What tests are needed before cervical cancer treatment?

Before treatment for cervical cancer, it is usually necessary to complete core items such as pathological biopsy, imaging examination, laboratory examination, endoscopy and systemic assessment. The diagnosis of cervical cancer requires pathological biopsy to clarify the histological type and degree of differentiation. Imaging examinations include pelvic magnetic resonance imaging and chest CT to evaluate the scope and metastasis of the tumor. Laboratory examinations include blood routine, tumor marker screening, and liver and kidney function tests. If necessary, cystoscopy or proctoscopy is required to rule out invasion of adjacent organs. Systemic assessment needs to be combined with electrocardiography and lung function to determine surgical tolerance.

1. Pathological biopsy

Cervical conization or needle biopsy is the gold standard for diagnosis, and can determine the histological types and differentiation levels of squamous cell carcinoma, adenocarcinoma, etc. The biopsy results directly affect the choice of treatment options. For example, early-stage squamous cell carcinoma may preserve fertility, while adenocarcinoma requires more extensive resection. Specimens need to undergo immunohistochemistry to detect PD-L1 expression status to provide a basis for subsequent immunotherapy. A small amount of vaginal bleeding may occur after the biopsy, and strenuous exercise needs to be avoided.

2. Imaging examination

Pelvic magnetic resonance imaging can clearly display tumor size, parametrial invasion depth and lymph node metastasis, with an accuracy of over 90%. Chest CT is used to detect lung metastasis, abdominal ultrasound or CT is used to evaluate the possibility of liver metastasis, and bone scan is suitable for patients with bone pain symptoms. Positron emission computed tomography is suitable for screening systemic metastases in advanced patients, but it is expensive and limited in medical insurance reimbursement.

3. Laboratory examination

Routine blood tests focus on hemoglobin levels to determine the degree of anemia. If the platelet count is too low, surgery may need to be postponed. Among tumor markers, squamous cell carcinoma antigen is of high value for monitoring squamous cell carcinoma, and elevated carcinoembryonic antigen indicates the possibility of adenocarcinoma. Abnormal liver and kidney function requires adjustment of the dosage of chemotherapy drugs, and HIV and syphilis screening are related to the level of surgical protection. Patients with hypothyroidism require preoperative hormone replacement therapy.

4. Endoscopy

Cystoscopy is suitable for patients whose tumors are located on the anterior lip of the cervix and whose bladder invasion is suspected on magnetic resonance imaging. It can be seen whether the mucosa in the trigone area of ​​the bladder is rough and bulging. Proctoscopy is used to rule out rectal infiltration for posterior lip tumors, and biopsy under the microscope can clarify the staging. A cleansing enema is required before the examination, and temporary hematuria or anal discomfort may occur after the operation. Organ invasion found during endoscopy requires multidisciplinary consultation to adjust the treatment plan.

5. Whole body assessment

Electrocardiogram screens for arrhythmias and myocardial ischemia, and those with abnormalities require cardiology consultation. Use bleomycin chemotherapy with caution if the carbon monoxide diffusing capacity in pulmonary function testing is lower than 60%. A score of ≥3 on the Nutritional Risk Screening Scale requires preoperative nutritional support. Psychiatric evaluation focuses on the degree of anxiety and depression, and psychological intervention is required when necessary. Patients with diabetes need to optimize blood sugar control to less than 8mmol/L on an empty stomach before surgery.

Before treatment, HPV typing testing must be completed to guide prognosis judgment, and the vulva must be kept clean to avoid infection during the examination. It is recommended that family members accompany the patient to participate in doctor-patient communication and prepare loose clothing for easy inspection. During the postoperative recovery period, you can take appropriate amounts of high-quality protein such as fish, eggs, and milk, and avoid spicy and irritating foods. Thirty minutes of aerobic exercise 3-5 times per week can help improve treatment tolerance, but should be paused during vaginal bleeding. Regularly review routine blood tests to monitor bone marrow suppression. If fever or abnormal vaginal discharge occurs, timely medical attention is required.