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Classification and external resources
Histopathologic image (H&E stain) of carcinoma in situ, stage 0.
ICD-10 : C53
ICD-9 : 180
OMIM : 603956
DiseasesDB : 2278
MedlinePlus : 000893
eMedicine : med/324 radio/140
MeSH : D002583
This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower uterine segment. The uterus also has a round leiomyoma up higher.
Cervical cancer is malignant cancer of the cervix uteri or cervical area.
Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.
Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccine effective against the two strains of HPV that cause the most cervical cancer has been licensed in the U.S. and the EU. These two HPV strains together are currently responsible for approximately 70% of all cervical cancers. Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening, even after vaccination.
Signs and symptoms
The early stages of cervical cancer may be completely asymptomatic. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer.
Causes
Human papillomavirus infection
The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. Types 16 and 18 are generally acknowledged to cause about 70% of cervical cancer cases. Together with type 31, they are the prime risk factors for cervical cancer.
Genital warts are caused by various strains of HPV which are usually not related to cervical cancer.
The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but most women infected with high risk HPV will not develop cervical cancer.
Cofactors
The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer. T
Biopsy procedures
While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix.
Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examination of cervical biopsies by a pathologist.
Cervical cancer is malignant cancer of the cervix uteri or cervical area.
Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.
Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccine effective against the two strains of HPV that cause the most cervical cancer has been licensed in the U.S. and the EU. These two HPV strains together are currently responsible for approximately 70% of all cervical cancers. Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening, even after vaccination.
Signs and symptoms
The early stages of cervical cancer may be completely asymptomatic. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer.
Causes
Human papillomavirus infection
The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. Types 16 and 18 are generally acknowledged to cause about 70% of cervical cancer cases. Together with type 31, they are the prime risk factors for cervical cancer.
Genital warts are caused by various strains of HPV which are usually not related to cervical cancer.
The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but most women infected with high risk HPV will not develop cervical cancer.
Cofactors
The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol (DES) and a family history of cervical cancer. T
Biopsy procedures
While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix.
Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examination of cervical biopsies by a pathologist.
• adenocarcinoma (about 15% of cervical cancers in the UK)
• adenosquamous carcinoma
• small cell carcinoma
For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used
Staging
The TNM staging system for cervical cancer is analogous to the FIGO stage.
• Stage I - limited to the cervix
• Stage II - invades beyond cervix
Treatment
Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.
According to the US National Cancer Institute's 2005 Health Information National Trends survey, only 40% of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had heard of its link to cervical cancer.
Screening
The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has been credited with dramatically reducing the incidence and mortality of cervical cancer in developed countries.
Until recently the Pap smear has remained the principal technology for preventing cervical cancer.
The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening.
HPV testing can reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cervical cancer detected by subsequent screening tests among women 32-38 years old according to a randomized controlled trial.
Together, HPV types 16 and 18 currently cause about 70% of cervical cancer cases. HPV types 6 and 11 cause about 90% of genital wart cases.Until recently the Pap smear has remained the principal technology for preventing cervical cancer.
The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening.
HPV testing can reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cervical cancer detected by subsequent screening tests among women 32-38 years old according to a randomized controlled trial.
Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence.
Subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the highest quartile
A statistically significantly lower level of alpha-tocopherol was observed in the blood serum of HPV-positive patients with cervical intraepithelial neoplasia.
A 56% reduction in HPV persistence risk was observed in women with the highest plasma [lycopene] concentrations compared with women with the lowest plasma lycopene concentrations.
A 56% reduction in HPV persistence risk was observed in women with the highest plasma [lycopene] concentrations compared with women with the lowest plasma lycopene concentrations.
Fish oil
In a 1999 study, Docosahexaenoic acid inhibited growth of HPV16 immortalized cells.
Prognosis depends on the stage of the cancer.
With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with stage IV cancer are alive after 5 years.
Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.
Average years of potential life lost from cervical cancer are 25.3 (SEER Cancer Statistics Review 1975-2000, National Cancer Institute (NCI)).
Regular screening has meant that pre cancerous changes and early stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.
About 1,000 women per year die of cervical cancer in the UK.
With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those with stage IV cancer are alive after 5 years.
Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.
Average years of potential life lost from cervical cancer are 25.3 (SEER Cancer Statistics Review 1975-2000, National Cancer Institute (NCI)).
Regular screening has meant that pre cancerous changes and early stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.
About 1,000 women per year die of cervical cancer in the UK.
Epidemiology
Worldwide, cervical cancer is the fifth most deadly cancer in women. Among gynecological cancers it ranks behind endometrial cancer and ovarian cancer. The incidence of new cases of cervical cancer in the United States was 7 per 100,000 women in 2004.
In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380 will die.
In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380 will die.
History
• 400 BCE - Hippocrates: cervical cancer incurable
• 1976 - Zur Hausen and Gisam: found HPV DNA in cervical cancer and warts
Epidemiologists working in the early 20th century noted that:
1. Cervical cancer was common in female sex workers.
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