Cervical Cancer
Last Updated: May 6, 2022
access_time15 min
Learning Objectives (5)
After completing this brick, you will be able to:
● Define cervical cancer.
● 1
● Describe the clinical presentation of cervical cancer.
● 2
● Describe the pathogenesis of cervical cancer, including the role of
human papillomavirus.
● 3
● Explain the diagnosis of cervical epithelial changes, including the
cytologic grading levels used for the findings from a Pap test.
● 4
● Explain how cervical cancer can be prevented and treated.
● 5
CASE CONNECTION
TS is a 14-year-old female who is seeing you for a physical before
entering high school. “I'm going to be a freshman this year, and I’m
both nervous and excited. I'm going to try out for the soccer team,”
she says. “I am pretty good midfielder.” As part of her routine
physical, you review her immunization record. “Let’s see, looks like
you’re a little overdue for one particular vaccine.” You turn to her
mother as you begin to explain further.
,What immunization is due at this time? How will you explain to her
mother why this is an important preventive measure? Consider your
answers as you read, and we’ll revisit TS at the end of the brick.
What Is Cervical Cancer?
Only 100 years ago, cervical cancer was the number 1 cause of cancer
death among women. But in the 1920s, George Papanicolaou, a Greek
physician living in New York, developed a test used to screen women
for cervical cancer, which is why it is called the Papanicolaou test, or
more commonly, the Pap test. After the widespread adoption of the
Pap test, deaths due to cervical cancer decreased by 70%.
Later, in the 1970s, Harald zur Hausen detected the human
papillomavirus (HPV) in warts and cervical cancer. Not only did this
discovery earn him the Nobel prize, it led to the development of the
HPV vaccine, which can prevent cervical cancer from ever
developing.
The association with viral infection means cervical cancer is a
uniquely preventable carcinoma (epithelial cancer). Although most
HPV infections resolve spontaneously, HPV can cause slow changes
in cervical epithelial cells, which may eventually become malignant.
,However, this process may take years, and prevention efforts are
rendering it less common.
Compared with healthy cells, HPV-infected cervical epithelial cells
have characteristic changes (dysplasia) that can be detected via
microscopy. This makes screening for dysplasia an easy task.
Screening allows intervention to keep dysplasia from progressing to
cervical carcinoma or to keep carcinoma from spreading and causing
death.
Screening tools and vaccines against HPV are the key to preventing
this devastating cancer, which is still a common cause of death in
countries where screening is less common. (It is the second most
common cancer in such areas.) The incidence in the United States is
now 4-5 cases per 100,000 per year (compared with 124 cases per
100,000 per year for breast cancer).
Established risk factors for cervical cancer include HPV infection,
diethylstilbestrol (DES) exposure, smoking, and an
immunocompromised state (eg, due to HIV infection or drug therapy
to prevent transplant rejection).
How Does a Patient with Cervical
Cancer Present?
, Remember from anatomy that the cervix is a barrel-shaped structure
that lies between the uterus and vagina (Figure 1). The vaginal surface
of the cervix is called the ectocervix (ecto = outer), while the inner
lining or canal is called the endocervix (endo = internal). The
ectocervix is made of squamous cells, and the endocervix consists of
columnar cells.
Figure 1
Last Updated: May 6, 2022
access_time15 min
Learning Objectives (5)
After completing this brick, you will be able to:
● Define cervical cancer.
● 1
● Describe the clinical presentation of cervical cancer.
● 2
● Describe the pathogenesis of cervical cancer, including the role of
human papillomavirus.
● 3
● Explain the diagnosis of cervical epithelial changes, including the
cytologic grading levels used for the findings from a Pap test.
● 4
● Explain how cervical cancer can be prevented and treated.
● 5
CASE CONNECTION
TS is a 14-year-old female who is seeing you for a physical before
entering high school. “I'm going to be a freshman this year, and I’m
both nervous and excited. I'm going to try out for the soccer team,”
she says. “I am pretty good midfielder.” As part of her routine
physical, you review her immunization record. “Let’s see, looks like
you’re a little overdue for one particular vaccine.” You turn to her
mother as you begin to explain further.
,What immunization is due at this time? How will you explain to her
mother why this is an important preventive measure? Consider your
answers as you read, and we’ll revisit TS at the end of the brick.
What Is Cervical Cancer?
Only 100 years ago, cervical cancer was the number 1 cause of cancer
death among women. But in the 1920s, George Papanicolaou, a Greek
physician living in New York, developed a test used to screen women
for cervical cancer, which is why it is called the Papanicolaou test, or
more commonly, the Pap test. After the widespread adoption of the
Pap test, deaths due to cervical cancer decreased by 70%.
Later, in the 1970s, Harald zur Hausen detected the human
papillomavirus (HPV) in warts and cervical cancer. Not only did this
discovery earn him the Nobel prize, it led to the development of the
HPV vaccine, which can prevent cervical cancer from ever
developing.
The association with viral infection means cervical cancer is a
uniquely preventable carcinoma (epithelial cancer). Although most
HPV infections resolve spontaneously, HPV can cause slow changes
in cervical epithelial cells, which may eventually become malignant.
,However, this process may take years, and prevention efforts are
rendering it less common.
Compared with healthy cells, HPV-infected cervical epithelial cells
have characteristic changes (dysplasia) that can be detected via
microscopy. This makes screening for dysplasia an easy task.
Screening allows intervention to keep dysplasia from progressing to
cervical carcinoma or to keep carcinoma from spreading and causing
death.
Screening tools and vaccines against HPV are the key to preventing
this devastating cancer, which is still a common cause of death in
countries where screening is less common. (It is the second most
common cancer in such areas.) The incidence in the United States is
now 4-5 cases per 100,000 per year (compared with 124 cases per
100,000 per year for breast cancer).
Established risk factors for cervical cancer include HPV infection,
diethylstilbestrol (DES) exposure, smoking, and an
immunocompromised state (eg, due to HIV infection or drug therapy
to prevent transplant rejection).
How Does a Patient with Cervical
Cancer Present?
, Remember from anatomy that the cervix is a barrel-shaped structure
that lies between the uterus and vagina (Figure 1). The vaginal surface
of the cervix is called the ectocervix (ecto = outer), while the inner
lining or canal is called the endocervix (endo = internal). The
ectocervix is made of squamous cells, and the endocervix consists of
columnar cells.
Figure 1
