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.
Differential diagnosis
Cervical cancer must be differentiated from other diseases that cause abnormal vaginal bleeding, such as cervical polyp, cervical leiomyoma, invasion of the cervix from primary uterine malignancy, vaginal cancer, cervical lymphoma, adenoma malignum, metastases to cervix, and cervical ectopic pregnancy.
Epidemiology and Demographics
Worldwide, cervical cancer is the third most common cancer among women and the second most frequent cause of cancer-related death, accounting for nearly 300,000 deaths annually.[1] In developing nations, it is often the most common cause of cancer-related death among women and a leading cause of death overall.[1] Once one of the most common cancers affecting U.S. women, cervical cancer now ranks 14th in frequency.[1] Because precancerous lesions found by Pap smears can be treated and cured before they develop into cancer, and because cervical cancer is often detected before it becomes advanced, the incidence and death rates for this disease are relatively low.[1] According to the most recent data, the age-adjusted incidence rate for cervical cancer was 6.73 cases per 100,000 women in the United States in 2011.
Risk Factors
The most potent risk factor in the development of cervical cancer is Human papillomavirus (HPV) infection. Other risk factors include smoking, increased number of sexual partners, and young age at time of first sexual intercourse.
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.