Chapter 33: Cervical Cancer

LEARNING OBJECTIVES

1. Demonstrate understanding of the etiology and risk factors associated with the development of cervical cancer.

2. Explain the risk and benefits of the human papillomavirus (HPV) vaccine and chemoprevention options available for decreasing the risk of developing cervical cancer.

3. Interpret and understand the utility of the Papanicolaou (Pap) test and HPV testing screening tests for diagnosing precancerous cervical lesions.

4. Describe the physical signs and symptoms of cervical cancer.

5. Recommend the appropriate surgical, radiation, and chemotherapy treatment options for newly diagnosed and recurrent cervical cancer patients.

6. Compare and contrast chemotherapy options for the management of advanced and recurrent cervical cancer.

INTRODUCTION

Cervical cancer is almost exclusively attributed to infection with human papillomavirus (HPV) and is especially prevalent in women who have limited access to health care. Women that have no/limited health care access or those with poor compliance to a routine annual Papanicolaou (Pap) test screening are at a higher risk for the disease, as they may miss the opportunity for early detection of precancerous lesions/dysplasia. Although primary treatment interventions are often successful in achieving a cure for early-stage disease, limited treatment options exist for recurrent or refractory cervical cancer that is associated with poor response rates. Prevention is the critical component for managing the risk of cervical cancer. The introduction of the HPV vaccine has been a preliminary step on the road to eliminating cervical cancer, but improvement in patient education and overall access to health care as well as developing effective treatment of persistent HPV infections will be necessary to fully eradicate cervical cancer.

Epidemiology

Cervical cancer is the fourth most common cancer among women worldwide.¹ Approximately 80% of the cases occur in developing countries, where it is the most common female cancer and the second most common cancer-related cause of death.² Although common in developing countries, cervical cancer in the United States is only the seventh most common cancer in women.³ Several histologies exist for cervical cancer, including squamous cell carcinoma (70%), cervical adenocarcinomas (CA) (24%), or mixed histology tumors, which are all attributed to HPV infection.⁴ HPV is the most common sexually transmitted infection in the United States, with an estimated 70 million adults currently infected and an incidence rate of 14 million cases per year.¹⁹ It has been estimated that the lifetime likelihood of exposure to HPV is 75% to 90%, with a 15% to 25% risk associated with each new partner.²⁰ Less than 1% of newly diagnosed cases consist of non-HPV-associated histologies, namely cervical neuroendocrine, small cell, and large cell carcinoma.⁵ The median age of diagnosis for cervical cancer is 49 years.³ Approximately 0.6% of women in the United States will develop invasive cancer of the cervix during their lifetime.³ In 2018, it is estimated that 13,240 new cases of cervical cancer will be diagnosed, associated with 4170 deaths in the ...