Cervical Cancer

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Genetics 6 Clinical-manifestations 7 Laboratory 8 Diagnostic-procedures 9 Staging 10 Complications 11 Management 12 More General Terms 13 Additional Terms 14 Internet Database 15 References

Introduction

• Also see Pap smear

Etiology

• Risk factors:

• infection with human papillomavirus types 16*, 18*, 31, 33, 35, 45, 51, 52, 56
• early age of 1st sexual intercourse
• multiple sexual partners
• male partner in a high risk group
• low
• smoking
• parity (number of pregnancies) [5]
• oral contraceptive use [5]; risk declines with cessation, returns to baseline in 10 years [9]

• * 50% associated with HPV-16 [6], 70% with types 16 or 18 Protective factors:

• barrier methods of contraception
• use of spermicides

Epidemiology

• 3rd most common form of gynecologic cancer
• 2nd most common cause of death from gynecologic cancer
• annual incidence increases after age 35 50% of cases occur in women age 35-55 years
• 57% of invasive cervical cancer occur in women > 50 years of age [8]
• 25% of cases & 40% of deaths occur in women > 65 years of age
• carcinoma in situ shows bimodal distribution

• 20-30 years of age
• 60-70 years of age

Pathology

• metastases

• bone (21%)
• brain (9%)
• skin (3%)
• adrenal (31%)
• kidney (26%)

Genetics

• associated with defects in FGFR3
• coexpression of KRT16 & KRT17
• other implicated genes NANOGP8, IGF2BP3, HES2, WAPAL, LETMD1, GUSB, PHF19, c-MYC, ST20, TP63, SLC39A6

Clinical-manifestations

• post-coital bleeding
• exophytic or ulcerative lesion on cervix ( pelvic exam)

Laboratory

• PCR/ southern blot/ in-situ hybridization
• Pap smear

Diagnostic-procedures

• coloposcopy with biopsy for tissue diagnosis
• cystoscopy to examine bladder for local metastasis
• proctoscopy to examine sigmoid colon for local metastasis

Staging

• 0) stage 0: carcinoma in situ
• stage 1: confined to uterus
• stage 2: invades beyond uterus, but not to pelvic wall
• stage 3: extend to pelvic wall &/or lower 3rd of vagina, or hydronephrosis
• stage 4: invades mucosa of bladder or rectum or extends beyond pelvis

Complications

• 
  
• disease interaction(s) of cancer with Alzheimer's disease

Management

• total hysterectomy for carcinoma in situ & early invasive carcinoma
• radiation therapy for more advanced disease, stages 1 & 2
• chemotherapy

• cisplatin for stages 2-4 [2]
• topotecan for recurrent & stage IVB cervical cancer in combination with cisplatin ONLY if patient has NOT previously received cisplatin ( NGC )

• prognosis: 5 year survival by stage at presentation 0) stage 0: 100%
• stage 1: 85%
• stage 2: 60%
• stage 3: 33%
• stage 4: 7%
• storing of embryos is an option prior to therapy in women of reproductive age
• see screening for cervical cancer

More General Terms

• urogenital malignancy (urogenital cancer)

Additional Terms

• cervical intraepithelial neoplasia
• Papanicolaou (Pap) smear
• papillomavirus
• PCR/southern blot/in-situ hybridization for cervical cancer
• screening for cervical cancer

Internet Database

OMIM: 603956

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 29
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 670
4. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 521, 607
5. Journal Watch 22(9):74, 2002 Munoz N et al Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359:1093, 2002 PMID: [1] Moreno V et al Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359:1085, 2002 PMID: [2]
6. Journal Watch 23(1):1, 2003 Koutsy LA et al A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med 347:1645, 2002 PMID: [3]
7. Journal Watch 24(3):27, 2004 Cuzick J et al Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet 362:1871, 2003 PMID: &dopt=Abstract Franco EL Are we ready for a paradigm change in cervical cancer screening? Lancet 362:1866, 2003 PMID: [4]
8. Bernard VB et al Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995-2001. Obstet Gynecol 103:564, 2004 PMID: [5]
9. International Collaboration of Epidemiologic Studies of Cervical Cancer. Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,909 women without cervical cancer from 24 epidemiologic studies. Lancer 2007, 370::1609 PMID: [6]
10. Cervical Cancer: NIH Institute and Center Resources [7]
11. National Guideline Clearinghouse
    - Cervical cancer screening for women who attend STD clinics or have a history of STDs. Sexually transmitted diseases treatment guidelines 2010. ngc-guideline: [8]
    - Cervical screening. (Program in Evidence-based Care) ngc-guideline: [9]
    - Cervical cancer screening guideline: October 2006. Kaiser Permanente Care Management Institute ngc-guideline: [10]
    - Role of imaging in cancer of the cervix. (American College of Radiology) ngc-guideline: [11]
    - Chemotherapy for recurrent, metastatic, or persistent cervical cancer: a clinical practice guideline. Program in Evidence-based Care ngc-guideline: [12]
    - Pretreatment planning of invasive cancer of the cervix. American College of Radiology (ACR) ngc-guideline: [13]
    - PET imaging in cervical cancer: recommendations. Program in Evidence-based Care ngc-guideline: [14]
    - Topotecan for the treatment of recurrent and stage IVB cervical cancer. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [15]
    - The delivery of brachytherapy for cervical cancer: organizational and technical advice to facilitate high-quality care in Ontario. Program in Evidence-based Care ngc-guideline: [16]
    - Cervical cancer prevention in low-resource settings. Society of Obstetricians and Gynaecologists of Canada ngc-guideline: [17]
    - Role of adjuvant therapy in the management of early stage cervical cancer American College of Radiology (ACR) ngc-guideline: [18]
    - Advanced cervical cancer American College of Radiology (ACR) ngc-guideline: [19]

cervical cancer