Staging of cervical cancer

Written by Gong Chun
Oncology
Updated on September 25, 2024
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The clinical staging of cervical cancer mainly uses the FIGO system, which adopts the staging criteria of the International Federation of Gynecology and Obstetrics (FIGO). Staging should be performed before treatment, and once done it does not change after treatment. Since FIGO staging of cervical cancer primarily relies on pelvic examination, it emphasizes the necessity of this examination being conducted by two experienced gynecologic oncologists. If needed, a pelvic examination under anesthesia is performed to ensure the accuracy of the evaluation. So, how is the staging performed? It involves measuring the size of the cervical lesion, particularly the measurement of endophytic tumors, the infiltration of cervical tissue, and the status of pelvic lymph nodes, providing accurate information with the aid of radiological data, especially magnetic resonance imaging (MRI).

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Characteristics of Bleeding in Cervical Cancer

The bleeding characteristics of cervical cancer should be considered based on the pathological type and stage of the disease. In the early stages, the bleeding may be contact-related, occurring after sexual intercourse or a gynecological examination, and may involve a small amount of fresh, light bleeding. As the disease progresses into the later stages, the tumor may cause irregular vaginal bleeding. The amount of this irregular bleeding varies, depending on the size of the lesion and the involvement of the blood vessels in the interstitial tissues. A larger lesion may naturally result in more bleeding. In advanced stages, major blood vessels may be affected, potentially leading to severe bleeding. Therefore, the characteristics of vaginal bleeding should be analyzed based on the specific circumstances. If the cancer is exophytic, bleeding tends to occur earlier and is usually more copious, whereas if it is endophytic, bleeding tends to occur later.

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How is cervical cancer screened?

Cervical cancer screening is a routine gynecological examination item for married women and women who are sexually active. Cervical cancer screening includes TCT (ThinPrep Cytologic Test) and HPV (Human Papillomavirus) tests. The TCT is a cytological examination of the cervix to determine if there are any cervical lesions based on cell morphology. HPV is the human papillomavirus, and its presence is a high-risk factor for cervical cancer. Therefore, cervical cancer screening consists of both TCT and HPV tests. If abnormalities are found in either test, a cervical biopsy may be necessary to confirm the presence of cervical lesions. It is best to conduct these tests between three to seven days after the end of menstruation.

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Precursors of cervical cancer

The occurrence and development of the cervix is a process from quantitative to qualitative change, evolving gradually to a sudden shift over a long period. The precursor might be the heterotypic zone of the cervix, which is a common site for abnormalities. During the formation of this heterotypic zone, cervical epithelial metaplasia is relatively active, and, compounded by infection with the human papillomavirus and further stimulated by external carcinogens, immature or proliferative squamous epithelial cells may exhibit gradual changes or atypical hyperplasia, potentially leading to sarcomatoid changes in the cervical epithelium. This might be a precursor sign.

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Is cervical polyp cervical cancer?

Cervical polyps are not cervical cancer. Most cervical polyps are caused by chronic inflammation of the cervix, whereas cervical cancer is caused by human papillomavirus (HPV) infection. After removing a cervical polyp and conducting a pathological examination, if it is benign, it is considered cured. However, cervical cancer is a malignant tumor that requires surgery. If high-risk factors are present after surgery, radiotherapy and chemotherapy are necessary. Therefore, these two diseases are different and vary in severity.

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How to get the cervical cancer vaccine?

The cervical cancer vaccine is administered in the same way as regular vaccines, which is an injection in the deltoid muscle. However, the scheduling of the subsequent doses of the cervical cancer vaccine differs. For the bivalent cervical cancer vaccine, the second dose is administered one month after the first dose, and the third dose at six months. For the quadrivalent and nonavalent vaccines, the second dose is administered two months after the first, with the third dose given at six months.