Author: Wen Qiang (Zhejiang Cancer Hospital)
Before discussing this issue, let’s take a look at the following clinical cases:
Case 1: Female, 49 years old, vaginal discharge for 3 months. The gynecological examination revealed that the cervix was hypertrophic and hard, and only a small amount of atypical squamous cells was obtained from cervical biopsy and cervical canal scraping.
However, pelvic MRI revealed a 5 cm diameter mass in the cervical canal, so a transvaginal puncture was performed under B-ultrasound localization, and it was finally found to be cervical cancer.
Case 2: Female, 65 years old, with irregular vaginal bleeding for 2 months. Colposcopy revealed severe cervical atrophy and severe erosion. At that time, the doctor only took a few biopsies on the surface of the cervix. Do cervical scraping.
Image source: Zhanku Hailuo
Biopsy pathology report suggests: chronic inflammation of cervical mucosa with high-grade squamous intraepithelial lesion. Cervical intraepithelial lesions were diagnosed and cervical conization was performed.
During the operation, a cauliflower-like tumor was found in the cervical canal. Part of the tissue was taken out and sent for pathological examination. The result was confirmed to be cervical squamous cell carcinoma.
Case 3: Female, 42 years old, vaginal contact bleeding for half a year, severe cervical erosion was found in gynecological examination, and a cauliflower-like tumor with a diameter of about 1 cm was seen locally, but both biopsy results indicated: cervical High-grade squamous intraepithelial lesion [CIN I (cervical intraepithelial neoplasia I)].
Therefore, loop electrosurgical excision procedure (LEEP) was performed, and the postoperative pathological findings were CIN III grade, with local early invasive cancer, so the operation was performed again.
Readers may have questions, The initial examination is a precancerous lesion, how can it eventually become cervical cancer?
Actually, from cervical precancerous lesions to cervical cancer is a continuous process, but different parts of the cervix progress at different speeds.When a certain When some parts are still in precancerous lesions, other parts may have become invasive cancer, that is, real cancer tissue.
Image source: Zhanku Hailuo
Therefore, it is entirely possible for two lesions to appear in the same patient at the same time, especially some early invasive lesions, which look similar to precancerous lesions with the naked eye. It’s hard to tell the difference.
Alternatively, if the patient is older, the cervix is atrophied, or the tumor is located in the cervical canal, there may be cases where what looks like a precancerous lesion on the outside is actually cancerous .
At this time, if the biopsy doctor is inexperienced, it is possible that only precancerous tissue is obtained, but no cancer tissue, and the patient will be treated as cervical intraepithelial neoplasia change to treatment.
The good news is that these patients often undergo cervical LEEP or cervical conization, which are much more extensive than cervical biopsy and can remove all of the problematic cervical tissue Excised, then made into a pathological section, and re-observed under a microscope.
During this process, it is possible to find invasive cancer lesions that were not found in the original biopsy, avoiding the occurrence of missed diagnosis.
Of course, the patient’s diagnosis has changed from cervical precancerous lesions to cervical cancer, and many patients have to undergo surgery again. Although reoperation often requires removal of the uterus, it is still worthwhile compared to delaying the disease after a missed diagnosis.
In addition to surgery, there are some auxiliary tests that can also be used to help us make judgments, such as pelvic CT (computed tomography, electronic computed tomography) and magnetic resonance imaging. Resonance, if the patient has tumors in the cervical canal, these imaging tests can help doctors find these lesions, and then formulate targeted examinations and treatments.
In addition, there are gynecological tumor markers. Usually, the indicators of patients with cervical precancerous lesions are normal. If it is found to be significantly increased, it is highly suspected whether there is the possibility of cervical cancer at the same time.
Image source: Zhanku Hailuo
In short,Cervical precancerous lesions and cervical cancer can coexist. Especially for some early lesions or lesions located in the cervical canal, it is difficult to detect by the naked eye alone, and requires the help of colposcopy, cervical canal scraping, cervical LEEP or Cervical conization for diagnosis.
This requires doctors to pay more attention and accumulate experience in order to reduce the occurrence of missed diagnosis.
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