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Cervical Cancer

  • R. Scott Bermudez
  • Kim Huang
  • I-Chow Hsu
Chapter

Abstract

Leading cause of cancer mortality in women in developing countries and third most common gynecological cancer in the US. Screening with Pap smear decreases mortality by 70%, accounting for the steady decline in incidence in developed nations. ACS recommends screening for all women who are sexually active or >20 years old. Following three normal annual exams after age 30, screening may be performed less frequently, at least once every 3 years. Fifty percent of newly diagnosed cancers occur in women who have never been screened. Risk factors: early first intercourse, multiple partners, history of other STD’s, high parity, smoking, immunosuppression, and prenatal DES exposure (clear cell CA). Ninety to ninety-five percent of cases are associated with HPV infection. HPV types 16 and 18 confer the highest risk of SCC and adenocarcinoma, respectively. HPV 6 and 11 are associated with benign warts. In 2006, the FDA approved the quadrivalent HPV recombinant vaccine for prevention of cancers caused by HPV types 6, 11, 16, and 18 for women aged 9–26 years. Eighty to ninety percent of invasive tumors are SCC, 10–20% are adenocarcinoma, and 1–2% are clear cell. SCC originates in the squamocolumnar junction with invasive disease frequently associated with adjacent CIS. Preinvasive disease: atypical squamous cells of uncertain significance (ASCUS), low-grade squamous intraepithelial lesion (LGSIL), and high-grade squamous intraepithelial lesion (HGSIL). ASCUS: 2/3 resolve spontaneously. Repeat Pap in 6 months and, if abnormal, perform colposcopy. LGSIL = Mild dysplasia/CIN 1. Half resolve spontaneously. Repeat Pap in 6 months and, if abnormal, perform colposcopy. HGSIL = Severe dysplasia / CIN 2/3/CIS. One-third resolve spontaneously. All undergo colposcopy with biopsy. The mean age of women diagnosed with cervical intraepithelial neoplasia (CIN) is 15–20 years younger than those diagnosed with invasive disease. Prognostic factors include LN metastases, tumor size, stage, uterine extension, and Hgb level <10. Risk of pelvic LN involvement for stage I, II, and III disease is approximately 15%, 30%, and 45%, respectively. Most common site for metastases are pelvic lymph nodes followed by lungs and paraaortic nodes.

Keywords

Cervical Intraepithelial Neoplasia Radical Hysterectomy Vaginal Cuff Protracted Venous Infusion Foley Balloon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Further Reading

  1. Greene FL, American Joint Committee on Cancer., American Cancer Society. AJCC cancer staging manual. 6th ed. New York: Springer; 2002.Google Scholar
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  4. Perez CA, Kavanagh BD. Uterine Cervix. In: Halperin CE, Perez CA, Brady LW, et al., editors. Principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1532-1609.Google Scholar
  5. Perez CA, Kavanagh BD. Uterine Cervix. In: Halperin CE, Perez CA, Brady LW, et al., editors. Principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 1532-1609.Google Scholar
  6. Swift PS, Hsu IC. Cancer of the Uterine Cervix. In: Leibel SA, Phillips TL, editors. Textbook of radiation oncology. 2nd ed. Philadelphia: Saunders; 2004. pp. 1055-1100.Google Scholar

Copyright information

© Springer-Verlag New York 2010

Authors and Affiliations

  • R. Scott Bermudez
    • 1
  • Kim Huang
    • 1
  • I-Chow Hsu
    • 1
  1. 1.Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA

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