Cervical cancer
The third most common cancer of the female reproductive system, cervical cancer is classified as either microinvasive or invasive.
Precursors to cervical cancer include:
minimal cervical dysplasia (squamous intraepithelial lenar), in which the lower third of the epithelium contains abnormal cells
carcinoma in situ, also known as cervical intraepithelial neoplasia, in which the full thickness of epithelium contains abnormally proliferating cells.
Dysplasia is curable 75% to 90% of the time with early detection and proper treatment. If untreated (and depending on the form in which it appears), it may progress to invasive cervical cancer. Mild dysplasia may regress and not progress in 80% to 85% of women, so treatment isn’t necessary in all cases, although close follow-up is always appropriate.
With invasive carcinoma, cancer cells penetrate the basement membrane and can spread directly to contiguous pelvic structures or disseminate to distant sites by lymphatic routes. Invasive carcinoma of the uterine cervix is responsible for 8,000 deaths annually in the United States alone.
In almost all cases (95%), the histologic type is squamous cell carcinoma, which varies from well-differentiated cells to highly anaplastic spindle cells. Only 5% are adenocarcinomas. Invasive carcinoma usually occurs in patients between ages 30 and 50, though
in rare cases it can occur in those younger than age 20.
in rare cases it can occur in those younger than age 20.
Causes
The human papillomavirus (HPV) is accepted as the cause of virtually all cervical dysplasias and cervical cancers. Certain strains of the HPV (16, 18, 31) are associated with an increased risk of cervical cancer. Several predisposing factors have been related to the development of cervical cancer: intercourse at a young age (younger than age 16), multiple sexual partners, and herpesvirus 2 and other bacterial or viral venereal infections.
Signs and symptoms
Cervical dysplasia produces no symptoms or other apparent changes. Early invasive cervical cancer can cause abnormal vaginal bleeding, persistent vaginal discharge, and postcoital pain and bleeding. In advanced stages, cervical cancer causes pelvic pain, vaginal leakage of urine and stool from a fistula, anorexia, weight loss, and anemia.
