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Cervical Cancer

Cervical Cancer

Cervical Cancer

Cervical cancer is one of the leading causes of cancer death in the world, particularly in developing countries.

Aetiology: Cervical cancer is strongly linked to 2 viruses: Herpes simplex 2 (HSV2) and human papillomavirus (HPV). Other risk factors include: multiple sexual partners, age (35-65) and smoking.

 

Pathophysiology: Early stages consists of dysplasia (starts mild), which occurs at the junction of columnar cells with squamous cells at the external os. The majority of cervical cancers arise from squamous cells. A pap smear test will reveal the signs of dysplasis before cancer has manifested. Invasive carcinomas appear as a protruding nodular mass or ulceration. As the carcinoma spreads into neighbouring tissues (including uterus and vagina), it may reach the connective tissue, bladder and rectum. Metastases to lymph or blood occurs rarely at late stages.

 

 

Clinical manifestations: Cervical cancer is asymptomatic in the early stages (but can be detected by a pap smear). Invasive cervical cancer may manifest as abnormal vaginal bleeding and discharge, as well as dyspareunia (painful intercourse) and postcoital bleeding.

 

Diagnosis: A clinical history, physical pelvic examination and pap smear can diagnose cervical cancer, along with a cervical biopsy. Pelvic CT or MRI may be used to assess the extent of spread.

 

 

Management: Management depends on the grading of the dysplastic changes. A loop electrosurgical excision procedure (LEEP) may be perform to diagnose and treat lesions. Surgery combined with radiation is the recommended treatment. Surgery ranges from: cryosurgery to hysterectomy. Radiation therapy may be external or internal (implants) depending on the invasiveness of the cancer. Prevention of cervical cancer can be achieved through HPV vaccination for girls before they become sexually active.

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