Real cases
Yayi (pseudonym) is 27 years old, and she has not yet given birth after 2 years of marriage. 1 year ago, Yayi tested positive for HPV16 in the outer hospital, TCT results: no intraepithelial lesions were seen. Yayi felt that he had no symptoms, TCT showed no lesions, and only 2 years of sexual history, so he did not go to the doctor, thinking of checking it again in half a year to 1 year.
In January 2022, YaYi went to the outer courtyard again to check the colposcopy, and the biopsy pathology suggested chronic cervical inflammation with atypical hyperplasia of the glandular epithelium. This "atypical hyperplasia" can scare YaYi, and she quickly took the pathological slices to our hospital for consultation.
The outcome of the consultation was worse than Yayi thought: cervical adenocarcinoma in situ. Based on the consultation opinions, we recommend colposcopic evaluation + LEEP.
Ya Yi is obviously just ANV infection, how did it become a precancerous lesion in just one year?
How far does HPV get to cervical cancer?
HPV infection cervical intraepithelial lesions Cervical cancer This is a necessary process for the vast majority of cervical cancers to occur. Cervical intraepithelial lesions are divided into low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions (including CIN2 and CIN3), and adenocarcinoma in situ. Among them, high-grade squamous intraepithelial lesions and adenocarcinoma in situ are precancerous lesions of the cervix.
However, not all HPV infections lead to cervical cancer, and high-risk HPV+ persistent infection is the high risk factor for the vast majority of cervical cancers. From HPV infection to the development of cervical cancer, it often takes 5 to 10 years, so regular screening can help patients treat in time and nip the cancer in the bud.
High-risk HPV:
HPV16、18、31、33、35、39、45、51、52、56、58、59、68、82
Cervical cancer screening recommendations:
< 25 years of age, sexually active women undergo annual cervical cytology (TCT/LCT).
Women aged 25 to 29 who are sexually active undergo regular screening for cervical cytology and HPV or cervical cytology.
≥ 30 years of age, sexually active women are regularly screened for combined cervical cytology and HPV.
Doctors also use HPV and cytology results to determine whether further colposcopic biopsies are needed.
Who is the strongest king of cervical cancer?
Among all the high-risk HPV viruses, HPV16 and 18 belong to the "most toxic kings", which are associated with more than 70% of cervical cancers. When HPV16/18 is positive, colposcopy is required as soon as possible, even if there are no abnormalities in the cytology screen.
In addition, even if HPV is negative, cytology screening suggests atypical glandular cells and requires colposcopy as soon as possible, as some cervical adenocarcinomas are not associated with HPV infection.
How terrible is a precancerous lesion of the cervix?
According to the postoperative pathological analysis of precancerous cervical lesions IN our hospital, the total proportion of cervical cancer found after precancerous lesion LEEP was 6.76%, of which the proportion of invasive cervical adenocarcinomas found after LEEP in situ adenocarcinoma was as high as 24%.
Whether it is to prevent the progression of precancerous lesions to cervical cancer or to detect occult cervical cancer, it shows the importance of precancerous lesions that need to be treated in a timely manner. Otherwise, delayed treatment requires a greater surgical scope, greater trauma to the human body, and the aggravation of the disease requires removal of the uterus and loss of reproductive function.
Cervical precancerous lesions, how to treat?
According to international guidelines, biopsy pathology confirms that high-grade squamous intraepithelial lesions (CIN2 or CIN3) are preferred for cervical coneectomy (including LEEP and cold knife cone), and a small proportion of patients can receive laser ablation, which requires a professional doctor to evaluate the condition of the lesion under colposcopy. Cervical cone are recommended for adenocarcinoma in situ (AIS).
Emphasis! Treatment of all CIN3 in nonpregnant women is not recommended for observation. The study found that cin2 was conservatively treated in 50% of the population, 50% resolved, 32% persisted, and 18% progressed to CIN3+; therefore, CIN2 was recommended for nonpregnant women.
Author Introduction
Shen Fang, attending physician in the Department of Cervicology. Graduated from Fudan University, he specializes in the diagnosis and treatment of precancerous lesions of the reproductive tract and occult cervical cancer.
Written by Specialist
Cong Qing, Secretary of the Center for the Diagnosis and Treatment of Cervical and Vaginal Early Diseases, Ph.D., Deputy Chief Physician, Master Supervisor.
Expertise:
Colposcopy, hysteroscopy and surgery. Including cervical precancerous lesions, early cervical cancer, vaginal, vulvar intraepithelial lesions, vulvar leukoplakia, uterine cavity mass, uterine adhesions, as well as refractory pelvic inflammatory disease, vaginitis and vulvitis and other common gynecological diseases diagnosis and treatment.
Clinic Hours:
Wednesday Afternoon Specialist Clinic (Yangpu Campus)
Monday afternoon vulvar week clinic (Yangpu Campus)
Auditing Specialist
Sui Long, Director of the Cervical and Vaginal Early Disease Diagnosis and Treatment Center, Chief Physician, Doctoral Supervisor.
Specialty: cervical lesions, vaginal endothelial neoplasia, vulvar endothelial tumor diagnosis and treatment; colposcopy technology; LEEP technology; laser treatment technology; freezing technology; high-energy focused ultrasound technology. The application of high-resolution anoscopic technology in the diagnosis and treatment of anal and anal canal precancerous lesions was the first in China; the application of hysteroscopic technology to diagnose and treat various diseases of the uterine cavity, especially in the correction of uterine malformations, endometrial resection of menorrhagia, complex uterine fibroid resection, cesarean incision diverticulum rectification, early endometrial cancer fertility preservation surgery, and accumulated rich experience in the basic and clinical research of reproductive-related uterine adhesions, minimally invasive treatment and prevention.
Clinic Hours:
Tuesday Morning (Huangpu Campus Special Needs Clinic)
Friday Morning (Yangpu Branch Special Needs Clinic)
Author: Shen Fang, Cong Qing
Editor: Li Miaoran