Cervical cancer is the third most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. In the United States, cervical cancer is relatively uncommon.
Signs and symptoms
The most common finding in patients with cervical cancer is an abnormal Papanicolaou (Pap) test result.
Physical symptoms of cervical cancer may include the following:
- Abnormal vaginal bleeding
- Vaginal discomfort
- Malodorous discharge
Human papillomavirus (HPV) infection must be present for cervical cancer to occur. Complete evaluation starts with Papanicolaou (Pap) testing.
Current screening recommendations for specific age groups, based on guidelines from the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology (ASCP), the US Preventive Services Task Force (USPSTF), and the American College of Obstetricians and Gynecologists (ACOG), are as follows:
< 21 years: No screening recommended
21-29 years: Cytology (Pap smear) alone every three years
30-65 years: Human papillomavirus (HPV) and cytology co-testing every five years (preferred) or cytology alone every three years (acceptable)
>65 years: No screening recommended if adequate prior screening has been negative and high risk is not present
The treatment of cervical cancer varies with the stage of the disease, as follows:
- Stage 0: Carcinoma in situ (stage 0) is treated with local ablative or excisional measures such as cryosurgery, laser ablation, and loop excision; surgical removal is preferred
- Stage IA1: The treatment of choice for stage IA1 disease is surgery; total hysterectomy, radical hysterectomy, and conization are accepted procedures
- Stage IA2, IB, or IIA: Combined external beam radiation with brachytherapy and radical hysterectomy with bilateral pelvic lymphadenectomy for patients with stage IB or IIA disease; radical vaginal trachelectomy with pelvic lymph node dissection is appropriate for fertility preservation in women with stage IA2 disease and those with stage IB1 disease whose lesions are 2 cm or smaller
- Stage IIB, III, or IVA: Cisplatin-based chemotherapy with radiation is the standard of care
- Stage IVB and recurrent cancer: Individualized therapy is used on a palliative basis; radiation therapy is used alone for control of bleeding and pain; systemic chemotherapy is used for disseminated disease