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Cervical Cancer

Specialties > Cancer

Background Knowledge 🧠

Definition

  • Cervical cancer is a malignancy originating from the cervix.
  • It primarily arises from the transformation zone between the exocervix and endocervix.
  • Most commonly caused by persistent infection with high-risk human papillomavirus (HPV).

Epidemiology

  • Second most common cancer in women worldwide.
  • Higher incidence in developing countries.
  • In the UK, accounts for approximately 2% of all cancers in women.
  • Peak incidence in women aged 30-45 years.
  • Screening programs have significantly reduced incidence and mortality.

Aetiology and Pathophysiology

  • Persistent infection with high-risk HPV types (16, 18, 31, 33).
  • Risk factors: Early sexual activity, multiple sexual partners, smoking, immunosuppression.
  • HPV infection leads to integration of viral DNA into host cells, causing dysplasia.
  • Progression from cervical intraepithelial neoplasia (CIN) to invasive cancer.

Types

  • Squamous cell carcinoma: Most common type, arising from the squamous cells of the exocervix.
  • Adenocarcinoma: Arises from the glandular cells of the endocervix, less common but increasing in incidence.
  • Other rare types: Clear cell carcinoma, small cell carcinoma, and neuroendocrine carcinoma.

Clinical Features 🌡️

Symptoms

  • Often asymptomatic in early stages.
  • Abnormal vaginal bleeding (postcoital, intermenstrual, postmenopausal).
  • Pelvic pain or discomfort.
  • Dyspareunia (pain during intercourse).
  • Unusual vaginal discharge.

Signs

  • Visible lesion on the cervix during speculum examination.
  • Ulceration or exophytic growth on the cervix.
  • Friable cervix that bleeds on contact.
  • Advanced disease may present with pelvic mass or signs of metastasis.
  • Lymphadenopathy in advanced stages.

Investigations 🧪

Investigations

  • Cervical screening (Pap smear) for early detection of dysplasia.
  • HPV DNA testing.
  • Colposcopy with biopsy for definitive diagnosis.
  • Imaging (MRI, CT, PET) for staging and assessing metastasis.
  • Blood tests: Full blood count, liver function tests, renal function tests.

Management 🥼

Management

  • Early-stage disease: Surgical options include conization, hysterectomy, or trachelectomy.
  • Locally advanced disease: Combined chemoradiotherapy is the standard treatment.
  • Metastatic disease: Palliative chemotherapy, radiotherapy, or targeted therapy.
  • Follow-up: Regular surveillance with physical exams and imaging.
  • Supportive care: Pain management, nutritional support, psychological support.

Complications

  • Local invasion causing urinary or bowel obstruction.
  • Fistula formation (vesicovaginal or rectovaginal).
  • Metastasis to distant organs (lungs, liver, bones).
  • Side effects of treatment (e.g., lymphoedema, radiation cystitis).

Prognosis

  • Five-year survival rate is high for early-stage disease (>90%).
  • Prognosis worsens with advanced-stage disease.
  • Regular follow-up is crucial for early detection of recurrence.
  • Overall survival depends on stage at diagnosis, treatment response, and patient factors.

Key Points

  • Cervical cancer is preventable through HPV vaccination and regular screening.
  • Early detection and treatment are key to favourable outcomes.
  • Management includes surgical, radiotherapeutic, and chemotherapeutic options.
  • Follow-up care is essential to monitor for recurrence and manage complications.

References/Further Reading

  • NICE guidelines on cervical cancer management.
  • British Journal of Obstetrics and Gynaecology articles.
  • Clinical Gynecologic Oncology by DiSaia and Creasman.
  • Journal of Clinical Oncology articles on cervical cancer.
  • UpToDate: Cervical cancer overview and management.
  • British Gynaecological Cancer Society guidelines.

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Cancer