User:PriceDL/Notes/Cervical cancer

Cervical cancer is one of the major gynecologic malignancies and the most common cause of mortality from cancer in the developing world. Almost all cases are associated with HPV, so the HPV vaccine program aims to reduce the incidence of cervical cancer hugely. In the UK all women aged 25-65 have routine cervical screening to check for cervical intraepithelial neoplasia. Abnormal areas of cells may be removed or destroyed before becoming malignant. Early stages are mostly asymptomatic and a common early symptom is postcoital bleeding. Treatment is dependent on staging and may involved simple or radical hysterectomy, and chemoradiation.

Epidemiology

 * Nearly all associated with HPV infection
 * HPV-16 and 18 responsible for >70%

Symptoms
Early stage disease asymptomatic

Symptoms usually appear when tumour starts to cause bleeding (postcoital bleeding common early symptom)

Pain if lymph nodes involved

Lack of atteptite, weight loss, fatigue (general vague cancer symptoms)

Single swollen leg

Cervical smear screening

 * Detects cervical intraepithelial neoplasia


 * Frequency:
 * Every 3 years starting at 25
 * Every 5 years from 50+
 * Over 65 not screened (unless not screened since turning 50 or they have abnormal test results)
 * Reduces mortality by 90%

Pathology

 * Squamous cell carcinoma (75-80%)
 * Adenocarcinomas (20-25%)

Staging
Stage Ib-2 to IVa require examination under anaesthesia, CXR, cystoscopy, proctoscopy, maybe more

CT, MRI, PET not used for staging

Screening

 * Screening program to detect pre-cancerous changes
 * HPV vaccine
 * Surgery and chemoradiotherapy curative in 80-95% stage I-II
 * 60% in stage III

CIN

 * Treatment indicated for CIN 2, CIN 3, persistent (1+ year) CIN 1
 * LEEP most common treatment (allows diagnosis as tissue is removed, not destroyed)
 * Laser vaporization and cryotherapy also, but don't provide tissue for diagnosis of invasive disease

Treatment

 * Ia-1 treated by cone biopsy or simple hysterectomy
 * Ia-2/Ib-1 treated by radical hysterectomy. Some lymphadenectomy may also be performed
 * Ib-2/IIa by primary chemoradiation therapy ± radical hysterectomy
 * IIb/III/IVa (useful surgery likely to be unsafe)
 * IVb palliative chemotherapy ± directed radiation