"Doctor, I have heavy menstrual bleeding. I need to use 10 sanitary towels a day." Ms. LIN (pseudonym), 39-year-old, had to hurry to Shenzhen Samii Medical Center (The Fourth People's Hospital of Shenzhen) (SSMC) in the middle of the night due to heavy vaginal hemorrhage. She worriedly told the emergency physician about the troubles of "menstruation". In fact, as early as 3 months ago, Ms. LIN's body had already sounded the alarm: abnormal vaginal bleeding after intercourse; sudden, heavy vaginal bleeding, even to the point of using nearly 10 sanitary towels a day, accompanied by severe abdominal pain. "No, it may be cancer!" After listening to the description of the condition, the emergency physician immediately arranged for a consultation with a gynecologist. After a series of detailed gynecological examinations such as colposcopy and magnetic resonance imaging, it was found that it was not excessive menstruation, but abnormal vaginal bleeding. In other words, she most likely has squamous cell carcinoma of the cervix.

How many years can I live with cervical cancer?

According to the physician, squamous cell carcinoma of the cervix is one of the types of cervical cancer that threatens the health of many women. According to the data from the International Agency for Research on Cancer in 2020, there were 600,000 new cases of cervical cancer worldwide, along with 340,000 deaths. The incidence and mortality are increasing year by year. At present, cervical cancer is the fourth most common cancer affecting women's health in the world and the second largest female malignant tumor in China. Approximately 75% to 80% of all cervical cancers are squamous cell carcinoma of the cervix, which is the most common histological type of cervical cancer.

Ms. LIN held the report with a gloomy face, as if she had been sentenced to death. YANG Rui, Head of the Obstetrics & Gynecology Department of SSIMC, comforted: "Don't be afraid. According to the current clinical diagnosis, you may be in Stage IIA1 (it belongs to moderately differentiated squamous cell carcinoma, which is still in Stage II. So, it can be treated and controlled by surgery and radiochemotherapy, and the prognosis is well), which has a 5-year survival rate of 75%." According to his years of clinical experience, YANG Rui said that Ms. LIN's condition developed to stage II cervical cancer, mainly due to the following 4 factors:

1. She has had sex for more than 20 years, but during this period she has only had B-mode ultrasound and never had cervical cancer screening test.

2. Bleeding occurred for 3 months after intercourse, but she didn't pay attention to it.

3. Insufficient health awareness and unclear understanding of the three common gynecological cancers.

4. Early marriage and early childbearing.

Pelvic and abdominal lymph node dissection + vaginal reconstruction is required in addition to tumor resection

Ms. LIN has already had a son, and she said that she did not want a second child in the future. In order to reduce the risk of cervical cancer recurrence, with Ms. LIN's consent, YANG Rui decided to perform radical hysterectomy + vaginal reconstruction for Ms. LIN. Radical hysterectomy is a very traumatic and difficult operation, which is prone to massive hemorrhage, neurological injury, and tissue injury around the intestine during the operation. There are also risks of severe infection and poor healing of surgical incision after the operation.

In terms of surgical difficulty, this operation is undoubtedly the "ceiling" of obstetrics and gynecology surgeries. YANG Rui led the team to make a comprehensive plan based on the Ms. LIN's condition. This operation included radical hysterectomy, bilateral salpingectomy, bilateral ovarian transposition and pelvic and abdominal lymph node dissection, each of which was customized for Ms. LIN.

First, why is pelvic and abdominal lymph node dissection required after tumor resection? In response to this question, YANG Rui made a vivid metaphor: if the tumor is regarded as a pile of rubbish in the room, sweeping away the rubbish (tumor resection) is something that many people can do. But, in our view, after cleaning the rubbish, wipe all the areas that may be contaminated near the rubbish, which is considered to clean the room thoroughly. Similarly, pelvic and abdominal lymph node dissection can greatly reduce the possibility of cancer recurrence.

YANG Rui is discussing the patient's condition with the obstetricians and gynecologists

Tumor resection did not completely solve Ms. LIN's problem. In order to improve Ms. LIN's life quality in the future, ovarian transposition and vaginal reconstruction should also be performed. Because Ms. LIN's uterus has been cut off, in order to maintain her ovarian functions such as sex hormones metabolism and endocrine in the future, the ovarian transposition is required to preserve her ovaries as much as possible. Since 1/3 of Ms. LIN's vagina had lesions, part of the vagina should to be removed. Therefore, in order to make up for the function of this vagina as much as possible, the physician used part of the bladder and rectum to reconstruct the vagina during the operation. This operation was finally completed successfully with less hemorrhage. Ms. LIN recovered well after the operation, and she will continue with radiotherapy to consolidate the effect of the operation. Ms. LIN also expressed her gratitude to the Obstetrics & Gynecology Department of SSMC.

Precautions for three common gynecological cancers

Based on years of experience, YANG Rui hereby reminds all female friends: "If you're bleeding but not on your menstrual period, you should suspect the possibility of the three common gynecological cancers. Therefore, you should come to the hospital for diagnosis and treatment in time to avoid delaying the best diagnosis and treatment period for the disease."

The following are the high-risk population, main symptoms and examinations required for the three common gynecological cancers summarized by YANG Rui.

Cervical cancer

• High-risk population: women with early marriage, early childbearing, multiple children and sexual disorder.

• Main symptoms: There are generally no obvious symptoms in the early stage, and abnormal vaginal bleeding, contact bleeding, abnormal discharge, and pain may appear as the disease progresses.

• Examinations required: TCT and HPV tests are required every one to two years.

Note: Although the HPV vaccine is an important measure in prevention of cervical cancer, it cannot replace routine screening because the HPV vaccine does not protect against all high-risk HPV types.

Endometrial cancer

• High-risk population: Women over 50 years' old who have not gone through menopause, have no childbearing history, have polycystic ovary syndrome, diabetes, hypertension, long-term medication after breast cancer surgery, or are obese.

• Main symptoms: Patients in the very early stage may have no obvious symptoms. Then, abnormal vaginal bleeding, abdominal pain lower, swelling and pain in the lower limbs, and other symptoms will appear as the disease progresses.

• Examinations required: Pelvic ultrasound, hysteroscopy, and magnetic resonance imaging should be done regularly, and fractional curettage can be done when necessary.

Ovarian cancer

• High-risk population: Women with a family history of ovarian cancer.

• Main symptoms: In the early stage of the disease, there may be no or mild symptoms, accompanied by inappetence, abdominal distension, and marasmus with unknown causes; as the disease progresses, abdominal distension, intra-abdominal masses, pain, or abnormal uterine bleeding may occur.

• Examinations required: Gynecological B-mode ultrasound should be done regularly, combined with blood tests for tumor markers CA125 and HE4.

Source | Crystal News App

Reported by: LUO Dan

Editor: FAN Shaohua