Cervical cancer: Difference between revisions

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{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Cervical cancer
| name = Cervical cancer
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| image = Cervix uteri cancer world map - Death - WHO2004.svg
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| deaths = High mortality in low-resource countries
| deaths = High mortality in low-resource countries
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'''Cervical cancer''' is a [[malignancy]] of the [[cervix]], the lower part of the [[uterus]] that connects to the [[vagina]]. It is the fourth most common [[cancer]] in women globally. Persistent infection with high-risk types of [[human papillomavirus]] (HPV), particularly types 16 and 18, is the leading cause. Early detection through [[screening (medicine)|screening]] and [[HPV vaccination]] has significantly reduced incidence and mortality in many countries.
'''Cervical cancer''' is a [[malignancy]] of the [[cervix]], the lower part of the [[uterus]] that connects to the [[vagina]]. It is the second most common cancer in women worldwide. Early detection through [[screening (medicine)|screening]] has significantly reduced the incidence and mortality rates in developed countries. The most common cause of cervical cancer is persistent infection with high-risk types of the [[human papillomavirus]] (HPV), particularly types 16 and 18.


== Signs and Symptoms ==
== Signs and Symptoms ==


In early stages, cervical cancer may be asymptomatic. However, as the disease progresses, symptoms may include:
[[File:Ca cervicis uteri T2 SAG.jpg|thumb|left|MRI of cervical cancer (T2-weighted sagittal view)]]
In early stages, cervical cancer may present without symptoms. As the disease progresses, it may cause:


* [[Vaginal bleeding]] – postcoital bleeding, intermenstrual bleeding, or postmenopausal bleeding.
* [[Vaginal bleeding]] — postcoital, intermenstrual, or postmenopausal
* [[Pelvic pain]] – persistent pain in the lower abdomen or pelvis.
* [[Pelvic pain]] — persistent or related to intercourse
* [[Dyspareunia]] – pain during sexual intercourse.
* [[Dyspareunia]] — painful sexual intercourse
* Foul-smelling vaginal discharge – often associated with advanced disease.
* Foul-smelling [[vaginal discharge]]
* Urinary or bowel symptoms – due to tumor invasion of nearby structures.
* Urinary or rectal symptoms in advanced stages due to local invasion
 
If metastasis occurs, symptoms may involve lungs, liver, bones, or other distant organs.


== Causes and Risk Factors ==
== Causes and Risk Factors ==


The primary cause of cervical cancer is persistent infection with high-risk HPV strains, particularly HPV-16 and HPV-18. Other risk factors include:
[[File:Figure 28 02 08.JPG|thumb|HPV infection progression to cervical cancer]]
The primary cause of cervical cancer is persistent infection with high-risk HPV strains. Contributing risk factors include:


* Early onset of sexual activity – increased risk of HPV exposure.
* Early sexual activity
* Multiple sexual partners – higher likelihood of contracting HPV.
* Multiple sexual partners
* Smoking – carcinogens in tobacco weaken the immune system.
* [[Smoking]]
* Long-term use of [[oral contraceptives]] – hormonal changes may play a role.
* Long-term [[oral contraceptive]] use
* Immunosuppression – conditions like [[HIV/AIDS]] increase susceptibility.
* [[Immunosuppression]] (e.g., [[HIV/AIDS]])
* Multiparity – having multiple full-term pregnancies.
* High parity (multiple full-term pregnancies)
* Lack of regular screening – delays early detection and treatment.
* Infrequent or no [[Pap smear|screening]]


== Diagnosis ==
== Diagnosis ==


Cervical cancer is diagnosed using various screening and diagnostic tests, including:
[[File:Cervical screening Test Vehicle in Minsheng Community 20120421.jpg|thumb|Mobile cervical screening unit in Taiwan]]


* [[Pap smear]] – detects precancerous changes.
* [[Pap smear]] – detects precancerous changes
* [[HPV DNA test]] – identifies high-risk HPV strains.
* [[HPV DNA test]] – detects high-risk HPV strains
* [[Colposcopy]] – magnified inspection of the cervix.
* [[Colposcopy]] – magnified cervical examination
* [[Biopsy]] – confirms cancer through histological examination.
* [[Biopsy]] – histological confirmation
* [[MRI]], [[CT scan]], or [[PET scan]] – assesses tumor spread in advanced cases.
* Imaging (e.g., [[MRI]], [[CT]], [[PET]]) – staging and spread evaluation


== Histology ==
== Histological Types ==


The most common histological subtypes of cervical cancer include:
[[File:Squamous carcinoma of the cervix.jpg|thumb|right|Advanced squamous carcinoma of the cervix]]
Common histological types include:


* [[Squamous cell carcinoma]] – (~80-85%) arises from the ectocervix.
* [[Squamous cell carcinoma]] (80–85%)
* [[Adenocarcinoma]] – (~15%) originates from glandular cells of the endocervix.
* [[Adenocarcinoma]] (15%)
* [[Adenosquamous carcinoma]] – mixed glandular and squamous features.
* [[Adenosquamous carcinoma]]
* [[Small cell carcinoma]] – aggressive neuroendocrine subtype.
* [[Small cell carcinoma]] (neuroendocrine)
* [[Lymphoma]] and [[melanoma]] – rare occurrences.


== Staging ==
== Staging ==


Cervical cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system, which includes:
Cervical cancer is staged using the [[FIGO]] system:


* Stage 0 – [[Carcinoma in situ]], pre-invasive cancer.
* Stage 0 – [[Carcinoma in situ]]
* Stage I – Cancer limited to the cervix.
* Stage I – Limited to the cervix
* IA – Diagnosed only by microscopy.
* Stage II – Beyond cervix, not to pelvic wall
* IB – Visible lesion or deeper invasion.
* Stage III – Extends to lower vagina/pelvic wall
* Stage II – Cancer extends beyond the cervix but not to the pelvic wall.
* Stage IV – Invades bladder/rectum or distant sites
* Stage III – Tumor spreads to the lower vagina, pelvic wall, or causes hydronephrosis.
* Stage IV – Cancer invades adjacent organs (e.g., bladder, rectum) or distant sites.


== Pathophysiology ==
== Pathophysiology ==


HPV-related cervical cancer involves viral oncogenes, particularly E6 and E7, which:
HPV oncogenes E6 and E7 play central roles:


* E6 – Inactivates tumor suppressor p53, preventing apoptosis.
* '''E6''' inactivates [[p53]], preventing apoptosis
* E7 – Inhibits [[retinoblastoma protein]] (Rb), allowing uncontrolled cell division.
* '''E7''' inhibits [[retinoblastoma protein]] (Rb), promoting uncontrolled division


These changes lead to cervical intraepithelial neoplasia (CIN) and, over time, invasive cancer.
These changes result in [[cervical intraepithelial neoplasia]] (CIN), which can progress to invasive cancer.


== Prevention ==
== Prevention ==


Effective prevention strategies include:
[[File:RICO tobacco litigation corrective statement, Whitehall, PA (cropped).jpg|thumb|Smoking is a modifiable risk factor for cervical cancer]]


* [[HPV vaccine]] – protects against HPV-16, 18, 31, 33, 45, 52, 58.
* [[HPV vaccine]] (e.g., Gardasil, Cervarix)
* Regular screening – routine Pap smears and HPV testing.
* Regular [[Pap smear]] and [[HPV testing]]
* Safe sex practices – use of [[condom]]s reduces HPV transmission.
* [[Condom]] use
* Smoking cessation – lowers the risk of progression from HPV infection to cancer.
* Smoking cessation
* Public health campaigns like [[Cervical Cancer Awareness Month]]


== Treatment ==
== Treatment ==


Treatment depends on the stage and spread of the cancer:
[[File:Diagram showing the position of the applicators for internal radiotherapy for cervical cancer CRUK 344.svg|thumb|left|Brachytherapy for cervical cancer]]
Treatment depends on stage and extent:


* Stage 0 (Carcinoma in situ):
=== Early-stage (Stage 0 & I) ===
* Loop electrical excision procedure (LEEP) or cone biopsy.
* Loop electrosurgical excision procedure ([[LEEP]])
* Hysterectomy in some cases.
* [[Cone biopsy]]
* [[Hysterectomy]] (simple or radical)


* Early-stage (IA & IB):
=== Locally Advanced (Stage II & III) ===
* Radical hysterectomy with pelvic lymph node dissection.
* [[Radiotherapy]] with [[chemotherapy]] (cisplatin-based)
* Radiotherapy for inoperable cases.
* [[Brachytherapy]] (internal radiation)


* Locally advanced (II & III):
=== Advanced-stage (Stage IV) ===
* Concurrent radiotherapy and chemotherapy.
* [[Palliative care]]
* Cisplatin-based chemotherapy.
* [[Targeted therapy]] (e.g., [[Bevacizumab]])
* [[Immunotherapy]] in select patients


* Advanced-stage (IV):
== Epidemiology ==
* Palliative chemotherapy.
* Targeted therapy with bevacizumab (anti-angiogenesis drug).


== Epidemiology ==
[[File:CDC health disparities for cervical cancer PSA.jpg|thumb|CDC campaign on cervical cancer health disparities]]
* Cervical cancer affects over 500,000 women annually
* High incidence and mortality in [[low- and middle-income countries]]
* [[World Health Organization|WHO]] aims for elimination through vaccination, screening, and treatment


* Cervical cancer is the fourth most common cancer in women worldwide.
== History ==
* High incidence in developing countries due to low screening rates.
* HPV-related cancers contribute to over 99% of cases.


In developed countries, routine HPV vaccination and Pap screening have significantly reduced mortality rates.
* Previously linked to sexual activity; rare in celibate women (e.g., nuns)
* Association with HPV confirmed in the 1970s
* [[HPV vaccine]] introduced in the 2000s, revolutionizing prevention


== History ==
== Public Health and Awareness ==


Early studies suggested that cervical cancer was associated with sexual activity:
[[File:Cervical Cryotherapy.png|thumb|left|Cryotherapy to treat precancerous cervical lesions]]


* More common in sexually active women.
* [[Breast and Cervical Cancer Early Detection Program]] in the U.S.
* Rare in nuns, except those who had been sexually active before.
* Global efforts like the [[WHO Cervical Cancer Elimination Strategy]]
* More prevalent in women whose male partners had multiple sexual partners.


The link to HPV was confirmed in the 1970s, and HPV testing is now a crucial part of screening programs.
== Glossary of Cervical Cancer Terms ==
* '''[[Cervarix]]''' – Another [[HPV vaccine]], primarily targeting HPV types 16 and 18, used in the prevention of [[cervical cancer]].
* '''[[Cervical Cancer Gene Database]]''' – A repository of genetic information related to [[cervical cancer]] susceptibility and pathogenesis.
* '''[[Cervical cancer staging]]''' – A classification system, usually based on the FIGO system, that describes the extent of spread of [[cervical cancer]] from stage 0 (pre-invasive) to stage IV (metastatic disease).
* '''[[Cervical conization]]''' – A surgical procedure in which a cone-shaped piece of tissue is removed from the cervix, often to treat or diagnose [[precancerous]] conditions.
* '''[[Cervical drug delivery]]''' – A field of research exploring localized administration of drugs to the cervix to treat or prevent cervical disease.
* '''[[Cervical intraepithelial neoplasia]]''' – Also known as CIN, it refers to abnormal precancerous changes in the cells of the cervix. It is graded as CIN 1 (mild), CIN 2 (moderate), or CIN 3 (severe).
* '''[[Cervical screening]]''' – A public health strategy that includes regular [[Pap tests]], [[HPV testing]], and follow-up procedures to detect cervical abnormalities early.
* '''[[CervicalCheck cancer scandal]]''' – A major public health controversy in [[Ireland]] involving misread cervical screening tests and delayed diagnoses.
* '''[[Cervicography]]''' – A technique in which photographs of the cervix are taken and reviewed by specialists to identify potential precancerous changes.
* '''[[Clear-cell adenocarcinoma of the vagina]]''' – A rare cancer that has been associated with in utero exposure to diethylstilbestrol (DES); relevant due to its similarities with cervical glandular cancers.
* '''[[Colposcopy]]''' – A diagnostic procedure using a special microscope to examine the cervix for abnormal areas after a suspicious Pap test.
* '''[[Dyskaryosis]]''' – An abnormality in the nucleus of cervical cells often seen in Pap smears; considered a sign of potential precancerous change.
* '''[[Gardasil]]''' – A brand of [[HPV vaccine]] that protects against multiple types of [[human papillomavirus]], including those linked to cervical, anal, vulvar, and oropharyngeal cancers.
* '''[[Glassy cell carcinoma of the cervix]]''' – A rare and aggressive form of [[cervical cancer]] with distinct histological appearance and poor prognosis.
* '''[[HPV vaccine]]''' – A preventive vaccine designed to protect against the most common cancer-causing strains of [[human papillomavirus]], such as types 16 and 18.
* '''[[HeLa]]''' – An immortal human cell line derived from [[Henrietta Lacks]], a woman with cervical cancer. Widely used in biomedical research.
* '''[[Human Papillomavirus (HPV) in Ghana]]''' – A topic concerning the prevalence, screening programs, and HPV vaccine access in [[Ghana]].
* '''[[Human papillomavirus infection]]''' – A sexually transmitted infection that is the primary cause of [[cervical cancer]].
* '''[[Koilocyte]]''' – An epithelial cell showing cytopathic effects of [[HPV infection]], commonly found in Pap smears of infected individuals.
* '''[[Liquid-based cytology]]''' – An alternative to the conventional [[Pap smear]] where cervical cells are preserved in a liquid medium, improving test accuracy.
* '''[[Loop electrical excision procedure]]''' – Also called LEEP, this method removes abnormal cervical tissue using a wire loop heated by electric current.
* '''[[Neuroendocrine carcinoma of the cervix]]''' – A highly aggressive and rare type of cervical malignancy characterized by neuroendocrine features.
* '''[[Pap test]]''' – Also called a Pap smear, this screening test collects cervical cells to detect [[precancerous]] or [[cancerous]] changes.
* '''[[Papanicolaou stain]]''' – A multichromatic staining technique used in the [[Pap test]] to highlight cellular details and detect precancerous changes.
* '''[[Speculoscopy]]''' – A visual inspection technique used to examine the cervix with acetic acid and a blue light to identify abnormal tissue.
* '''[[Squamous intraepithelial lesion]]''' – A term used in [[cytology]] reports to describe changes in squamous cells that may be precancerous. Classified as low-grade (LSIL) or high-grade (HSIL).
* '''[[Trachelectomy]]''' – A fertility-sparing surgical procedure involving removal of the cervix while preserving the uterus, often performed for early-stage [[cervical cancer]].
* '''[[Villoglandular adenocarcinoma of the cervix]]''' – A rare variant of [[cervical adenocarcinoma]] seen in younger women, often associated with a favorable prognosis.


== See Also ==
== See Also ==
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== External Links ==
== External Links ==
* [https://www.who.int/health-topics/cervical-cancer WHO: Cervical Cancer Information]
* [https://www.who.int/health-topics/cervical-cancer WHO: Cervical Cancer]\n* [https://www.cancer.org/cancer/cervical-cancer.html American Cancer Society]\n* [https://www.cdc.gov/cancer/cervical/ CDC: Cervical Cancer]
* [https://www.cancer.org/cancer/cervical-cancer.html American Cancer Society: Cervical Cancer]
* [https://www.cdc.gov/cancer/cervical/ CDC: Cervical Cancer]


{{Tumors}}
{{Tumors}}

Latest revision as of 17:23, 26 March 2025

Editor-In-Chief: Prab R Tumpati, MD
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Malignancy of the cervix


Cervical cancer
Synonyms N/A
Pronounce
Field Oncology, Gynecology
Symptoms Vaginal bleeding, pelvic pain, dyspareunia
Complications Metastasis, kidney failure, pelvic pain, fistula formation
Onset
Duration
Types N/A
Causes Human papillomavirus (HPV) infection
Risks Multiple sexual partners, smoking, immunosuppression, oral contraceptive use, multiparity
Diagnosis Pap smear, Colposcopy, Biopsy, HPV DNA test
Differential diagnosis Endometrial cancer, Vaginal cancer, Cervicitis
Prevention HPV vaccine, Regular screening, Safe sex practices
Treatment Surgery, Radiotherapy, Chemotherapy, Targeted therapy
Medication N/A
Prognosis Good if detected early; poor in advanced stages
Frequency Second most common cancer in women worldwide
Deaths High mortality in low-resource countries


Cervical cancer is a malignancy of the cervix, the lower part of the uterus that connects to the vagina. It is the fourth most common cancer in women globally. Persistent infection with high-risk types of human papillomavirus (HPV), particularly types 16 and 18, is the leading cause. Early detection through screening and HPV vaccination has significantly reduced incidence and mortality in many countries.

Signs and Symptoms[edit]

MRI of cervical cancer (T2-weighted sagittal view)

In early stages, cervical cancer may present without symptoms. As the disease progresses, it may cause:

Causes and Risk Factors[edit]

HPV infection progression to cervical cancer

The primary cause of cervical cancer is persistent infection with high-risk HPV strains. Contributing risk factors include:

Diagnosis[edit]

Mobile cervical screening unit in Taiwan
  • Pap smear – detects precancerous changes
  • HPV DNA test – detects high-risk HPV strains
  • Colposcopy – magnified cervical examination
  • Biopsy – histological confirmation
  • Imaging (e.g., MRI, CT, PET) – staging and spread evaluation

Histological Types[edit]

Advanced squamous carcinoma of the cervix

Common histological types include:

Staging[edit]

Cervical cancer is staged using the FIGO system:

  • Stage 0 – Carcinoma in situ
  • Stage I – Limited to the cervix
  • Stage II – Beyond cervix, not to pelvic wall
  • Stage III – Extends to lower vagina/pelvic wall
  • Stage IV – Invades bladder/rectum or distant sites

Pathophysiology[edit]

HPV oncogenes E6 and E7 play central roles:

These changes result in cervical intraepithelial neoplasia (CIN), which can progress to invasive cancer.

Prevention[edit]

Smoking is a modifiable risk factor for cervical cancer

Treatment[edit]

Brachytherapy for cervical cancer

Treatment depends on stage and extent:

Early-stage (Stage 0 & I)[edit]

Locally Advanced (Stage II & III)[edit]

Advanced-stage (Stage IV)[edit]

Epidemiology[edit]

CDC campaign on cervical cancer health disparities
  • Cervical cancer affects over 500,000 women annually
  • High incidence and mortality in low- and middle-income countries
  • WHO aims for elimination through vaccination, screening, and treatment

History[edit]

  • Previously linked to sexual activity; rare in celibate women (e.g., nuns)
  • Association with HPV confirmed in the 1970s
  • HPV vaccine introduced in the 2000s, revolutionizing prevention

Public Health and Awareness[edit]

Cryotherapy to treat precancerous cervical lesions

Glossary of Cervical Cancer Terms[edit]

See Also[edit]

External Links[edit]


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Carcinogenesis
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