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^{[clarification needed]}

Prevention

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%)

Management

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^{[clarification needed]}
- 60% in stage III^{[clarification needed]}

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

References

Obstetrics and Gynecology at a glance (4th ed.). pp. 66-69.	Fantastic
Kumar and Clark	Pretty much useless
"Diagnosis and management of cervical cancer". BMJ. doi:10.1136/bmj.39337.615197.80.	Not terribly good as an overview