P03.005 Cervical cancer

Cervical cancer arises from the cervix, the lower part of the uterus (womb) that connects to the vagina. It is primarily caused by persistent infection with high-risk types of human papillomavirus (HPV), a sexually transmitted virus.

Epidemiology

• Global Burden: Cervical cancer is the fourth most common cancer in women globally, with approximately 570,000 new cases and 311,000 deaths annually.
• Risk Factors: HPV infection (especially types 16 and 18), early age at first sexual intercourse, multiple sexual partners, smoking, and immunosuppression increase the risk.

Pathophysiology

• HPV Infection: Persistent infection with high-risk HPV types (e.g., HPV 16 and 18) leads to cellular changes (dysplasia) in the cervix.
• Progression: Without treatment, dysplasia can progress to invasive cervical cancer, infiltrating nearby tissues and potentially metastasizing to distant organs.

Clinical Features

• Early Stage: Often asymptomatic; abnormal vaginal bleeding (post-coital or intermenstrual bleeding) may occur.
• Advanced Stage: Pelvic pain, urinary symptoms (e.g., hematuria), weight loss, and bowel symptoms (e.g., constipation) may manifest.

Diagnosis

• Screening: Pap smear (cytology) is the primary screening method, detecting precancerous changes. HPV testing may also be used.
• Diagnostic Tests: Colposcopy with biopsy confirms the diagnosis. Imaging (e.g., MRI, CT scan) assesses extent of disease.

Management

• Early Stage (IA to IIA): Surgery (e.g., cone biopsy, radical hysterectomy) or radiotherapy alone is curative.
• Advanced Stage (IIB to IV): Concurrent chemoradiotherapy (CCRT) is the standard treatment.
• Palliative Care: Focuses on symptom management and quality of life in advanced cases.

Prevention

• HPV Vaccination: Effective against high-risk HPV types (e.g., 16, 18); recommended before sexual debut.
• Screening Programs: Regular Pap smears or HPV testing reduce mortality by detecting precancerous lesions early.

Prognosis

• Early Detection: Excellent prognosis with 5-year survival rates exceeding 90% for localized disease.
• Advanced Disease: Poor prognosis; 5-year survival rates decrease significantly with advanced stage at diagnosis.

Points to Remember

• Cervical cancer is primarily caused by HPV infection.
• Pap smear is a crucial screening tool; HPV testing enhances detection sensitivity.
• Management depends on the stage of disease; early detection improves outcomes.
• Prevention strategies include vaccination and regular screening.
• Education and awareness are key to reducing cervical cancer incidence globally.

Conclusion Cervical cancer poses significant health challenges but is largely preventable through vaccination, early detection, and timely intervention. Understanding its epidemiology, pathophysiology, clinical features, and management is essential for medical students preparing for clinical practice and examinations like PLAB.

References

1. American Cancer Society. Cervical Cancer Overview. Available at: https://www.cancer.org/cancer/cervical-cancer.html
2. World Health Organization. Comprehensive Cervical Cancer Control: A Guide to Essential Practice. Geneva: WHO Press; 2014.
3. National Institute for Health and Care Excellence (NICE). Cervical Cancer: Diagnosis and Management. Available at: https://www.nice.org.uk/guidance/ng140