Cervical Cancer

1. Risk Factors

1.1. Sexually/premenopausal active women

1.2. Women with multiple sexual partners

1.3. Smoking

1.4. Women who have had many children

1.5. Women with a long history of oral contraceptive use

1.6. Immunocompromised women

1.7. Women who use vaginal douches

2. Evaluation and Treatment

2.1. Regular Pap test or HPV screening is necessary for early detection.

2.2. Women 30-65 years of age, HPV testing is recommended at the same time as the Pap test.

2.3. Women 21-29 years of age, HPV testing is only indicated if Pap test is abnormal.

2.4. When dysplasia (replacement of some epithelial cells by atypical neoplastic cells) is detected further testing is warranted such as a coloscopy. This involves examining the cervix visually and taking needed biopsies.

2.5. Premalignant cellular changes require removal of abnormal cells. These procedures can be performed in the office with minimal sedation.

2.6. Invasive cancer requires surgery, including removal of the cervix and other affected tissues, or a hysterectomy.

2.7. Multidrug chemotherapy regimens

2.8. Radiation

3. Statistics

3.1. About 90% of cervical cancer cases can be detected through early use of screening tests.

3.2. Every year, about 12,000 women are diagnosed with cervical cancer.

3.3. In economically developed countries cancer is the most common cause of death.

3.4. Cervical cancer is the fourth most common cancer to affect women worldwide.

3.5. In 2016, an estimated 4120 women died as a result of cervical cancer.

3.6. Being non-Hispanic White, Hispanic or Latino, Asian, Native Hawaiian or other Pacific Islander, in the age group 18-44 years and 75 years and above, having less than a high school education and an annual household income of less than a $25,000, having never married, and residing in the West region of the U.S. reduced the likelihood of participation in cervical cancer screening.

4. Strategies for Risk Reduction

4.1. Regular HPV and Pap test

4.2. No smoking

4.3. HPV Vaccine in young boys and girls

5. Pathophysiologic Etiology

5.1. Almost exclusively caused by cervical human papillomavirus (HPV) infection.

5.2. HPV infection with "high risk" categories leads to dysplasia of cervix: also known as precancerous cell changes that lead to invasive cancer.

5.3. Most sexually active women will contract HPV in their lifetime; most infections are asymptomatic and resolve on their own.

5.4. HPV strain 16 and 18 are the most common cancer causing infections; causing 70% of all cervical cancers.

5.5. The transformation zone of the cervix is vulnerable to oncogenic effects of HPV and because metaplastic cells are at an increased risk of incorporating foreign or abnormal genetic material, this is where neoplastic changes are most common.

5.6. Mutations in genes regulating the immune response have been identified as playing a role.

6. Clinical Manifestations

6.1. Predominantly asymptomatic

6.2. If symptoms do occur they may include vaginal bleeding or abnormal discharge.

6.3. Advanced disease may cause urinary or rectal symptoms, pelvic or back pain, and anemia.

7. Carcinogenetic Agents

7.1. HPV infection

7.2. Smoking