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 second most common cancer in women worldwide. Early detection through 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

In early stages, cervical cancer may be asymptomatic. However, as the disease progresses, symptoms may include:

• 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.

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:

• Early onset of sexual activity – increased risk of HPV exposure.
• Multiple sexual partners – higher likelihood of contracting HPV.
• Smoking – carcinogens in tobacco weaken the immune system.
• Long-term use of oral contraceptives – hormonal changes may play a role.
• Immunosuppression – conditions like HIV/AIDS increase susceptibility.
• Multiparity – having multiple full-term pregnancies.
• Lack of regular screening – delays early detection and treatment.

Diagnosis

Cervical cancer is diagnosed using various screening and diagnostic tests, including:

• Pap smear – detects precancerous changes.
• HPV DNA test – identifies high-risk HPV strains.
• Colposcopy – magnified inspection of the cervix.
• Biopsy – confirms cancer through histological examination.
• MRI, CT scan, or PET scan – assesses tumor spread in advanced cases.

Histology

The most common histological subtypes of cervical cancer include:

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

Staging

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

• Stage 0 – Carcinoma in situ, pre-invasive cancer.
• Stage I – Cancer limited to the cervix.
• IA – Diagnosed only by microscopy.
• IB – Visible lesion or deeper invasion.
• Stage II – Cancer extends beyond the cervix but not to the pelvic wall.
• 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

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

• E6 – Inactivates tumor suppressor p53, preventing apoptosis.
• E7 – Inhibits retinoblastoma protein (Rb), allowing uncontrolled cell division.

These changes lead to cervical intraepithelial neoplasia (CIN) and, over time, invasive cancer.

Prevention

Effective prevention strategies include:

• HPV vaccine – protects against HPV-16, 18, 31, 33, 45, 52, 58.
• Regular screening – routine Pap smears and HPV testing.
• Safe sex practices – use of condoms reduces HPV transmission.
• Smoking cessation – lowers the risk of progression from HPV infection to cancer.

Treatment

Treatment depends on the stage and spread of the cancer:

• Stage 0 (Carcinoma in situ):
• Loop electrical excision procedure (LEEP) or cone biopsy.
• Hysterectomy in some cases.

• Early-stage (IA & IB):
• Radical hysterectomy with pelvic lymph node dissection.
• Radiotherapy for inoperable cases.

• Locally advanced (II & III):
• Concurrent radiotherapy and chemotherapy.
• Cisplatin-based chemotherapy.

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

Epidemiology

• Cervical cancer is the fourth most common cancer in women worldwide.
• 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.

History

Early studies suggested that cervical cancer was associated with sexual activity:

• More common in sexually active women.
• Rare in nuns, except those who had been sexually active before.
• 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

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

External Links

• WHO: Cervical Cancer Information
• American Cancer Society: Cervical Cancer
• CDC: Cervical Cancer

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