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PATIENT STORY

A 51-year-old woman presents with postcoital bleeding. She has not had a period in 3 years, but has started spotting after intercourse. Her last Papanicolaou (Pap) test was after the birth of her last child 25 years ago and was normal. Other than an occasional mild hot flash, she has no other complaints. On colposcopy she was found to have a densely acetowhite lesion with abnormal vessel near the cervical os (Figure 93-1). Biopsy demonstrated invasive squamous cell carcinoma. The patient then had a radical hysterectomy with pelvic/paraaortic lymphadenectomy. Fortunately, her lymph nodes were all negative.

FIGURE 93-1

Colposcopic view of invasive squamous cell carcinoma. The lesion is densely acetowhite with abnormal vessels on the anterior lip just above the cervical os. (Reproduced with permission from E.J. Mayeaux, Jr., MD.)

INTRODUCTION

Colposcopy is an important visualization technique used to investigate abnormal Pap tests and to direct biopsies for histologic diagnosis of cervical cancer. Follow-up for abnormal cervical cancer screening tests and abnormal colposcopy results is now based on the estimated risk of cervical cancer development.1 Because human papillomavirus (HPV) is present in 95% to 100% of all squamous cell cancers (SCCs), the International Agency for Research on Cancer proclaimed cervical cancer to be the first human cancer known to have a single necessary cause.2,3

EPIDEMIOLOGY

  • Worldwide, carcinoma of the cervix is the fourth most common cancer in women, and the seventh most common cancer overall. There were an estimated 528,000 new cases worldwide in 2012, with around 85% of the global burden occurring in the less developed regions. There were an estimated 266,000 deaths from cervical cancer worldwide in 2012, which accounts for 7.5% of all female cancer deaths.4

  • In the United States in 2014, 12,578 women were diagnosed with cervical cancer and 4115 women died from the disease.5

  • In developed countries, roughly half of cases occur in women never screened and an additional 10% in women not screened within the past 5 years.6

  • Ninety-three percent of invasive cervical cancers are SCCs (Figures 93-1, 93-2, 93-3, 93-4). They almost all contain HPV DNA, and 90% are subtypes 16 or 18, which are the most virulent.7

  • Approximately 7% of cases are adenocarcinomas, but these are on the rise7 (Figure 93-5).

  • It is rare to find invasive cancer of the uterine cervix in pregnancy. The incidence varies from 1 to 15 cases per 10,000 pregnancies, and the prognosis is similar to that of nonpregnant patients.8

  • The peak prevalence of invasive cervical cancer is 40 to 50 years of age.9

FIGURE 93-2

Colposcopic view of invasive squamous cell cancer with abnormal vessels. (Reproduced with permission from E.J. Mayeaux, Jr., MD....

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