Cancer of the Cervix, Vulva, Vagina
Herpes simplex virus infections increase that woman’s risk, women that are HIV positive are at much higher risk, those that are smokers, and those that are immunosuppressed or renal transplant patients for example that have an HPV infection are at much higher risk to go on to develop cervical cancer. There are at least 10-20 million women with HPV infections and probably you can equate that to the same number of men out there. Of those 20 million, only about 1.2 million go on to develop these preinvasive lesions, cervical dysplasia, and only about 13,000 a year develop invasive cancer. Because a patient has HPV show up on a Pap smear with cytologic changes associated with HPV, or has mild dysplasia caused by HPV, doesn’t mean that she is going to go on to develop invasive cancer. Unfortunately we don’t have an antiviral agent or an HPV vaccine yet available. So to identify which patients are at high risk and low risk is somewhat of a clinical challenge to the gynecologist and the GYN-oncologist.
Most patients with invasive cervix cancer we would hope would be picked up with an abnormal Pap smear, appropriately referred to a gynecologist. The patient would undergo colposcopy, which is nothing more than a 15 power dissecting binocular microscope to look at the cervix, identify the lesion, biopsy the invasive lesion and go on to stage and treat. Cold knife conization is a larger biopsy. Yet unfortunately most patients that we see today still have gross lesions that Papanicolaou was trying to prevent or avoid, but have gross lesions that can be directly biopsied by the gynecologist. Identifying that patient is a common problem in the United States yet today.
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The symptoms associated with cervix cancer is vaginal bleeding. It is one of the classic symptoms, although not oftentimes volunteered in my experience, but if you ask the patient, yes she has had bleeding after intercourse; it stops after a day or so and doesn’t reoccur until she has intercourse again. As the cervix cancer progresses you can get pelvic pain, obstruction of the lymphatics and lead to lymphedema or obstruction of ureters and ultimately uremia. But the most common early symptom is abnormal bleeding, and again managing that patient by telephone is inappropriate. She needs to be seen, a Pap smear obtained and examined.