Cervical cancer

Overview – In the unites states, cancer of the cervix is the third most common cancer of the female reproductive system.

The cervix is the lower part of the uterus that connects to the vagina.

Human papillomavirus plays a role in causing most cervical cancer and is sexually acquired infection. Cervical cancer begins when healthy cells in the cervix develop changes and start to grow and multiply out of control.

Risk factors of cervical cancer include early onset of sexual activity, multiple sexual partners, history of sexually transmitted infections (eg, Chlamydia trachomatis, genital herpes), immunosuppression (eg, human immunodeficiency virus infection).

The most common histologic types of cervical cancer are squamous cell cancer and adenocarcinoma.

Symptoms

  • Early cervical cancer is frequently asymptomatic.
  • The more advanced cervical cancer can present with irregular and heavy vaginal bleeding, vaginal bleeding after sexual intercourse, pain after intercourse, pelvic or low back pain, pressure-related urinary or bowel symptoms such as blood in the urine, blood in the stool.

Screening recommendations for cervical cancer

  • The USPSTF (US preventive services task force) recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

Diagnosis

  • The diagnosis of cervical cancer starts with the pelvic examination to look for any visible lesion.
  • Cervical cytology (also called the pap test) is done as a screening test in asymptomatic women and is also performed for women with suspected cervical cancer.
  • Human papillomavirus (HPV) testing is used in combination with cervical cytology.
  • Cervical biopsy and colposcopy are done in women who have symptoms, or visible lesions on pelvic examination, or in those who have only abnormal cervical cytology.
  • Other tests could be done to look for metastases.

Staging

  • 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging is

 

Stage Description
I The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
IA Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5 mm
IA1 Measured stromal invasion <3 mm in depth
IA2 Measured stromal invasion ≥3 mm and <5 mm in depth
IB Invasive carcinoma with measured deepest invasion ≥5 mm (greater than Stage IA), lesion limited to the cervix uteri
IB1 Invasive carcinoma ≥5 mm depth of stromal invasion, and <2 cm in greatest dimension
IB2 Invasive carcinoma ≥2 cm and <4 cm in greatest dimension
IB3 Invasive carcinoma ≥4 cm in greatest dimension
II The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall
IIA Involvement limited to the upper two-thirds of the vagina without parametrial involvement
IIA1 Invasive carcinoma <4 cm in greatest dimension
IIA2 Invasive carcinoma ≥4 cm in greatest dimension
IIB With parametrial involvement but not up to the pelvic wall
III The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes
IIIA The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
IIIB Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
IIIC Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)
IIIC1 Pelvic lymph node metastasis only
IIIC2 Para-aortic lymph node metastasis
IV The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to Stage IV.)
IVA Spread to adjacent pelvic organs
IVB Spread to distant organs

 

Medical management

  • Early-stage cancer is typically treated with surgery. Depending on the stage of cancer, fertility preservation the surgical options include removing cancer only, removing the cervix, or removing the cervix and uterus.
  • Radiation can be used with chemotherapy as the primary treatment for locally advanced cervical cancers, or after surgery, if there’s an increased risk that cancer will come back.
  • Chemotherapy, immunotherapy are other treatment options for locally advanced and very advanced cancers.

Lifestyle management

  • Follow a healthy diet and exercise program recommended by your doctor.
  • Keep all your appointment with your doctor.
  • Talk to your doctor about palliative (supportive) care. Palliative care complements your ongoing medical treatment. Palliative care is given by specially trained professionals to improve the quality of life for people with cancer and their families.
  • Getting enough rest can help combat the stress and fatigue of cancer.

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