Click here to view next page of this article


Cervical Cancer

Cervical cancer is the third most common female genital tract cancer. The peak age of occurrence is 45-50 years, with a range extending from the late teens to the elderly.

Clinical Evaluation of Possible Cervical Cancer

Abnormal vaginal bleeding or discharge are the most common symptoms of cervical cancer. Excessively heavy or prolonged menses may be noted. Post-coital bleeding is less frequent. Sometimes a malodorous discharge is the only symptom.

Pelvic or sciatic pain, difficulty in voiding, and leg edema may develop late in the disease.

Exophytic growths often bleed on contact. However, the malignancy may sometimes develop entirely within the endocervical canal, and the cervix may appear normal. The cancer may also appear as a small, shallow, ulcerative crater.

Palpation may demonstrate a very hard, indurated, ballooned or barrel-shaped cervix.

The Pap smear often provides the first indication of cancer. Because the results of cervical cytology testing may be falsely negative in 15-40% should be done on all clinically suspicious lesions.

When cervical cytologic findings indicate the presence of invasive carcinoma or cervical intraepithelial neoplasia, but no lesion is visible on the cervix, the malignancy may be detected by colposcopically directed biopsy. In instances where cytology suggests cervical neoplasia but there is no colposcopically visible lesion, conization of the cervix with fractional dilation and curettage is necessary.

Conization is indicated if the cytology suggests neoplasia in the following instances:

There is no lesion visible colposcopically.

The atypical epithelium extends up the cervical canal beyond visualization.

Results of colposcopically directed biopsy do not account for the abnormal cells found by Pap smear.

Microinvasion is apparent on cervical punch biopsy.

Endocervical curettage identifies cervical intraepithelial neoplasia.

Staging of Cervical Cancer

Cervix cancer is the only clinically staged cancer. The clinical stage is determined primarily by inspection and palpation of the cervix, vagina and pelvis, and by examination of extra-pelvic areas, particularly the abdomen (liver) and supraclavicular nodes.

The qualities of the cervix (eg, exophytic or endophytic with smooth ectocervix; soft or hard) and size of lesion are noted.

The entire vagina is palpated to determine whether disease has spread to the upper two-thirds of the vagina (stage IIA) and if it involves

Treatment consists of