Cervical cancer

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Malignancy of the cervix

Cervical cancer
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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

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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, 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

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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 sexual activity
• Multiple sexual partners
• Smoking
• Long-term oral contraceptive use
• Immunosuppression (e.g., HIV/AIDS)
• High parity (multiple full-term pregnancies)
• Infrequent or no screening

Diagnosis

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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

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Advanced squamous carcinoma of the cervix

Common histological types include:

• Squamous cell carcinoma (80–85%)
• Adenocarcinoma (15%)
• Adenosquamous carcinoma
• Small cell carcinoma (neuroendocrine)

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:

• E6 inactivates p53, preventing apoptosis
• E7 inhibits retinoblastoma protein (Rb), promoting uncontrolled division

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

Prevention

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Smoking is a modifiable risk factor for cervical cancer

• HPV vaccine (e.g., Gardasil, Cervarix)
• Regular Pap smear and HPV testing
• Condom use
• Smoking cessation
• Public health campaigns like Cervical Cancer Awareness Month

Treatment

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Brachytherapy for cervical cancer

Treatment depends on stage and extent:

Early-stage (Stage 0 & I)

• Loop electrosurgical excision procedure (LEEP)
• Cone biopsy
• Hysterectomy (simple or radical)

Locally Advanced (Stage II & III)

• Radiotherapy with chemotherapy (cisplatin-based)
• Brachytherapy (internal radiation)

Advanced-stage (Stage IV)

• Palliative care
• Targeted therapy (e.g., Bevacizumab)
• Immunotherapy in select patients

Epidemiology

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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

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Cryotherapy to treat precancerous cervical lesions

• Breast and Cervical Cancer Early Detection Program in the U.S.
• Global efforts like the WHO Cervical Cancer Elimination Strategy

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

• HPV vaccine
• Pap smear
• Gynecologic oncology
• Cancer staging
• Oncology
• Colposcopy
• Hysterectomy
• Loop electrical excision procedure

External Links

• WHO: Cervical Cancer\n* American Cancer Society\n* CDC: Cervical Cancer

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