Cervical Cancer

Cervical Cancer

Overview

Cervical cancer is cancer of the uterine cervix.

Cervix viewed through speculum with patient in lithotomy position

Epidemiology

• Cervical cancer is the fourth most common cancer in women.
• In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide
• about 311,000 women died from the disease.
• Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.

Pathophysiology

• Cervical cancer starts with abnormal changes in the cellular lining of the cervix.
• Typically these changes occur in the squamous-columnar junction of the cervix.
• Here, columnar epithelial cells meet the protective flat squamous epithelial cells from the outer cervix and vagina in what is termed the transformation zone.
• The continuous replacement of columnar epithelial cells by squamous epithelial cells in this area makes these cells vulnerable to take up foreign or abnormal genetic material

Cervical Cancer Aetiology

• Cervical cancer is a sexually transmitted disease. HPV is the primary cause of cervical cancer. Some strains of HPV have a predilection to the genital tract and transmission is usually through sexual contact.

Cervical Cancer Risk Factors

• Smoking
• Giving birth to more than 7 children
• having first child before 17yrs
• Number of sexual partners
• Early age of intercourse
• weak immune system

The stages of cancer progression

The pre-cancerous stage before the cells turn cancerous is called Cervical Intraepithelial Neoplasia (CIN)

Cervical Pathology Images

Clinical Manifestations

• May be silent until advanced disease develops
• Symptoms of Invasion:
  • Post-coital bleedingZ
  • Foul vaginal dischargeZ
  • Abnormal bleedingZ - intermenustral
  • Unilateral leg swelling or pain
  • Pelvic mass
  • Pelvic pain
  • Gross cervical lesion

Assessment

• History
• Physical examination
• Investigation:
  • Pap smear test: To Obtain Cells From the Cervix for Cervical Cytology ScreeningZ
  • Cold cone biopsy
  • MRI, a CT, blood tests or a X-ray
  • Colposcopy,Z

Treatment

• Treatment of Early Disease
  • simple hysterectomyZ
  • microinvasive cancer Radical hysterectomy -removal of the uterus with its associated connective tissues, the upper vagina, and pelvic lymph nodes..
  • Chemoradiation therapy
• Advanced Staging
  • Chemoradiation

Five types of standard treatment are used:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

Radical Hysterectomy - removal of the uterus