Cervical cancer

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File:The development of cervical cancer.jpg

Malignancy of the cervix

Cervical cancer
File:Cervix uteri cancer world map - Death - WHO2004.svg
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

File:Ca cervicis uteri T2 SAG.jpg

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

File:Figure 28 02 08.JPG

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

File:Cervical screening Test Vehicle in Minsheng Community 20120421.jpg

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

File:Squamous carcinoma of the cervix.jpg

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

File:RICO tobacco litigation corrective statement, Whitehall, PA (cropped).jpg

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

File:Diagram showing the position of the applicators for internal radiotherapy for cervical cancer CRUK 344.svg

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

File:CDC health disparities for cervical cancer PSA.jpg

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

File:Cervical Cryotherapy.png

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

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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