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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 2006, and 4,800 of these women were estimated to die of the disease cancer of the cervix.

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.

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.

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.

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.

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.

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.

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.