Cervical Cancer
Gynecologic Cancers
Frequency: Uterine > Ovarian > Cervical > Vulvar > Vaginal and Other
Cervical Cancer
Risk Factors: Associated with Human Papilloma Virus (HPV) Þ some now believe HPV is the cause
- age of first coitus, multiple sexual partners, STDs, low socioeconomic status, cigarette smoking, immunosuppression
- American women are not considered low risk by recent NIH Consensus Conference Standards
Pap Smear: introduced in 1943 by George Papanicolaou MD, Ph.D.
Incidence:
Ý incidence in Black population
Pap smear has caused ß in incidence of invasive cancer due to detection of premalignant cells; Ý reduction with more frequent Pap smear exams
Ý incidence in Young White Women due to behavioral changes
HPV, multiple sexual partners, smoking, ß screening
HPV: small double stranded DNA virus, 7 early genes
- E6 and E7 bind tumor suppressor genes p53 and retinoblastoma genes
Þ required for malignant transformation
HPV strains 16 + 18 are associated with malignancy
Recommendations: all women 18 years of age or sexually active should undergo an annual Pap test and pelvic exam
- after 3 or more consecutive normal Pap smears, the Pap test may be performed less frequently
- Cessation of Pap Smear Screening – no upper age limit for screening cessation
- 25% of cervical cancer occurs in women
> 65 yrs old
40% of cervical cancer deaths occur in women > 65 yrs old Þ due to less screening
Future Directions of Cytology: HPV testing, Computer-Assisted Slide Review, Computer-Assisted Liquid Based Preparation
Staging: done clinically – biopsy, physical exam, cytoscopy, sigmoidoscopy, chest X-ray, plain X-ray, lab studies
- Stage 1
carcinoma confined to cervix
- Stage 2
carcinoma extends beyond the cervix, but has not extended to the pelvic wall; involves vagina, but not as far as the lower third
- Stage 3
carcinoma extends to the pelvic wall; tumor involves the lower third of the vagina; all cases involving kidney are included
- Stage 4
carcinoma extends beyond true pelvis or has clinically involved the mucosa of the bladder or rectum
- extends laterally along fascia planes
- Metastasis – spread predominantly locally and via lymphatics
Treatment: often use combination therapyÞ chemotherapy, radiation therapy and surgery
- center portion of large lesions are often hypoxic and radio and chemo resistant
- Stage I Treatment: surgery
- Stage II Treatment: chemotherapy, radiation therapy
- If lesion is
> 4 cm radiation and chemotherapy are used because of Ý risk of metastases
Brachytherapy: placement of radioactive materials directly into lesion to supply high dose of radiation to a specific area