Cervical cancer

Cervical cancer
Name	Cervical cancer
Caption	Histopathology of cervical squamous cell carcinoma, a common type.
Field	Gynecologic oncology, Oncology
Symptoms	Abnormal vaginal bleeding, pelvic pain, pain during intercourse
Complications	Kidney failure, Fistula, Metastasis
Types	Squamous cell carcinoma, Adenocarcinoma
Causes	Persistent infection with high-risk Human papillomavirus
Risks	Smoking, HIV/AIDS, multiple sexual partners, early sexual activity
Diagnosis	Pap test, Colposcopy, Biopsy
Differential	Cervical intraepithelial neoplasia, Cervicitis
Prevention	HPV vaccine, screening, safe sex
Treatment	Surgery, Radiation therapy, Chemotherapy
Prognosis	High survival with early detection
Frequency	Fourth most common cancer in women globally
Deaths	Over 300,000 annually

Cervical cancer is a malignancy arising from the uterine cervix, primarily caused by persistent infection with oncogenic strains of the Human papillomavirus. It is a major global health issue, particularly in low-resource settings where screening and vaccination programs are limited. The disease typically develops slowly from pre-cancerous lesions, allowing for effective prevention through regular screening.

Signs and symptoms

Early stages are often asymptomatic, highlighting the critical role of screening. Initial symptoms may include abnormal vaginal bleeding, such as postcoital bleeding, intermenstrual bleeding, or heavy menstrual periods. Advanced disease can present with pelvic pain, pain during intercourse, and a malodorous Vaginal discharge. Severe complications from local invasion or metastasis may involve kidney obstruction, fistula formation, and leg swelling.

Causes and risk factors

The primary cause is persistent infection with high-risk Human papillomavirus types, notably HPV 16 and HPV 18, which are responsible for approximately 70% of cases. Co-factors that increase the risk of progression from infection to cancer include tobacco use, immunosuppression (e.g., from HIV or transplant medications), long-term use of oral contraceptives, and high parity. Behavioral factors such as early age of first sexual intercourse and multiple sexual partners increase exposure to HPV.

Prevention

Primary prevention is achieved through vaccination against HPV with vaccines like Gardasil 9 and Cervarix. The World Health Organization recommends vaccination for girls aged 9-14. Secondary prevention involves regular screening via the Papanicolaou (Pap) smear or HPV DNA testing, which can detect pre-cancerous lesions (Cervical intraepithelial neoplasia). The adoption of barrier protection and smoking cessation are additional preventive measures. Organizations like the American Cancer Society provide screening guidelines.

Diagnosis

Diagnosis typically begins with an abnormal Pap test or HPV test result, prompting further investigation. Colposcopy, a magnified examination of the cervix often performed at institutions like the Mayo Clinic, is the next step, with directed biopsies of suspicious areas. Histopathological analysis confirms the diagnosis and type, most commonly Squamous cell carcinoma or Adenocarcinoma. Staging follows the International Federation of Gynecology and Obstetrics (FIGO) system and may involve imaging such as MRI, CT scan, or PET scan.

Treatment

Treatment depends on the stage, desire for fertility, and patient health. For pre-invasive and early-stage disease (FIGO stages IA1-IB1), options include LEEP, conization, or simple hysterectomy. Radical hysterectomy with pelvic lymph node dissection is standard for slightly more advanced localized disease. For locally advanced cancer (FIGO stages IB2-IVA), primary treatment is concurrent chemoradiation, often using Cisplatin and Brachytherapy. The National Cancer Institute supports clinical trials for advanced or recurrent disease, which may involve agents like Bevacizumab.

Prognosis

Prognosis is highly stage-dependent. The five-year survival rate for localized disease exceeds 90%, but drops significantly for regional and distant spread. Factors worsening prognosis include larger tumor size, lymph node involvement, non-squamous histology, and poor response to Radiation therapy. Follow-up care involves regular examinations and monitoring for recurrence, which may be managed with palliative chemotherapy or Radiotherapy.

Epidemiology

Cervical cancer is the fourth most common cancer among women worldwide, with an estimated 604,000 new cases and over 300,000 deaths in 2020 according to the International Agency for Research on Cancer. The burden is disproportionately high in low- and middle-income countries, particularly in Sub-Saharan Africa, Latin America, and South Asia, due to limited access to vaccination and screening. In high-income countries like the United States and the United Kingdom, widespread screening programs have dramatically reduced incidence and mortality.

Category:Gynecologic cancer Category:Human papillomavirus-associated diseases Category:Women's health