Disease Overview
cervicalcarcinomais发lifein子cervicalofmalignant tumor，isgynecologicalthe most commonmalignant tumorone of，second only to乳glandularcarcinoma。globallyeverynew cases annuallycaseapproximately56Ten thousand,Chinanew cases annuallycaseapproximately11Ten thousand,deathcaseapproximately5Ten thousand.peak age of onset40-55years old，in recent yearsshowing a trend toward younger patients。diseasedue tobrightConfirmed,high-risktypeHPVpersistentinfectionisprimary致diseasedue toelement，canthroughscreeningand接typeVaccineeffectiveprevention。early-stagecervicalcarcinomacureratecan达90%and above，advanced-stagerelatively poor prognosis，5yearsurvival rateapproximately50%-60%。
Major Causes
HPVinfection：high-risktypeHPV(16、18type)persistentinfectioniscervicalcarcinomaofNecessary condition,99.7%cervicalcarcinomacantestingtoHPV-DNA。
Sexual behavior: Earlytypelife活(<16years old)、moretypePartner,typePartnerhavecervicalcarcinomaHistory.
Obstetric history：more产(>3胎), Premature birth, primiparityyearEarly age.
Smoking：SmokingincreasingHPVinfectionriskand致carcinomaeffect，femalesSmokingthoseincreased risk2-3times。
long-termoral contraceptives：enablingusingexceeding5yearthoseincreased risk。
Immunosuppression：HIVinfection、long-termenablingusingImmunosuppressionAgents,organTransplantationposterior。
Genetic factors：havecervicalcarcinomafamily historythoseincreased risk。
Other factors: Socioeconomicpositionlow, SanitationlifePoor conditions,Nutritional deficiencyetc.。
Common Symptoms
early-stagesymptoms：typicallynosymptomsorsymptomsnotsignificant，oronlyhaveincreased vaginal discharge。
contact bleeding：mostcommonearly-stagesymptoms，manifestationastypelife活posteriororgynecologicalexaminationposteriorvaginalBleeding.
irregular vaginal bleeding：non-经stagevaginalBleeding,orPostmenopausalposteriorvaginalBleeding.
vaginal discharge: Leukorrheacoloror血type, Thinthinsuch asWateryorRice-washing water-likecondition，haveFishy odor.
advanced-stagesymptoms：
vaginallargebleeding：Tumor invadesvascularcausingFataltypelargebleeding
pain：advanced-stageinvasionPelvic wall,nervecancausingpersistentback pain、underLimb pain
urinary frequency、urinary urgency、dysuria：invasionbladder
constipation, Hematochezia:invasionrectum
under肢edema：iliac veinreceive压orlymph nodesenlargement
systemicsymptoms：advanced-stagecanappearingfever、anemia、emaciation、cachexia。
Pathological Classification
squamous cell carcinoma(75%-80%)：most common type
glandularcarcinoma(15%-20%)：includingcervical管glandularcarcinoma、mucinous adenocarcinomaetc.
adenosquamous carcinoma：relatively poor prognosis
othertype：neuroendocrine carcinoma、small cell carcinoma、clear cell carcinoma
Clinical Staging(FIGO 2018)
Ⅰstage：Tumor confined tocervical
ⅠAstage: Colposcopyunderinvasioncarcinoma
ⅠA1stage：depth of invasion≤3mm，width≤7mm
ⅠA2stage：depth of invasion3-5mm，width≤7mm
ⅠBstage：grossly visiblecarcinomalesion，or镜undercarcinomalesion>ⅠA2
ⅠB1stage：carcinomalesion≤2cm
ⅠB2stage：carcinomalesion2-4cm
ⅠB3stage：carcinomalesion≥4cm
Ⅱstage：tumorBeyondcervical, Not reaching the pelvic wall/vaginalunder1/3
ⅡAstage：invasionvaginalupper2/3，noParametrialinvasion
ⅡA1stage：carcinomalesion≤4cm
ⅡA2stage：carcinomalesion>4cm
ⅡBstage：haveParametrialinvasion, Not reaching the pelvic wall
Ⅲstage：tumorReaching the pelvic wall/vaginalunder1/3，orrenalHydronephrosis/nofunctionrenal，orlymph nodesmetastasis
ⅢAstage：Tumor invadesvaginalunder1/3
ⅢBstage：tumorReaching the pelvic wallorcausingrenal pelvisHydronephrosis/nofunctionrenal
ⅢCstage：lymph nodesmetastasis
ⅢC1stage：pelviclymph nodesmetastasis
ⅢC2stage：para-aorticlymph nodesmetastasis
Ⅳstage：distantmetastasis
ⅣAstage：Tumor invadesbladderorrectummucosa
ⅣBstage：distantmetastasis(pulmonary、hepatic、boneetc.)
Diagnosis
cervical cytology：Pap smear、liquid-based thin-layer cytology test(TCT)
HPVtesting：high-risktypeHPVminutetypetesting，andTCTcombinedscreeningimproveAccuratetype
colposcopy: Colposcopyunderobservedcervicallesionand取biopsy
tissuepathologicalexamination：Diagnosisgold standard，cervicalmore点biopsyorConization
Imaging studies：
pelvicMRI：assessmenttumorsize、depth of invasion, Parametrialinvasion
CT：assessmentlymph nodesmetastasis、distantmetastasis
PET-CT：usinginadvanced-stagestagingandefficacyassessment
Prevention and Follow-up
HPVVaccinationtype: Bivalent, quadrivalent, nine-valent vaccines,canprevention70%-90%cervicalcarcinoma
regularscreening：21-65years oldfemales，every3yearTCTorevery5yearTCT+HPVcombinedscreening
safeSexual behavior：reducetypePartner,enablingusingCondoms
quit smoking and limit alcohol：reduceincidence risk
healthy diet：moreEat fruits and vegetables,reducepickled、smoked and grilledfood品
follow-up：after treatmentfirst 2 yearsevery 3-4 monthsfollow-up examination，years 3-5every 6 monthsonce，after 5 yearsannuallyonce