Cervical Cancer
Carcinoma of the cervix continues to occur, although the incidence is clearly decreasing; what we are talking about are predominantly squamous cell carcinomas which are the most common variety, accounting for approximately 80% of all cervical cancers, adenocarcinoma represents approximately 20%, other cell types are much less common. There are currently approximately 14,000 cases a year, and the clinical spectrum is changing, cervical carcinoma has traditionally been a big topic in gynecology for understandable reasons, it is still important for us as gynecologists to be leaders in this field in our ability to recognize the disease and suggest appropriate treatment.
At the present time in the United States, approximately one-half of the cases of invasive carcinoma of the cervix are advanced at the time of diagnosis. What is the cause of death? It is either uncontrolled disease in the pelvis, or distant metastasis and I will come back to these issues. The pattern of spread is something you are familiar with, and something we want to keep in mind when we talk about treatment. There is first of all, local expansion in the pelvis, lymphatic spread through the regional and more distant lymph nodes, hematogenous spread is of importance predominantly in the late stages of the disease. What are the symptoms of cervical carcinoma? As a reminder, patient’s traditionally present with either abnormal vaginal bleeding or discharge. I want to share with you that not recognizing this continues to occur, and is not infrequently a cause or a reason for not timely diagnosing sometimes advanced cervical carcinoma. Most of the symptoms, are symptoms of advanced disease, pain, typical lumbosacral pain, pain in the gluteal area, hematuria, rectal bleeding. A lot of patient’s with cervical cancer of course, will have no symptoms because the disease will be diagnosed in the workup of an abnormal PAP smear.
The diagnosis typically relies on the biopsy of any gross lesion of the cervix. Workup of an abnormal PAP smear in a number of cases will lead to the diagnosis of an invasive cancer of the cervix, and this will include colposcopy and biopsy or cone biopsy. As a reminder, the cervix is grossly abnormal as in this case, the first thing to do is to biopsy here, this lesion is not approached by doing a PAP smear, and again, maybe with decreasing incidents of cervical cancer and the fact that we are more adapt in working up abnormal PAP smears and doing colposcopy, one needs to be reminded of the fact that lesions such as these need to be biopsied, and the answer will be obvious.