Cervical Cancer: Diagnosis and Treatment

Diagnosis

Due to the frequent asymptomatic presentation of cervical cancer, diagnosis may be incidental on routine pelvic examination. A cervical lesion is often visible with invasive disease and cancer is confirmed via biopsy. However, cytology from a Pap smear may be negative in up to 50% of cases involving invasive disease.⁴ In addition, the Pap smear commonly shows severe inflammation in malignant disease. If such cases are clinically suspect, further testing is required.

An abnormal Pap evaluation requires further evaluation, which may include colposcopy with directed biopsy of abnormal cervical tissue or conization.

A histologic diagnosis is followed by a full clinical staging arrived at through focused physical examination; radiography; blood work, which may include tumor markers; and endoscopy (in presumed advanced disease).

Treatment

Cervical cancer is staged using the system established by the International Federation of Gynecology and Obstetrics (FIGO) through clinical (as opposed to pathological or surgical) evaluation. The following stages include multiple subtypes that further classify the cervical cancer:

Stage 0: Carcinoma remains in situ.
Stage I: Carcinoma is limited to the uterus.
Stage II: Carcinoma has spread from the uterus, but does not include lower third of vagina or pelvic wall.
Stage III: Carcinoma has spread to the lower third of vagina or pelvic wall, or causes hydronephrosis.
Stage IV: Carcinoma has spread to the bladder or rectum, or to distant organs beyond the pelvic area.

In general, squamous cell carcinoma, adenocarcinoma, and adenosquamous cervical cancer call for the same treatment. Early–stage disease is treated with either radical hysterectomy (with regional lymphadenectomy), or radiation with chemotherapy. Radiation and chemotherapy may also be administered after surgery in women at high risk of recurrence (eg, positive surgical margins or lymph nodes, or parametrial invasion).

Surgery preserves the ovaries and may be preferable to radiation and chemotherapy for premenopausal women. In addition to causing hormone–deficient vaginal stenosis, radiation and chemotherapy may damage the vagina, which could lead to dyspareunia in sexually active women.

Women with early cervical cancer who want to retain fertility may select a conization procedure or other surgical options that remove the cancerous lesion, but permit pregnancy.