Cervical Cancer

– Cancer of the cervix, predominantly squamous cell carcinoma (90% of cases). The remaining 10% are adenocarcinomas and are thought to be related to in utero exposure to diethylstilbestrol.

Causes and Incidence

Cervical cancer is now generally considered a sexually transmitted disease (STD). Probable agents are the human papilloma viruses, with the herpes simplex virus a possible cofactor. Also, research suggests a possible dietary link, with deficiencies in vitamins A and C and folic acid contributing to cervical cancer. Cancer of the cervix is the second most common malignancy of the female reproductive tract, with more than 13,500 cases diagnosed annually in the United States; in addition, 45,000 cases of carcinoma in situ are diagnosed each year. Cervical cancer is most common among women of lower economic status, and the age at diagnosis is declining. Women with a history of early, frequent coitus and multiple sex partners are at greater risk. The death rate from cervical cancer remains high among women in underdeveloped nations.

Disease Process

Cervical cancer begins as a neoplastic change in the cervical epithelium and eventually involves the full thickness of the epithelium. An invasive tumor forms in a cauliflower shape, with a friable texture and a hard, nodular edge. The bladder, rectum, and lungs are common sites of invasion and metastasis.

Symptoms

Cervical cancer has no characteristic or typical symptom. Bleeding, which begins as a blood-tinged discharge and progresses to spotting and frank bleeding, is the only significant sign. The bleeding is caused by ulceration of the epithelial surface; however, some tumors spread without ulceration and thus without bleeding. Other possible indicators include prolonged menstrual periods or an increase in number of periods, and bleeding immediately after intercourse.

Potential Complications

The prognosis with carcinoma in situ and noninvasive tumors is excellent, with survival rates approaching 100%. The prognosis with advanced disease is dismal, and complications arise from spread to the bowel, bladder, and pelvis and metastasis to the lung.

Diagnostic Tests

If a Papanicolaou (Pap) smear of the cervix reveals atypical cells, a definitive diagnosis is obtained by colposcopy or biopsy. Cervicography may aid in staging of the tumor.

Treatments

Surgery
Conization, cryotherapy, electrocautery, laser ablation to treat carcinoma in situ; hysterectomy to treat tumors with no parametrial invasion; pelvic exenteration to treat advanced disease.

Drugs
Chemotherapy in experimental treatment stage for advanced disease.

General
Radiation to treat invasive disease and recurrences and as a palliative measure; counseling for body image and changes in sexual functioning.

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