Cervical carcinoma

Cervical carcinoma 

Updated: 01/10/2023

© Jun Wang, MD, PhD

General features
  • Incident declining due to screening (Pap test, HPV test)
  • Expected to decline more due to HPV vaccination
  • Majority are squamous cell carcinoma, followed by adenocarcinoma
  • Screening techniques NOT sensitive enough for adenocarcinoma
  • May be HPV independent in both squamous and adenocarcinoma 
  • HPV-independent cancers tend to have worse prognosis
  • Current WHO classification 2020
Clinical presentations
  • Usually asymptomatic
  • Commonly identified after abnormal Pap test
  • Most common symptom: vaginal bleeding, usually postcoital
  • May have watery, mucoid or purulent discharges with malodor
  • Symptoms associated with affected structures if advanced, including pelvic or lower back pain, bowel or urinary symptoms, etc
Key risk factors
  • Early age at first intercourse
  • Multiple sexual partners
  • Male partner with multiple prior sexual partners
  • Cigarette smoking
  • History of HSIL or adenocarcinoma in situ
  • Oral contraceptives, parity, family history, associated genital infections, no circumcision in male partner, etc
Key pathogenesis
  • HPV products
E6: Promotes degradation of p53, abnormal activation of telomerase
E7: Inactivates retinoblastoma 1, a tumor suppressor
Key morphological features
Treatment
  • Surgery
  • Pelvic exenteration
  • Radiation


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