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Clinical Summary

Cervical cancer was once one of the most common causes of death from cancer in US women; however, deaths have decreased significantly with the use of routine Pap smears, which can detect precancerous changes and prompt early treatment. It is most commonly diagnosed between the ages of 35 and 44, but risk increases with age, and more than 15% of new cases are in women older than age 65. It is rare in women younger than 20. Squamous cell carcinoma accounts for 90% of cases, with adenocarcinoma being the second most common. Risk factors include infection with human papillomavirus (HPV), smoking, chlamydial infections, immunosuppression, intrauterine device (IUD) use, family history, multiple full-term pregnancies, early age at 1st pregnancy, and long-term oral contraceptive use. Most cervical cancer or precancerous lesions are found incidentally or during routine gynecologic exam. More advanced cases may present with pelvic discomfort, vaginal bleeding or discharge, bleeding after intercourse, and dyspareunia. Speculum examination with careful visual inspection of the cervix is key to identification. Definitive diagnosis is made by biopsy.

FIGURE 10.26

Cervical Cancer. An early cervical cancer is seen. Note the inflamed cervix with friable mucosa. (Photo contributor: Loyd A. West, MD.)

Management and Disposition

With the exception of rapid bleeding from a large lesion, emergent treatment is not typically warranted for cervical cancer. If heavy active bleeding is present, apply pressure manually or by packing the vagina to tamponade the bleeding. Consult gynecologist immediately. Refer all stable patients with suspicious lesions for outpatient gynecologic evaluation.

Pearls

  1. Cervical cancer is considered by some to be an STI because almost all cases are caused by infection with HPV.

  2. The increasing use of HPV vaccinations is reducing the incidence of infection with resultant decreased incidence of cervical cancer.

FIGURE 10.27

Cervical Cancer. An irregular inflamed and friable-appearing cervix biopsy positive for cervical cancer is seen. (Photo contributor: Loyd A. West, MD.)

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