions through Lippo knife, and then go to the laboratory. Cervical precancerous lesions are Grade III, generally not dominant, cold knife cutting is not electrified, and the cervix is partially removed and then tested. Lippel knife is generally recommended for patients with grade II precancerous lesions, and then for diagnosis or treatment. Now it is still widely used in China.
Compere: How often should we recheck after this kind of operation? What items should be checked generally?
Wang Jianliu: Cervical cancer. For patients with cervical cancer, whether they have finished surgery or radiotherapy, we call them lifelong follow-up, and they should be followed up all the time. Generally, we recommend that they should be followed up in the first three years after surgery, then they can be rechecked once every three to six months, and once every year after three to five years. Regular follow-up is required.
No matter what kind of treatment you take, because cervical cancer still has a certain recurrence rate, we need regular follow-up, so we can find a few cases of recurrence of patients in time, called lifelong follow-up, and I will be fine if I cannot finish the treatment.
Compere: We should always observe whether it has other changes.
Wang Jianliu: Yes.
Host: Just now, we talked about a lot of problems about treatment. Many people are very concerned about prevention. Many friends asked, I heard that there is a vaccine for cervical cancer, but I wonder if it has been applied in China? How about the effect? Do we use this vaccine now?
Wang Jianliu: This is a newly developed problem. Cervical cancer can be prevented, starting from the prevention of virus infection. Vaccines against this virus have been developed at home and abroad. For example, measles and rubella can be vaccinated in the past to prevent infection, so that the body can obtain permanent immunity.
Now there are HPV vaccines researched abroad, including in China. There are many kinds of HPV involved here. According to current research, there are more than 100 HPV viruses that can cause cervical cancer. Of course, it is the most common, probably two, three, four. Now the vaccines against HPV researched at home and abroad are all made for the most common subtypes of HPV that cause cervical cancer. At present, the vaccines produced abroad have not yet been commercialized, and clinical observation is still being carried out in our country. As far as I know, the domestic production of these vaccines has also started clinical observation in China this year, and no formal prevention has been approved for use in the population.
So we don't have such a vaccine for prevention in China at present, but in foreign countries, such as the United States and Europe, they have used these vaccines for prevention, while our country has not officially approved clinical observation.
Host: We expect so many types of viruses. It's hard to say that one or two can cover all lesions. Let's take a look again. It seems that many netizens are constantly asking questions. A netizen listened to Professor Wang's lecture on these questions.
Netizen: What else can become cervical cancer? For example, can cervical polyps become cervical cancer? Should polyps be removed?
Wang Jianliu: Cervical polyp is a result of inflammation. It has no direct relationship with cervical cancer. If a polyp grows on the cervix and looks like a polyp to the naked eye, it is better to remove it for test. The pathological test is inflammatory polyp, so don't bother about it. Cervical polyps are generally recommended to be removed.
Netizen: Can women of childbearing age who have cervical cancer still have children? Now they are CIN2, can they get pregnant first and then have Lippel surgery?
Wang Jianliu: CIN2 is the second grade cervical precancerous lesion. Her main treatment method is to use a Lippo knife. This friend of CIN2, I personally suggest that you should have surgery first and then get pregnant. Because we say that the diagnosis of CIN2, a cervical precancerous lesion, is based on colposcopy biopsy, which may miss precancerous lesions. In some cases, precancerous lesions will be upgraded to level 3, even a few are cancers. First, perform Lippo knife surgery. If it is clear that it is CIN2, we can know the early cervical precancerous lesions. After three months and half a year of follow-up, there is no problem. We can get pregnant again, which is safer. It is not recommended to get pregnant first, because it may promote the progress of pathological changes after pregnancy, which is incomplete.
Compere: Get rid of the disease and then get pregnant.
Netizen: Are there any precautions for cervical biopsy?
Wang Jianliu: Cervical biopsy is a method used for cervical lesions. The doctor conducts a biopsy under the direction of colposcopy and sees the doctor. According to her condition, she will take a colposcopy biopsy. The doctor who conducts a colposcopy biopsy will tell her what problems she should pay attention to.
Netizen: Does physical therapy have to be done for the third degree of cervical erosion? When is the best time to do it?
Wang Jianliu: Cervical erosion is three degrees, severe cervical erosion. If there are symptoms, for example, the secretion is yellow, or there is contact bleeding that needs to be treated. One way to use it is to use traditional Chinese medicine vaginal suppository, or antibiotics such as metronidazole to diminish inflammation.
Another treatment method is physical therapy. For those with contact bleeding, more secretions, obvious inflammation, and severe cervical erosion, laser, electric ironing, microwave and other treatment methods can be used.
Netizen: One month after the Lipper knife operation, we found that the cervical canal was slightly hyperplastic. Is it normal? What should we do?
Wang Jianliu.
Host: Cervical cancer is a tumor with a very high incidence among women, but we didn't know much about cervical cancer before. After listening to your lecture today, I really have a comprehensive understanding of cervical cancer. Thank you very much for coming to our studio as a guest, and thank you very much for your attention to our program, Due to time constraints, our program will end here. Famous doctors will gather to talk about people's health. See you on the next program.
Wang Jianliu: Thank you.