Adolescent and pediatric vaginal clear cell carcinoma

　　The vaginal or cervical clear cell carcinoma in adolescents and children is greatly influenced by their mothers. In the 1940s, diethylstilbestrol was widely used to prevent adverse reactions during pregnancy. In 1971, the U.S. FDA reported that it had the side effect of causing vaginal clear cell carcinoma in female offspring. Fifty years later, this side effect still attracts widespread attention. Robboy believes that if the mother receives estrogen treatment in the first three months before pregnancy, although it only lasts for 1 to 2 months, her offspring may have the possibility of developing cancer. Since the latent period of carcinogenic factors can last up to 10 to 20 years, and can be induced to cause disease by endogenous hormones secreted by the ovaries during puberty. Poskanzer performed vaginal biopsy on 110 adolescents who had used estrogen, and confirmed that 35% developed vaginal adenosis, while only 1% in the group that did not use estrogen.

　　This disease can be complicated by infection, mainly itching of the vulva and vagina, increased vaginal discharge, and congestion and edema of the vulva, clitoris, urethral orifice, and vaginal orifice mucosa. Increased discharge, even purulent discharge. Excessive discharge can stimulate the vulva, causing itching, restlessness, and even scratching with hands. Through fingers and scratched areas, the infection can further spread, with some accompanied by symptoms of urinary urgency and frequency, urinary tract infections, and systemic infections, such as pulmonary infections, etc.

　　This disease is more common in the upper part of the vagina, followed by the cervix. The tumor is usually limited to the upper third of the vagina, and the anterior wall is more common than the posterior wall. Occasionally, it also appears on the lateral wall or the lower third of the vagina. Vaginal discharge, bloody leukorrhea, and irregular vaginal bleeding are the main symptoms of the disease. Some patients have no obvious symptoms and are found during gynecological examination. When the diameter of the lesion is as small as 3mm, it cannot be felt clinically. Some lesions can be as large as 10cm, presenting nodular or polypoid, with a granular feeling when touched, hard and prominent. Some tumors are flat and slightly protuberant from the vagina.

　　For adolescents born after the mother has used estrogen during pregnancy, whether they have symptoms or not, they are all high-risk subjects for clear cell carcinoma of the vagina or cervix. They should undergo vaginal cytological smear examination and gynecological examination every 6 months. In early cases, if only the local lesion is removed, the recurrence rate is still high, so regardless of the stage of the disease, radical surgery is required.

　　Anderson et al. believe that the accuracy of Papanicolaou vaginal smear in diagnosing clear cell carcinoma reaches 73%. Vaginal smear has certain value in screening and diagnosis, and it also helps in monitoring treatment and follow-up reviews. If the smear remains positive after treatment, it indicates that the tumor has not regressed; if the cells have shown degenerative changes, but typical tumor cells are found in multiple smears, it indicates that the tumor has recurred, and further treatment is required.

　　Adolescents and children with clear cell carcinoma of the vaginal canal need to pay more attention to their diet, not only eating more foods that are beneficial for the recovery of the condition, but also being aware of dietary taboos.

　　First, the food that should be eaten by adolescents and children with clear cell carcinoma of the vaginal canal:

　　1. It is advisable to eat anti-tumor foods, such as wheat, Job's tears, water chestnuts, jellyfish, asparagus, fried geckos, fried scorpions, fried centipedes, fried silkworms, and seaweed.

　　2. It is recommended to consume foods that have protective effects against chemotherapy, such as mushrooms, silver ear, black fungus, golden flower, walnuts, sesame seeds, sunflower seeds, kiwi fruit, goat blood, pork blood, goose blood, chicken blood, lotus seeds, mung beans, Job's tears, crucian carp, green beans, sturgeon, shark, plum, almond, and finger citron.

　　Second, dietary taboos for adolescents and children with vaginal clear cell carcinoma:

　　1. Avoid stimulants such as coffee and cocoa.

　　2. Avoid spicy and刺激性 food, such as scallions, garlic, chives, Sichuan pepper, chili, cinnamon, etc.

　　3. Avoid moldy, charred food, such as moldy peanuts, moldy soybeans, charred fish.

　　4. Avoid greasy, salted and dried fish, fried, smoked food.

　　5. Avoid salty foods.

　　6. Avoid smoking and alcohol.

　　The application of traditional Chinese medicine in the treatment of this disease includes: one is when the pathogen is still in the Qi phase at the initial stage, and the other is as part of a comprehensive therapy after surgical treatment in the late stage.

　　First,辨证选方

　　1. Qi Stagnation and Blood Stasis

　　Therapeutic Method: Promote Qi and resolve blood stasis.

　　Herbal Medicine: Modify and add Shaofu Decoction. Danggui 20g, Chishao 15g, Chuanxiong 10g, Lingzhi 15g, Puhuang 15g, Yanhusuo 10g, Moxibuxin 15g, Fangfeng 10g, Ganjiang 10g, Rougui 15g. Add Chenpi and Xiangfu for obvious qi stagnation; add Fuling and Baizhu for obvious leukorrhea; add Baihua Shecaogao and Huangjing for detoxification and removing blood stasis if the condition is severe.

　　2. Damp Heat and Toxin Accumulation

　　Therapeutic Method: Clear heat and drain dampness, detoxify and resolve masses.

　　Herbal Medicine: Add and modify the Zhi Dai Formula. Fuling 20g, Zhuling 20g, Zexie 15g, Chishao 10g, Danpi 10g, Yinchen 10g, Huangbai 10g, Zhizi 10g, Niuxi 10g, Cheqianzi 15g, Baihua Shecaogao 25g, Tufuling 15g. Add Gongying and狄ding for excessive leukorrhea.

　　3. Deficiency of both the heart and spleen

　　Therapeutic Method: Tonify the heart and spleen.

　　Herbal Medicine: Guipi Decoction added. Dangshen 15g, Huangqi 20g, Baizhu 15g, Fushen 20g, Suanzaoren 10g, Guoyuanrou 10g, Muxiang 10g, Zhigancao 10g, Danggui 15g, Yuanzhi 10g, Dazao 10 pieces, Shengjiang 3 slices. Add Shuadi for blood deficiency; remove Dangshen and add Renshen for qi deficiency.

　　Second, Special Prescription

　　1. Hongsheng丹: Red mercuric oxide powder for external use. Action: Remove decay and promote granulation. Suitable for early stage patients with mild illness, and also for patients with late stage illness who cannot undergo surgery.

　　2. Huaxue Huisheng Tablets: Honey pills, 6 grams per pill, 1 pill per time, twice a day after meals, taken with warm wine or warm water. Function: Dissipate stasis and remove blood stasis. Used for blood stasis obstruction during the postoperative recovery period.