Epidemiological Trend And Clinical Characteristic Of Cervical Carcinoma In Changchun Territory For The Last 20 Years

Objective:To evaluate the new trend in the epidemiology and the clinical casescharacteristics of cervical cancer in Changchun territory for the last 20 years,andexplore appropriate treatment corresponding to these changes.Methods:The clinical and pathological date of 1844 patients with cervicalcancer treated between January,1985 and December,2005 were retrospectivelyanalyzed in the First,the Second and the Third clinical hospital of JilinUniversity. The epidemiological data, medical history, physical signs, auxiliaryexaminations, course of treatment, histopathological data and follow upinformation from all the patients were all collected into a database and stratifiedby the decade and age of disease onset, and draw the tables according tocorresponding cases data. The data were examined with analysis of variance andKruscal-Wallis test using SPSS12.0 software.Results:1. The new changes in the epidemiology of cervical cancerThe average age of cervical cancer onset gradually decreased over the past20 years. From 54.44±8.74 years in 1985-1990 to 43.06±9.02 years in2001-2005, The rate of young(≤35years old) patients rose from 6.14% to26.83%.The average age in different five years examined with analysis ofvariance have significant statistical differences (P<0.01). The age of cervicalcancer shows young tendency. Furthermore, the ratios of early-stage cancer(stages0～ Ⅰ b) and non-squamous cancer steadily increased. The ratio ofearly-stage increase from 37.88% in 1985-1990 to 58.29% in 2000-2005 . Theratio of non-squamous increase from 9.90% to 20.78%. And the ratio ofadencarcinoma increase from 8.19% to 19.24%.The ratio of poorlydifferentiated increase steadily from 25.94% to 36.66%. The age of menarche ofpatients is ahead. The average age of menarche is ahead from 15.56±1.97 in1985～1990 to 13.74±2.53 in 2001～2005. The average age in different fiveyears examined with analysis of variance have significant statistical differences(P<0.01). The beginning time of sexual life is ealier than before. The beginningtime of sexual life is from 21.93±2.87 in 1985～1990 to 18.76±3.17 in 2001～2005. The average age in different five years examined with analysis of variancehave significant statistical differences (P<0.01).Reported a history of sexuallytransmitted disease(STD) is gradually increase, in the early 2000s, infected thehigh risk type human papilloma virus (HPV) is steadily increase ,but the ratiosof pregnancy and delivery is decrease gradually (P<0.01).2. The young tendency of cervical cancer and its characteristicThe average age of cervical cancer onset gradually decreased over the past20 years. From 54.44±8.74 years in 1985-1990 to 43.06±9.02 years in2001-2005, The rate of young(≤35years old) patients rose from 6.14% to26.83%. The ratio of young patients increase 4.37 times, corresponding, the ratioof old patients decrease. Especially, the young(≤35years old) patients has itsown clinic characteristic, such as: the first and main symptom is contactingbleed;the ratios of early-stage cancer (stages0～ Ⅰb ), non-squamous cancer,lymph nodes mestastasis, poorly differentiated and infected HPV increasedsignificantly.3. Surgical treatmentOut of the 1844 cervical cancer patients, 1506 underwent surgical treatment.For the 39 cases of stage cervical intraepithelial neoplasia (CIN) of grade Ⅲ and7 cases of stage Ⅰa cancer, cervical conization was performed to preservereproductive function.the other 1311 patients underwent radical hysterectomyand pelvic lymphadenectomy, including 154 patients underwent radiotherapybefore operation and 149 patients underwent neoadjuvant intraarterialchemotherapy before operation.the ratio of Surgical treatment rise graduallywith the time going .4. Radiotherapy and Neoadjuvant chemotherapyOf all the patients with cervical cancinoma, 1018 received radiotherapy,among whom 338 received radical radiotherapy including 27 patients of stageb～Ⅱ a who could not tolerate or refused surgery and 311 patients of stageⅡ b～Ⅳ. Adjuvant radiotherapy parior to surgery was performed in 154 patients,among of them , 39 patients pathologic diagnosis after surgery didn't detectcarcinoma tissue , only finding tumor cell of after radiotherapy. Additionradiotherapy after radiotherapy was performed in 526 patients.In recently ten years, 189 patients underwent Neoadjuvant chemotherapy.Of the 24 patients administrated by vein. The rest of 165 patients receivedneoadjuvant intraarterial chemotherapy(NAIC). Overall relieve ratio is 90.3%,after 1～2 course ,149 patients gained the chance of radical hysterectomy andpelvic lymphadenectomy.5. Preservation of reproductive endocrine functionIn 102 patients who dersired pregnancy, cervical conization was performedthe 39 cases of stage cervical intraepithelial neoplasia (CIN) of grade Ⅲ and 7cases of stage Ⅰa cancer;the uterus was not preserved in the other 56 patients instage Ⅰ b or worse. In 467 patients not beyond45 years of age with stage0～Ⅱ bsquamous cancer, either one or both of the ovaries were preserved in situ or bytransposition. Comparing the ovaries in situ preserved, the ovarines weretransposed to iliac fossa could better avoid radiotherapy's risk inducing theovarine exhaustion. The both of the ovarines preserved was better.Conclusion:1. The average age of cervical cancer onset gradually decreased over thepast 20 years;the ratios of early-stage cancer (stages0～Ⅰ b ) and non-squamouscancer steadily increased. The age of menarche of patients is ahead;thebeginning time of sexual life is ealier than before. Reported a history of sexuallytransmitted disease(STD) is gradually increase, in the early 2000s, infected thehigh risk type human papilloma virus (HPV) is steadily increase ,but the ratiosof pregnancy and delivery is decrease gradually.2. The young(≤35years old) patients has its own clinic characteristic, suchas: the first and main symptom is contacting bleed;the ratios of early-stagecancer (stages0～ Ⅰ b), non-squamous cancer, lymph nodes mestastasis, poorlydifferentiated and infected HPV increased significantly.3. Preservation of reproductive endrocrine function ought to be fullyconsidered in cervical cancer treatment in women at childbearing age.4. Surgical treatment combination radiotherapy and chemotherapy is stillthe main way of treating the cervical cancer. Especially, neoadjuvant intraarterialchemotherapy(NAIC) and Chemoradiothrapy are the useful methods for cervicalcancer treatment at present.