a Department of Oncology-Pathology, Karolinska Institutet, and Unit of Gynecological Oncology, Radiumhemmet , Karolinska University Hospital , Stockholm , Sweden.
b Clinical Cancer Epidemiology, Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.
Acta Oncol. 2018 Mar;57(3):338-345. doi: 10.1080/0284186X.2017.1400684. Epub 2017 Nov 15.
Women who have been treated for cervical cancer have persistent changes in their sexual function, which result in considerable distress. The aim of this study was to investigate the morphology of the vaginal epithelium in cervical cancer survivors treated with radiotherapy and its correlation to serum levels of sex steroid hormones and sexual function.
We included 34 patients treated for cervical cancer with radiotherapy and 37 healthy age-matched control women scheduled for benign gynecological surgery. After inspection and grading of vaginal atrophy, vaginal biopsies were taken. Epithelial structures were analyzed by measuring epithelial thickness as well as the number, height and width of the dermal papillae and the dermal papillae distance. Sex steroid hormone levels were analyzed and a questionnaire designed to assess sexual function was filled out.
In the cervical cancer survivors treated with radiotherapy, the vaginal epithelium volume was reduced compared to control women. Longer distance between the dermal papillae (p < .001) and a shorter distance from basal layer to epithelial surface (p < .05) were measured. Mucosal atrophy was observed in 91% of the survivors. There was no difference in serum estradiol between cancer survivors and control women, implying that the cancer survivors were sufficiently substituted. The epithelial thickness correlated to serum levels of estradiol. The cervical cancer survivors reported more physical sexual symptoms. The highest relative risk (RR) was found for insufficient vaginal lubrication (RR 12.6), vaginal inelasticity (RR 6.5), reduced genital swelling when sexually aroused (RR 5.9), and for reduction of vaginal length during intercourse (RR 3.9).
We found that cervical cancer treatment including radiotherapy is associated with vaginal epithelial atrophy and sexual dysfunction. To hamper the atrophic process affecting the sexual function, an early start of local estrogen after therapy might be of importance.
接受宫颈癌治疗的女性其性功能会持续发生改变，从而导致相当大的痛苦。本研究旨在探讨接受放疗的宫颈癌幸存者阴道上皮形态及其与血清性激素水平和性功能的相关性。
我们纳入了 34 名接受放疗的宫颈癌患者和 37 名年龄匹配的健康对照组女性，这些女性计划接受良性妇科手术。在检查和阴道萎缩分级后，进行阴道活检。通过测量上皮厚度以及真皮乳头的数量、高度和宽度以及真皮乳头之间的距离，分析上皮结构。分析了性激素水平，并填写了一份评估性功能的问卷。
接受放疗的宫颈癌幸存者的阴道上皮体积与对照组女性相比有所减少。真皮乳头之间的距离更长（p<0.001），基底细胞到上皮表面的距离更短（p<0.05）。91%的幸存者存在黏膜萎缩。癌症幸存者和对照组女性的血清雌二醇水平没有差异，这意味着癌症幸存者已经得到了充分的替代。上皮厚度与血清雌二醇水平相关。宫颈癌幸存者报告了更多的身体性功能症状。发现未充分阴道润滑的相对风险最高（RR 12.6），阴道无弹性（RR 6.5），性唤起时生殖器肿胀减少（RR 5.9），性交时阴道长度缩短（RR 3.9）。
我们发现包括放疗在内的宫颈癌治疗与阴道上皮萎缩和性功能障碍有关。为了阻止影响性功能的萎缩过程，治疗后尽早开始局部雌激素治疗可能很重要。
