99% of cervical cancers are related to TA!

This article involves professional knowledge and is only for medical professionals to read for reference.
Professor Zhou Qi talks with patients with cervical small-cell neuroendocrine cancer, from recurrence prevention to treatment of adverse reactions of radiotherapy and chemotherapy.

The Department of Gynecology, Tumor Hospital of Chongqing University has been committed to the treatment and rehabilitation of patients with gynecological cancer, especially in the field of cervical cancer.
The Department of Gynecology, Tumor Hospital of Chongqing University has its own unique experience.

During the 2021 Cancer Prevention and Treatment Week, the Gynecological Oncology Committee of the Chinese Anti-Cancer Association and the "medical community" specially invited Professor Zhou Qi from the Department of Gynecological Oncology of Chongqing University Affiliated Tumor Hospital to have an in-depth conversation with the host Ms.
Wang Juan (Ms.
Wang is also A patient with cervical cancer who was diagnosed as cervical high-grade small cell neuroendocrine carcinoma (Stage IIIC1r), combined with Ms.
Wang's experience in diagnosis and treatment, talked about the radiotherapy and chemotherapy for advanced cervical cancer.

 Highlights 1.
What is the incidence, treatment and prognosis of high-grade small cell neuroendocrine carcinoma of the cervix? 2.
How to prevent cervical cancer? What are the complications after treatment? 3.
How to deal with bone marrow suppression that may occur during radiotherapy and chemotherapy? 4.
How to follow up patients with cervical cancer after treatment? 5.
Why do patients with cervical cancer undergo vaginal lavage after radiotherapy? 6.
How do ordinary people prevent HPV? Treatment and prognosis of cervical high-grade small cell neuroendocrine carcinoma stage IIIC▎Moderator: What is the current treatment and prognosis of cervical high-grade small cell neuroendocrine carcinoma stage IIIC? Professor Zhou Qi: Cervical small cell neuroendocrine carcinoma is a rare pathological type of cervical cancer, accounting for less than 2% of cervical cancer.
The vast majority of cervical cancers are squamous cell carcinomas, followed by adenocarcinoma and adenosquamous carcinoma, which are sensitive to radiotherapy.
In other words, radiation therapy is effective.

For patients with cervical small-cell neuroendocrine carcinoma, as long as they can be operated on when they are found, they should try their best to strive for surgical treatment.
Postoperative supplementary treatment includes comprehensive treatment including radiotherapy and chemotherapy.

However, once the disease is found to be at an advanced stage, the opportunity for surgery is lost, and small cell neuroendocrine carcinoma is relatively sensitive to radiotherapy and chemotherapy.

Stage IIIC means that there is pelvic lymph node metastasis.
Often cervical cancer of stage IIIC loses the opportunity to undergo surgery.
Even if surgery, postoperative radiotherapy and chemotherapy are required.
Surgery to find pelvic lymph node metastasis requires additional postoperative radiotherapy or chemotherapy.
Most cervical cancers He is sensitive to radiotherapy.

As far as Ms.
Wang is concerned, pelvic lymph node metastasis has been found at the time of diagnosis, and the cervical lesions are very large.
Although it is neuroendocrine cancer, my plan is still radiotherapy plus concurrent chemotherapy.
Pelvic radiotherapy includes the radical treatment of cervical lesions and lymph node drainage areas.
For sexual radiotherapy, the chemotherapy regimen selected etoposide + cisplatin, and after concurrent radiotherapy and chemotherapy, etoposide + cisplatin was given 5 times every 3 weeks for a total of 7 courses of chemotherapy.

After the above-mentioned treatment, Ms.
Wang Juan's condition has now been well controlled and has entered the follow-up phase.

At the end of the treatment follow-up, it was found that the bone marrow suppression was IV grade.
After platelet transfusion and other treatments, the risk period has passed, and the bone marrow suppression has improved.

During the conversation, I learned that although Ms.
Wang had been screened for cervical cancer in the past, it was five years ago, and the pathological type of cervical cancer that Ms.
Wang suffered from was relatively hidden.
As far as Ms.
Wang was concerned, she was the first Symptoms are increased vaginal discharge.
After admission, check for HPV type 18 infection.

The performance of complications after the prevention and treatment of cervical cancer▎Moderator: What kind of cancer is cervical cancer? Can it be prevented? How to treat and what complications may exist after treatment? Professor Zhou Qi: As the name suggests, cervical cancer is a malignant tumor that grows on the cervix.
According to the pathological type, it is divided into squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and other pathological types, such as neuroendocrine carcinoma.

In terms of prevention, cervical cancer is a malignant tumor that has a good preventive effect on all cancers.
HPV vaccine can be used to prevent HPV infection, which greatly reduces the incidence of HPV infection-related cervical cancer.
Usually, 99% of cervical cancers are at high risk.
Type HPV infection related.

Secondly, cervical cancer is the easiest tumor to be found by screening.

Although the host has been screened for cervical cancer in the past, it was five years ago, and the frequency of subsequent screenings was too low.
According to the host's 43-year-old age, cervical cancer screening should be performed every 2 years. The screening methods for cervical cancer are now very complete.
If precancerous lesions are found in the screening stage, as long as the precancerous lesions are treated in time, the patient will not suffer from cervical cancer.

In terms of treatment, surgery is the main treatment for early cervical cancer.
Radical resection can achieve a cure rate of more than 90%.
For advanced cervical cancer and advanced cervical cancer, radiotherapy and chemotherapy are the main treatment methods.

Complications in patients with cervical cancer after treatment mainly depend on which treatment the patient takes.
If the patient has undergone surgery, there may be complications related to surgery, including temporary dysuria, lymphedema, etc.
Most of these complications are transient, as long as they undergo corresponding treatment and rehabilitation, they can get better over time.

If the patient is receiving radiotherapy, there may be pelvic fibrosis, lower extremity edema, frequent urination, urgency, hematuria, and increased stool frequency as the main manifestations of radiation cystitis and proctitis.
These complications are also under the guidance of a doctor Can be controlled.

Moreover, with the improvement of technical surgery and radiotherapy techniques, the occurrence of these complications will also decrease, and patients should not be too anxious, let alone refuse treatment.

With current cervical cancer treatment, even if it is advanced, as long as a reasonable treatment plan is adopted, patients can achieve long-term survival with a higher quality of life.

The manifestations and treatment of bone marrow suppression after radiotherapy and chemotherapy ▎Moderator: After radiotherapy and chemotherapy, dizziness, soft feet and blood cell decline occurred.
What is going on? Professor Zhou Qi: According to the pathological type of the host’s cervical cancer, we chose a chemotherapy regimen of etoposide + cisplatin.
Etoposide has a more obvious effect on the bone marrow.
In severe cases, it can cause IV degree of myelosuppression.
Dizziness, soft feet, fatigue and decreased blood cells are the reactions caused by bone marrow suppression.

In clinical practice, we will classify the bone marrow suppression according to the degree of red blood cell, white blood cell and platelet decline in the patient, usually divided into grades I-IV, grades I and II are relatively mild bone marrow suppression, as long as the patient has enough diet Sufficient nutrition and rest can recover on its own.

Patients with grade III and above, especially grade IV, need specific analysis to clarify the type of blood cell decline, and give interventional treatment.
The intervention methods mainly include two types.
Injecting stimulating factors to mobilize bone marrow cells into the blood.
Make blood cells return to normal levels; transfusion of the corresponding blood components to make it through the dangerous period, at the same time, the patient must also strengthen nutrition to give the bone marrow hematopoiesis with raw materials.

For patients with neutropenia, attention should be paid to prevent infection, and for patients with low platelets, attention should be paid to prevent bleeding.
Once infection and bleeding occur, they need to return to the hospital for treatment.

We also advocate preventive treatment for myelosuppression, monitoring, early detection, and early intervention, so that patients do not have infections and bleeding caused by the decline of white blood cells and platelets caused by myelosuppression, which can be done at present.

Frequency of follow-up after cervical cancer treatment▎Moderator: How to follow-up after treatment for cervical cancer patients and what are the issues that need attention? Professor Zhou Qi: The treatment of malignant tumors will come to an end.
After the treatment, regular follow-up is very important.
Because the tumor is most likely to recur within 3 to 5 years after treatment, the tumor recurrence is detected early and treated in time.

Therefore, generally speaking, the first re-examination will be carried out within 1 to 2 months after the end of the treatment; if there is no special case, the re-examination will be carried out every three months for the subsequent year; and the re-examination will be carried out every six months for 3 years; After 3 years, a review will be conducted every six months to a year.

The content of review after cervical cancer treatment mainly includes: pelvic ultrasound, pelvic magnetic resonance/CT, and regular upper abdomen, lung examinations, and tumor marker examinations.
If the pathological type is squamous cell carcinoma, the squamous cell carcinoma antigen in the tumor markers will be used as Important indicators for re-examination, carcinoembryonic antigen and CA series markers are also included in the examination.

For patients such as small cell neuroendocrine carcinoma, it is necessary to pay attention to whether there is distant metastasis in the review process.

In short, once a problem is found during the review process, it can be diagnosed as a recurrence, and then deal with it according to the situation of the recurrence site.

In addition to re-examination, patients also need to exercise properly, eat a balanced diet, do not have a partial eclipse, supplement high-quality protein and vitamins, and do what they can.

Monitor any uncomfortable symptoms that you have after treatment.
If the symptoms are severe, you need to go to the hospital where you are treated for corresponding treatment.

Reasons for lavage after cervical cancer radiotherapy▎Moderator: Why do cervical cancer patients need vaginal lavage after radiotherapy? Professor Zhou Qi: There are three reasons for lavage after radiotherapy.
First, after radiotherapy, the cancerous tissue of cervical cancer will be necrotic, and the necrotic tissue is mainly discharged through the vagina.

Therefore, the purpose of vaginal lavage is to wash away the necrotic tissue and avoid local infection; second, after radiotherapy, the tissue around the cervix will undergo fibrosis, which may lead to stickiness, making it difficult to detect recurrent cervical cancer.
Lavage can reduce the occurrence of stickiness; third, patients with radiotherapy may have bladder and rectal irritation symptoms, which are manifested as frequent urination, urgency and increased frequency of bowel movements.
Symptoms can be controlled by local medication.

Prevention of HPV infection in healthy people▎Moderator: How can normal people prevent human papilloma (HPV) virus infection? Professor Zhou Qi: As we all know, with the popularization of medical knowledge, everyone has a certain understanding of the correlation between the incidence of cervical cancer and HPV infection.

There are many opportunities for women to be infected with HPV in their lifetime.
The human immune function can eliminate the HPV virus.
Once HPV-positive occurs for more than one year, we call it persistent infection, and the probability of contracting cervical cancer will increase.

Therefore, it is important to pay attention to personal hygiene, especially sexual hygiene, to improve bad living habits, to improve the body's immunity, and to strengthen the ability to resist diseases and prevent infections.

The means to prevent HPV infection mainly include: injection of HPV vaccine.
Currently on the market there are mainly bivalent vaccines, quadrivalent vaccines and nine-valent vaccines.
The valence in the vaccine represents the number of HPV types covered, such as: The bivalent vaccine mainly prevents the infection of HPV16 and HPV18, and the quadrivalent vaccine also prevents the infection of HPV6 and HPV11 on the basis of the bivalent vaccine.

Different vaccines also have corresponding age regulations.
Generally speaking, if a woman is between 9 and 45 years old, she can choose the HPV vaccine that suits her.
Moreover, the younger the age, the better the effect of HPV vaccination. For women of childbearing age, it is not that everything will be well after vaccination, but also cervical cancer screening once every two years.
The screening content is mainly cervical cytology and HPV virus examination.

Through screening, precancerous lesions lurking in the cervix can be found.
As long as the precancerous lesions are blocked in time, the patient can be cured and no longer cause cervical cancer.

The World Health Organization puts forward the goal of eliminating cervical cancer globally by 2030.

To achieve this goal, we need to start with health education, advocate HPV vaccination for young women, do a good job of screening, treat and manage cervical precancerous lesions.
The specific goal is to reach the HPV vaccination rate for girls under 15 years of age.
90%, 70% of women aged 25-65 are screened on time, and 90% of women with cervical lesions have been well managed.
This is also the purpose of this "medical" interview-let everyone Know: Cervical cancer can be prevented, and cervical cancer should be treated in a standardized manner.

Cervical cancer is preventable and controllable, and needs the attention of the whole society! Healthy Chinese health home, caring for women, scientifically preventing cancer.

Expert Profile Zhou Qi Chief Physician, Professor, Doctoral Supervisor, Special Government Special Allowance Expert of the State Council, Member of the Education Committee of the International Gynecological Cancer Union (IGCS), Chairman of the Sixth Gynecological Oncology Committee of the Chinese Anti-Cancer Association (CGCS), Executive Director of the Chinese Anti-Cancer Association Wu Jieping Foundation Deputy Director of the Oncology Department, Director of the China Cancer Foundation, Deputy Leader of the Cervical Cancer Placement Collaboration Group, Deputy Director of the Chinese Clinical Oncology (CSCO) Gynecological Oncology Committee, Executive Director of the Council of Chinese Society of Clinical Oncology, Deputy Director of the Obstetrics and Gynecology Branch of the Chinese Society of Geriatrics Chairman, China Association for Prenatal and Child Care, CSCCP, Vice Chairman, China Health Care International Exchange Promotion Association, Vice Chairman, Committee of Obstetrics and Gynecology, China Association of Preventive Medicine, Standing Committee Member, Cancer Prevention and Control Professional Committee, Chinese Preventive Medicine Association, Chairman, Chongqing Medical Doctors Association, Chongqing Medical Chief Expert