Cervical cancer
Invasive cervical carcinoma is a human papillomavirus-driven squamous or glandular cancer staged by FIGO criteria, treated with fertility-sparing or radical surgery for early disease and cisplatin-based chemoradiation for locally advanced disease.
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What this article covers
- Overview
Invasive cervical carcinoma: malignant transformation of cervical epithelium, almost always driven by persistent high-risk human papillomavirus (HPV) infection, progressed beyond the pre-invasive…
- Epidemiology
Incidence: approximately 13,000 new invasive cervical cancers are diagnosed in the United States annually, with about 4,200 deaths.
- Risk factors
Persistent high-risk HPV infection: the causative agent in nearly all cases, detectable in 99.7% of cervical cancers; vaccination markedly decreases incidence of both dysplasia and cancer.
- Pathophysiology
HPV integration: persistent high-risk HPV integrates into the host genome and expresses the E6 and E7 oncoproteins, driving progression from normal epithelium through cervical dysplasia to invasive carcinoma.
- Clinical features
Asymptomatic early disease: early cervical cancer is frequently asymptomatic, which is why screening rather than symptom-triggered evaluation detects most curable disease.
- Differential diagnosis
Cervical dysplasia (cervical intraepithelial neoplasia): the pre-invasive precursor; excluded by absence of stromal invasion on biopsy.
- Diagnosis
First, diagnosis is established by direct biopsy, colposcopy-directed biopsy, or cone biopsy (conization) of a visible cervical lesion; stromal invasion on biopsy, as opposed to intraepithelial…
- Management
First, establish stage and fertility intent, since both together set the pathway.
- Complications
Hydronephrosis and renal failure: ureteral obstruction by pelvic sidewall or parametrial tumor, defining stage III disease, requiring urgent decompression when severe.
- Prognosis
Anatomic stage at diagnosis is the most important predictor of prognosis, more so than histologic subtype.
- Prevention
Primary prevention with HPV vaccination: the nine-valent vaccine is given at age 11 or 12 years, or through age 26 years if not previously vaccinated, as a two-dose series if started before age 15…
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Related articles
- Cervical dysplasia
Persistent high-risk HPV infection drives squamous metaplasia at the cervical transformation zone into CIN 1/2/3, a histologic continuum staged by Pap cytology (Bethesda) and confirmed by colposcopic biopsy. Management follows ASCCP risk-based thresholds, from surveillance for CIN 1 to excisional or ablative treatment for CIN 2/3, to prevent progression to invasive cervical cancer.
- Human papillomavirus (HPV) infection
Human papillomavirus is a nonenveloped DNA virus with low-risk types (6, 11) that cause warts and high-risk types (16, 18, and others) that drive cervical, anal, vulvar, penile, and oropharyngeal cancer, prevented by 9-valent vaccination and managed by type-specific screening rather than treatment of the virus itself.
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Acute cervicitis is inflammation of the uterine cervix diagnosed by visualized mucopurulent endocervical discharge or a friable os that bleeds with a swab, most often caused by Neisseria gonorrhoeae or Chlamydia trachomatis, treated empirically at the same visit while nucleic acid amplification testing is pending.
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- Epithelial ovarian cancer
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- Vulvar cancer
Vulvar cancer is usually squamous cell carcinoma of the vulvar skin, arising either from high-risk HPV infection (younger, premenopausal patients) or from long-standing lichen sclerosus (older, postmenopausal patients), and is confirmed by punch biopsy of any persistent vulvar lesion or unexplained pruritus; treatment is surgical, with radical vulvectomy and inguinal lymphadenectomy for invasive disease.
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Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.
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