Cervical and vaginal cancer
Cervical cancer
Epidemiology and risk factors
- Incidence (annual). The USA: 12,000 new cases and 4,200 deaths; the UK: 3,400 new cases and 950 deaths. Cervical cancer is the most frequent cause of cancer death in developing nations because of a lack of effective screening. Worldwide it is estimated that there are 530,000 cases of cervical cancer, and 275,000 deaths per year.
- Median age. Early 50s in USA/UK.
- Risk. Cervical cancer is a disease of sexually active women. It is more prevalent in women of lower socioeconomic status and is correlated with early age at first coitus and having multiple sexual partners.
- Human papillomavirus (HPV) is the primary causative agent in cervical cancer. HPV-6 and -11 predispose to benign condylomas. HPV-16, -18, -31, and -45 account for 80% of all invasive cervical cancers.
Prevention and diagnosis
- Screening. Regular Pap smear screening reduces a woman’s chance of dying of cervical cancer by 90%. HPV vaccines (see Chapter 29) have great potential to eradicate this highly preventable disease.
- Symptoms. The early stages of cervical cancer may be completely asymptomatic. Postcoital bleeding is a common early symptom. Menorrhagia or metrorrhagia occurs later. Symptoms of advanced disease may include loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, and leaking of urine or feces.
- Physical examination. The cervical lesion may appear exophytic, barrel shaped, or ulcerative. A small tumor may be entirely visible. Larger lesions that extend beyond the cervix are usually too difficult to assess completely in the office for potential involvement of the bladder, rectum, or parametrium.
Pathology
- Squamous cell carcinoma (75–80%) is the most common type, but the incidence is decreasing in countries with widespread Pap smear screening.
- Adenocarcinomas (20–25%) are more difficult to detect and appear to be increasing in incidence, especially among younger women.
