This page has moved. Click here to view.

Cancer of the Cervix 

Invasive cervical cancer accounts for one sixth of all genital cancers in women in the United States. According to American Cancer Society statistics, 14,500 new cases of invasive cervical cancer were expected to be diagnosed in the United States in 1997, and 4,800 of these women were estimated to die of the disease cancer of the cervix, cervix cancer, cervical cancer. Screening can 

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). Two other 

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

Etiology

Viral proteins E6 and E7 are produced by high-risk types of HPV and are critical for malignant transformation because of their ability to bind and disable p53 and Rb host proteins. It has become clear that functional p53 inactivation contributes to the development of squamous cell carcinoma of the lower genital tract. In the absence of

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 presumed to be cancer. Patients with an abnormal Pap test without a gross lesion need colposcopic examination and biopsy or, if indicated,

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

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 invasive cervical cancer found at total hysterectomy for benign indications can undergo postoperative radiation. Alternatively, more 

Modern intraoperative radiation therapy has been used in combination with maximum surgical debuiking with or without external-beam therapy in patients with periaortic or pelvic sidewall recurrences. This technique calls for high-dose radiation to be delivered directly to the area involved. The radiation therapy is performed in the operating room during the surgical procedure. Complete resection of the tumor and full coverage of the surgical surface at 

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

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 patients who meet the definition of stage IA cervical carcinoma. In young women who have lesions less than 3 mm in diameter and 

Stages IB1, IB2, 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 patients who have early-stage (ie, stage IB 1, IB2, or IIA) disease after consultation with their physicians. Survival rates for patients with

The outcome is optimal for an otherwise-healthy young woman who undergoes a radical hysterectomy and whose operative findings and postoperative course are free of complications. The ovaries continue to function, and the vaginal membrane is unaltered. The patient is free of her cancer and recovers sooner and with fewer long-term side

If radical hysterectomy is determined to be the preferred treatment, the procedure should include pelvic lymphadenectomy; thorough exploration of the abdomen, including the periaortic lymph nodes; and removal of the

Factors that adversely affect survival include the presence of metastatic nodal disease, the size of the lesion, lymphatic or vascular space involvement, and the type of carcinoma. Small-cell carcinomas are associated with the poorest outcome. Adenocarcinomas frequently form bulky, barrel-shaped lesions that respond poorly to treatment. The

Prospective randomized trials comparing standard radical hysterectomy with laparoscopic radical hysterectomy are needed to determine any potential operative, postoperative, or survival benefits associated with the 

t 10--year survival data are not available because stage IB was divided into two substages less than 10 years ago.

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 cancer may result in

Persistent or Recurrent Cervical Cancer

Persistent or recurrent carcinoma of the cervix can be a devastating problem, with patients having a 1-year survival rate of 15% and a 5-year survival rate of less than 5%. Most patients with recurrences can be considered to be in