Cervical cancer: Difference between revisions

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{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Cervical cancer
| name = Cervical cancer
| image =
| image = Cervix uteri cancer world map - Death - WHO2004.svg
| caption =
| caption =
| pronounce =
| pronounce =
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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.
* [[Pelvic pain]] – persistent pain in the lower abdomen or pelvis.
* [[Dyspareunia]] – pain during sexual intercourse.
* Foul-smelling vaginal discharge – often associated with advanced disease.
* Urinary or bowel symptoms – due to tumor invasion of nearby structures.


If metastasis occurs, symptoms may involve lungs, liver, bones, or other distant organs.
* [[Vaginal bleeding]] — postcoital, intermenstrual, or postmenopausal
* [[Pelvic pain]] — persistent or related to intercourse
* [[Dyspareunia]] — painful sexual intercourse
* Foul-smelling [[vaginal discharge]]
* Urinary or rectal symptoms in advanced stages due to local invasion


== 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):
* Loop electrical excision procedure (LEEP) or cone biopsy.
* Hysterectomy in some cases.


* Early-stage (IA & IB):
=== Early-stage (Stage 0 & I) ===
* Radical hysterectomy with pelvic lymph node dissection.
* Loop electrosurgical excision procedure ([[LEEP]])
* Radiotherapy for inoperable cases.
* [[Cone biopsy]]
* [[Hysterectomy]] (simple or radical)


* Locally advanced (II & III):
=== Locally Advanced (Stage II & III) ===
* Concurrent radiotherapy and chemotherapy.
* [[Radiotherapy]] with [[chemotherapy]] (cisplatin-based)
* Cisplatin-based chemotherapy.
* [[Brachytherapy]] (internal radiation)


* Advanced-stage (IV):
=== Advanced-stage (Stage IV) ===
* Palliative chemotherapy.
* [[Palliative care]]
* Targeted therapy with bevacizumab (anti-angiogenesis drug).
* [[Targeted therapy]] (e.g., [[Bevacizumab]])
* [[Immunotherapy]] in select patients


== Epidemiology ==
== Epidemiology ==


* Cervical cancer is the fourth most common cancer in women worldwide.
[[File:CDC health disparities for cervical cancer PSA.jpg|thumb|CDC campaign on cervical cancer health disparities]]
* High incidence in developing countries due to low screening rates.
* Cervical cancer affects over 500,000 women annually
* HPV-related cancers contribute to over 99% of cases.
* High incidence and mortality in [[low- and middle-income countries]]
* [[World Health Organization|WHO]] aims for elimination through vaccination, screening, and treatment


In developed countries, routine HPV vaccination and Pap screening have significantly reduced mortality rates.
== History ==


== History ==
* 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 ==


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.


== 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.cancer.org/cancer/cervical-cancer.html American Cancer Society: Cervical Cancer]
* [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.cdc.gov/cancer/cervical/ CDC: Cervical Cancer]


{{Tumors}}
{{Tumors}}

Revision as of 17:15, 26 March 2025

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics

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

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

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

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

Advanced squamous carcinoma of the cervix

Common histological types include:

Staging

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

HPV oncogenes E6 and E7 play central roles:

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

Prevention

Smoking is a modifiable risk factor for cervical cancer

Treatment

Brachytherapy for cervical cancer

Treatment depends on stage and extent:

Early-stage (Stage 0 & I)

Locally Advanced (Stage II & III)

Advanced-stage (Stage IV)

Epidemiology

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

  • 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

Cryotherapy to treat precancerous cervical lesions


See Also

External Links


Overview of tumors, cancer and oncology
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Carcinogenesis
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