Refers to neoplasia arising from the cervix

Aetiology

• The vast majority of cervical squamous cell cancers are caused by persistent human papillomavirus (HPV) infection
  • HPV 16 and 18 cause 70% of cervical cancer - E6 and E7 proteins
    • Part of the vaccination program in the UK

Risk factors

• Smoking
• Age of onset of intercourse
• 'High risk' male
• Long-term (> 8 years) combined oral contraceptive pill use
• Multiple partners
• Other sexually transmitted infections
• Immunodeficiency (e.g. HIV)

Pathophysiology

• The majority (70%) of cervical cancers are squamous cell carcinomas
  • Develops from pre-existing CIN, therefore most cases should be preventable by screening
  • Local spread - uterine body, vagina, bladder, ureters, rectum
  • Lymphatic spread is early - pelvic, para-aortic nodes
  • Haematogenous spread is late - liver, lungs, bone
• Of the remainder, 15% are adenocarcinoma and 15% are mixed in type

Clinical features

Symptoms

• Often asymptomatic, particularly in the early stages of disease, and many cases are detected through routine screening
• Most common presenting symptom of cervical cancer is abnormal vaginal bleeding (e.g post-coital, intermenstrual or post-menopausal)
• Other symptoms:
  • Pelvic pain
  • Abnormal vaginal discharge (blood-stained, foul-smelling)
  • Dyspareunia
  • Weight loss
  • Ureteric obstruction/renal failure
  • Haematuria/urinary infections

Signs