Cervical cancer is the most common gynecologic cancer in women. Most of these cancers stem from infection with the human papillomavirus, although other host factors affect neoplastic progression following initial infection. Compared with other gynecologic malignancies, cervical cancer develops in a younger population of women. Thus, screening for this neoplasia with Pap smear sampling typically begins in young adulthood.
Most early cancers are asymptomatic. Symptoms of advancing cervical cancer may include bleeding, watery discharge, and signs associated with venous, lymphatic, neural, or ureteral compression. Diagnosis of cervical cancer usually follows histologic evaluation of biopsies taken during colposcopic examination or biopsies from a grossly abnormal cervix.
This cancer is staged clinically. Treatment varies and is typically dictated by this staging. In general, early-stage disease is effectively eradicated surgically by either conization or radical hysterectomy. However, for those with advanced disease, chemoradiation is primarily selected. As expected, disease prognosis differs with tumor stage, and stage is the most important indicator of long-term survival. Women with stage I disease typically have high survival and low recurrence rates, whereas those with advanced disease have a poorer long-term prognosis.
Prevention lies mainly in identifying and treating women with high-grade dysplasia. For this reason, regular Pap smear screening is recommended by the American College of Obstetricians and Gynecologists (2009) and by the U.S. Preventive Services Task Force (2003) (Chap. 29). It is hoped that the human papillomavirus (HPV) vaccines will prove effective in reducing the incidence of cervical cancer in the future.
Cervical cancer is common worldwide and ranks third among all malignancies for women (Ferlay, 2010). In 2008, an estimated 529,000 new cases were identified globally, and 275,000 deaths were recorded. In general, higher incidences are found in developing countries, and these countries contribute 85 percent of reported cases annually. Economically advantaged countries have significantly lower cervical cancer rates and add only 3.6 percent of new cancers. This incidence disparity highlights successes achieved by cervical cancer screening programs in which Pap smears are regularly obtained.
Within the United States, cervical cancer is the third most common gynecologic cancer and the 11th most common solid malignant neoplasm among women. In the United States, women have a 1 in 147 lifetime risk of developing this cancer. In 2011, the American Cancer Society estimated that there will be 12,710 new cases and 4290 deaths from this malignancy (Siegel, 2011). Of U.S. women, African-Americans and women in lower socioeconomic groups have the highest age-standardized death rates from this cancer, and Hispanic and Latino women have the highest incidence rates (Table 30-1). This trend is thought to result mainly from financial and cultural characteristics affecting access to screening and treatment. The age at which cervical cancer develops is in general earlier than that for other gynecologic malignancies, and the median age at diagnosis is 48 years (National Cancer Institute, 2011). In women ...