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Cervical cancer
Related Subjects: |Causes of abnormal Vaginal bleeding |Vaginal Carcinoma |Cervical cancer |Endometrial (Uterine) Cancer |Post Menopausal Bleeding |Anatomy of the Uterus |Anatomy of the Ovary |Gynaecological History Taking |Colposcopy |Premature Menopause |Polycystic Ovary syndrome
📖 About
- 🚺 Cervical cancer is largely detectable and preventable through screening and vaccination.
- ❗ Causes ~1,500 deaths annually in the UK.
- 🧬 Histology: ~80–85% squamous cell carcinoma, ~15% adenocarcinoma.
- Spreads locally, via lymphatics, and through blood (lung, liver, bone, brain).
🔬 Aetiology
- 🌐 HPV infection is the primary cause. - HPV 16 → squamous cell carcinoma - HPV 18 → adenocarcinoma - HPV 33 also implicated
- Oncogenesis via inactivation of tumour suppressor genes Rb and p53.
- Spread: - 📍 Lateral → pelvic sidewall - 📍 Anterior → bladder base - 📍 Posterior → rectum - 📍 Inferior → vagina
⚡ Risk Factors
- Multiple sexual partners, early first intercourse.
- Partner with many partners, especially if uncircumcised.
- High parity and history of STDs.
- Immunosuppression (HIV, transplant patients).
- Smoking 🚬 (esp. squamous carcinoma).
🩺 Clinical Features
- 📌 Early → usually asymptomatic, detected on screening.
- 🚨 Red flag: post-coital bleeding, intermenstrual bleeding, persistent foul discharge.
- ⚡ Advanced: pelvic pain, haematuria, rectal bleeding, hydronephrosis/obstructive uropathy.
- 🌍 Systemic: weight loss, anaemia, cachexia.
🎯 Staging and Management
| Stage | Details | Management | 5-yr Survival |
|---|---|---|---|
| I | Confined to cervix | Conization (fertility) / simple hysterectomy | ~80% |
| II | Upper 2/3 vagina; IIb = parametria | Radical hysterectomy + LN dissection / chemoradiation | ~60% |
| III | Lower 1/3 vagina or pelvic wall | Chemoradiation (cisplatin-based) | ~30% |
| IV | Bladder, rectum, distant mets | Chemoradiation / palliative | ~15% |
🧪 Investigations
- 🩸 Bloods: FBC, U&E (renal function before cisplatin/radiotherapy).
- 🖥 Imaging: MRI (local spread), CT abdo/pelvis, PET for mets.
- 🔍 Endoscopy: cystoscopy & sigmoidoscopy if bladder/rectal involvement suspected.
💊 Management
- Pre-invasive (CIN): Colposcopy + treatment - Cryotherapy, laser, or loop excision (LLETZ) - Cone biopsy if adenocarcinoma suspected
- Invasive disease: - Cisplatin-based chemoradiation = mainstay - Surgery in early stages - Radiotherapy may cause vaginal stenosis/infertility
🛡 Prevention
- 💉 HPV vaccination (types 16, 18, 31, 33, 45) - routine in UK since 2008.
- 📋 NHS Cervical Screening Programme: cytology/HPV testing (ages 25–64).
- 🚭 Smoking cessation to reduce risk.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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