gynecology and obstetrics
Cervical Cancer
Introduction
Cervical cancer is usually squamous cell carcinoma; adenocarcinoma is less common. The cause of most cervical cancers is human papillomavirus (HPV) infection. Cervical neoplasia is often asymptomatic; the first symptom of cervical cancer is usually irregular, often postcoital, vaginal bleeding. Diagnosis is by a cervical Papanicolaou test and biopsy. Staging is clinical, combined with imaging and pathology results when available. Treatment usually involves surgical resection for early-stage disease or chemoradiation therapy for locally advanced disease. If the cancer has widely metastasized, chemotherapy is often used alone or, sometimes, followed by pelvic radiation. (See also Cervical Cancer Screening and Prevention .) In the United States, cervical cancer is the 3rd most common gynecologic cancer and the 15th most common cancer among women ( General references ) . Mean age at diagnosis is 50; it is frequently diagnosed in women aged 35 to 44 years. The National Cancer Institute estimates that in 2023, there will be 13,960 new cases of invasive cervical cancer and 4310 deaths ( Risk factorsassociated with cervical cancer include Human Papillomavirus (HPV) Infection None Cervical intraepithelial neoplasia Increased potential exposure to sexually transmitted diseases (eg, early age at first sexual activity or first childbirth, multiple sex partners, high-risk sex partners) History of vulvar or vaginal squamous intraepithelial neoplasia or cancer Anal intraepithelial neoplasia or cancer Oral contraceptive use Cigarette smoking Immunodeficiency The precursor to cervical cancer is cervical intraepithelial neoplasia (CIN). The great majority of cases of CIN and invasive cervical cancer are caused by persistent infection with Human Papillomavirus (HPV) Infection , transmitted mainly through sexual activity. Most (70%) of precancerous and invasive disease can be directly attributed to HPV types 16 or 18; however, 99% of cervical cancer specimens contain DNA from one of more than 14 high-risk HPV genotypes ( 