Cervical cancer

About

• Largely detectable and preventable disease
• Causes about 1500 deaths in the UK per year

Aetiology

• Viral infection HPV types 16 (squamous), 18 (adenocarcinoma) and 33
• Inactivation of Rb and p53 genes
• Most commonly squamous, less commonly adenocarcinoma
• Spreads locally to lymphatics to pelvic nodes
• Local invasion to pelvic sidewall laterally, the base of bladder anteriorly and the rectum posteriorly, vagina inferiorly
• Spread then to lung, liver, bone and brain

Risks are those of viral exposure

• Number of sexual contacts
• High parity, Other STDs
• Partner with many other partners especially uncircumcised
• Early first coitus, HIV, Smoking (squamous)

Clinical

• Early stages asymptomatic
• Vaginal bleeding
• Later stages due to local invasion and then distal spread

Investigations

• FBC, U&E - renal function
• IVP, CT abdomen and pelvis
• Cystoscopy or sigmoidoscopy
• MRI/PET scanning

Management

• Preinvasive cancer managed by colposcopy and CIN managed with cryosurgery, laser, loop excision of the transformation zone. Cone biopsy may be performed if any uncertainty and may be curative. Colposcopy misses adenocarcinoma within the endocervical canal.
• Invasive disease is mostly SCC rather than adenocarcinoma
• Chemotherapy uses Cisplatin. Radiotherapy causes vaginal stenosis.

Staging