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In the United States, invasive cervical cancer causes one sixth of all genital cancers in women. There are about 14,500 new cases of invasive cervical cancer diagnosed each year in the United States, and approximately 4,800 of these women will die of the disease. Screening is the best method of prevention.
A number of risk factors predispose women to cervical cancer. These factors include beginning sexual intercourse at an early age, having multiple male sexual partners, having male sexual partners who themselves have had multiple sexual partners, smoking, and infection with HPV or human immunodeficiency virus (HIV).
Risk of cervical cancer is increased 3.5 times among smokers compared with nonsmokers, even when the data are adjusted for the other variables listed above. Even passive smoking increases the risk of cervical neoplasia approximately threefold if women are exposed to cigarette smoke for 3 hours daily.
SCREENING
The American College of Obstetricians and Gynecologists recommends that annual Pap test screening
ETIOLOGY
Viral proteins E6 and E7 are produced by high-risk types of HPV and are critical for malignant t
DIAGNOSIS
Patients with a gross cervical lesion should undergo simple cervical biopsy of the tumor. Loop electrosurgical excision procedure or cold knife conization is not indicated in patients with visible or palpable lesions
STAGING
Clinical staging allows comparison of treatment results between treatment centers. Clinical staging for cervical cancer is based primarily on inspection and palpation of the cervix, vagina, parametrium, and pelvic sidewalls, as well as physical examination of extrapelvic areas such as the supraclavicular nodal region or the upper abdominal region. The extent of disease can be further evaluated by chest roentgenography, excretory urography, or--if indicated--cystoscopy and
TREATMENT
Gynecologists and radiation oncologists should collaborate in planning combined-modality therapy for all but those patients with the most straightforward early-stage, low-volume disease. Patients with unexpected
Modern intraoperative radiation therapy has been used in combination with maximum surgical debulking with or without external-beam therapy in patients with periaortic or pelvic sidewall recurrences. This technique The high incidence of distant metastasis warrants the continued search for effective systemic chemotherapy.
Cisplatin is the most active single agent in the treatment of metastatic squamous cell cancer of the cervix, yielding responses in 20% of patients. Combination cisplatin-based chemotherapy is more toxic and, to date, is not associated with an overall survival benefit. Because there is a high incidence of distant
Early Invasive Carcinoma
The various definitions for early invasive carcinoma have been brought into better uniformity since the 1995 FIGO reclassification of stage IA cervical carcinoma. Simple extrafascial hysterectomy is appropriate for
Stages lB1, lB2, and IIA
Early-stage invasive carcinoma of the cervix may be treated by either radical hysterectomy or radiation therapy. In the United States, the choice between these two treatment modalities is made individually by
Bulky Cervical Cancer
With very bulky, advanced cervical lesions, which are high risk by definition, radiation therapy alone is of limited value. Strategies combining multiagent chemotherapy and surgery in patients with bulky cervical...