Cervical cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Common complications of cervical cancer include pain, vaginal bleeding, fistula and renal failure. Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 70%.
Natural history
- Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%.[1][2]
- Progression to cervical cancer in situ (CIS) occurs in approximately 11% of cervical intraepithelial neoplasia(CIN1) and 22% of cervical intraepithelial neoplasia(CIN2). Progression to invasive cancer occurs in approximately 1% of cervical intraepithelial neoplasia (CIN1), 5% in cervical intraepithelial neoplasia (CIN2) and at least 12% in cervical intraepithelial neoplasia (CIN3)
- Once the cancer spreads to the other organs, it is most likely fatal.
Complications
Advanced stage of cervical cancer can cause varieties of complications, some of these are include:[3]
- Pain
- Vaginal hemorrhage
- Enterovaginal, rectovaginal, and vesico- or ureterovaginal fistulas
- Renal failure and/or uremia
- Malnutrition
- Anemia
- Mental depression
Prognosis
The prognosis for patients with cervical cancer is Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%, this is heavily because of annual screening wiht Pap smear and introduction of new preventive methods like HPV vaccination to decrease the mortality and incidence rates. Majority of cervical cancer cases can be detected early through the use of screening by Pap test and HPV DNA testing.
Prognosis of cervical cancer depends upon the clinical stage of the disease and distant metastasis.[1][2][4]
These prognostic factors that affecting survival rate are include:[5]
- Patient age
- Maximum tumor diameter of ≥6 cm
- Pelvic lymph node enlargement, and distant metastasis
- Pretreatment hemoglobin level
- Concurrent chemoradiotherapy, increases survival rate significantly in patients with advanced stage of cervical cancer in comparison with those receiving radiation therapy alone.
- Performance status
- Bilateral disease
- Clinical stage
- Other prognostic factors
- Other prognostic factors that may affect outcome include the following:
- Human immunodeficiency virus (HIV) status: Women with HIV have more aggressive and advanced disease and a poorer prognosis.
- C-myc overexpression: A study of patients with known invasive squamous carcinoma of the cervix found that overexpression of the C-myc oncogene was associated with a poorer prognosis.
- Number of cells in S phase: The number of cells in S phase may also have prognostic significance in early cervical carcinoma.
- HPV-18 DNA: HPV-18 DNA has been found to be an independent adverse molecular prognostic factor. Two studies have shown a worse outcome when HPV-18 was identified in cervical cancers of patients undergoing radical hysterectomy and pelvic lymphadenectomy.
- A polymorphism in the Gamma-glutamyl hydrolase enzyme, which is related to folate metabolism, has been shown to decrease response to cisplatin, and as a result is associated with poorer outcomes.
Refrences
- ↑ 1.0 1.1 Yuan, Chiou-Chung; Wang, Peng-Hui; Lai, Chiung-Ru; Tsu, En-Jie; Yen, Ming-Shyen; Ng, Heung-Tat (1999). "Recurrence and Survival Analyses of 1,115 Cervical Cancer Patients Treated with Radical Hysterectomy". Gynecologic and Obstetric Investigation. 47 (2): 127–132. doi:10.1159/000010076. ISSN 0378-7346.
- ↑ 2.0 2.1 B.K., Vishma; B., Prakash; Kulkarni, Praveen; M., Renuka (2016). "Survival and prognostic factors for cervical cancer: a hospital based study in Mysuru, India". International Journal of Community Medicine and Public Health: 218–223. doi:10.18203/2394-6040.ijcmph20151566. ISSN 2394-6032.
- ↑ Schmitz, Herbert E.; Isaacs, John H. (1957). "Complications of Advanced Cervical Cancer and Their Management". Radiology. 69 (3): 324–329. doi:10.1148/69.3.324. ISSN 0033-8419.
- ↑ Jung, Kyu-Won; Won, Young-Joo; Kong, Hyun-Joo; Oh, Chang-Mo; Shin, Aesun; Lee, Jin-Soo (2013). "Survival of Korean Adult Cancer Patients by Stage at Diagnosis, 2006-2010: National Cancer Registry Study". Cancer Research and Treatment. 45 (3): 162–171. doi:10.4143/crt.2013.45.3.162. ISSN 1598-2998.
- ↑ Endo, Daisuke; Todo, Yukiharu; Okamoto, Kazuhira; Minobe, Shinichiro; Kato, Hidenori; Nishiyama, Noriaki (2015). "Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort". Journal of Gynecologic Oncology. 26 (1): 12. doi:10.3802/jgo.2015.26.1.12. ISSN 2005-0380.