Cervical cancer
Related Subjects:
|Causes of abnormal Vaginal bleeding
|Vaginal Carcinoma
|Cervical cancer
|Endometrial (Uterine) Cancer
|Post Menopausal Bleeding
|Anatomy of the Uterus
|Anatomy of the Ovary
|Gynaecological History Taking
|Colposcopy
|Premature Menopause
|Polycystic Ovary syndrome
📖 About
- 🚺 Cervical cancer is largely detectable and preventable through screening and vaccination.
- ❗ Causes ~1,500 deaths annually in the UK.
- 🧬 Histology: ~80–85% squamous cell carcinoma, ~15% adenocarcinoma.
- Spreads locally, via lymphatics, and through blood (lung, liver, bone, brain).
🔬 Aetiology
- 🌐 HPV infection is the primary cause.
- HPV 16 → squamous cell carcinoma
- HPV 18 → adenocarcinoma
- HPV 33 also implicated
- Oncogenesis via inactivation of tumour suppressor genes Rb and p53.
- Spread:
- 📍 Lateral → pelvic sidewall
- 📍 Anterior → bladder base
- 📍 Posterior → rectum
- 📍 Inferior → vagina
⚡ Risk Factors
- Multiple sexual partners, early first intercourse.
- Partner with many partners, especially if uncircumcised.
- High parity and history of STDs.
- Immunosuppression (HIV, transplant patients).
- Smoking 🚬 (esp. squamous carcinoma).
🩺 Clinical Features
- 📌 Early → usually asymptomatic, detected on screening.
- 🚨 Red flag: post-coital bleeding, intermenstrual bleeding, persistent foul discharge.
- ⚡ Advanced: pelvic pain, haematuria, rectal bleeding, hydronephrosis/obstructive uropathy.
- 🌍 Systemic: weight loss, anaemia, cachexia.
🎯 Staging and Management
| Stage | Details | Management | 5-yr Survival |
|---|
| I | Confined to cervix | Conization (fertility) / simple hysterectomy | ~80% |
| II | Upper 2/3 vagina; IIb = parametria | Radical hysterectomy + LN dissection / chemoradiation | ~60% |
| III | Lower 1/3 vagina or pelvic wall | Chemoradiation (cisplatin-based) | ~30% |
| IV | Bladder, rectum, distant mets | Chemoradiation / palliative | ~15% |
🧪 Investigations
- 🩸 Bloods: FBC, U&E (renal function before cisplatin/radiotherapy).
- 🖥 Imaging: MRI (local spread), CT abdo/pelvis, PET for mets.
- 🔍 Endoscopy: cystoscopy & sigmoidoscopy if bladder/rectal involvement suspected.
💊 Management
- Pre-invasive (CIN): Colposcopy + treatment
- Cryotherapy, laser, or loop excision (LLETZ)
- Cone biopsy if adenocarcinoma suspected
- Invasive disease:
- Cisplatin-based chemoradiation = mainstay
- Surgery in early stages
- Radiotherapy may cause vaginal stenosis/infertility
🛡 Prevention
- 💉 HPV vaccination (types 16, 18, 31, 33, 45) - routine in UK since 2008.
- 📋 NHS Cervical Screening Programme: cytology/HPV testing (ages 25–64).
- 🚭 Smoking cessation to reduce risk.
