Cervical cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]
Overview
Cervical cancer is a malignant cancer of the cervix. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages, which has made cervical cancer the focus of intense screening efforts using the Pap smear. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Most scientific studies have found that human papillomavirus (HPV) infection is responsible for virtually all cases of cervical cancer.[1][2] Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced stages of the disease. An effective HPV vaccine against the two most common cancer-causing strains of HPV has recently been licensed in the U.S. (see Vaccine section, below). These two HPV strains together are responsible for approximately 70%[3][4] of all cervical cancers. Experts recommend that women combine the benefits of both programs by seeking regular Pap smear screening, even after vaccination.
Historical Perspective
Cervical cancer was first described in 400 BC. In 1928, the Papanicolaou technique was developed by Papanicolaou to diagnose cervical cancer. In 1976, Harald zur Hausen and Gisam were the first to discover the association between HPV and development of cervical cancer.
Classification
Cervical cancer may be classified into many subtypes based on WHO histological classification.
Pathophysiology
Cervical cancer arises at squamous-columnar junction.
Epidemiology and Demographics
Cervical cancer is one of the most common and fatal forms of cancer worldwide.
Risk Factors
Cervical cancer is associated with a range of risk factors including, genetic, environmental and infection-based exposures.
Natural History, Complications and Prognosis
Prognosis depends on the stage of the cancer. With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with stage IV cancer are alive after 5 years.
Diagnosis
Staging
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervicalcurettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervicalconization.
History and Symptoms
Cervical cancer may be entirely asymptomatic at first, later manifesting in a range of symptoms such as loss of appetite, fatigue, and edema.
Other Diagnostic Studies
Cervical biopsy is the confirmatory test for the diagnosis of cervical cancer or pre-cancer.
Treatment
Primary Prevention
Prevention of cervical cancer includes a comprehensive approach involving awareness, screening, and usage of preventative vaccinations.