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General Medicine

Cervical Malignancy

Olga L. Nunez, MD, Jean Khara G. Casillan, RN, MD and Stuti Nagpal, MD, FAAFP Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Most cervical cancers begin in the transformation zone.

  • 60–75% are from squamous epithelium and 25–40% are glandular.

EPIDEMIOLOGY

Incidence

  • Cervical cancer is the second most common mal...

DIAGNOSIS

HISTORY

  • Patient with HPV infection may be asymptomatic. The most common symptom is postcoital vaginal bleeding. Other symptoms are intermenstrual or postmenopausal bleeding and vaginal discha...

TREATMENT

GENERAL MEASURES

Improve nutritional state, correct anemia (Hb <12 g/dL), and treat pelvic infections. 

MEDICATION

  • Chemoradiation with cisplatin-containing regimen has superior survival over...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • With completion of definitive therapy and based on individual risk factors, patients are evaluated with physical/pelvic examinations:

    • Every 3 to ...

REFERENCES

1
Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin Number 131: screening for cervical cancer. Obstet Gynecol.  2012;120(5):1222–1238.
2
International Federation of Gynec...

ADDITIONAL READING

  • Martin-Hirsch PP, Paraskevaidis E, Bryant A, et al. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev.  2013;(12):CD001318.

  • National Comprehensive Cance...

CODES

ICD10

  • C53.9 Malignant neoplasm of cervix uteri, unspecified

  • C53.0 Malignant neoplasm of endocervix

  • C53.1 Malignant neoplasm of exocervix

  • C53.8 Malignant neoplasm of overlapping sites of cervix uteri

ICD9

CLINICAL PEARLS

  • Cervical cancer is the second most common malignancy in women worldwide. Improving access to screening is likely to have the greatest impact in reduction of the burden of disease.

  • Women...

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FIG. 3.85. Recurrent cervical carcinoma with vesicovaginal fistula. Fat-suppressed, gadolinium-enhanced T1-weighted image of pelvis demonstrates enhancing infiltrating pelvic tumor (arrow) and wide communication between bladder and vagina (arrowhead) allowing passage of high signal intensity gadolinium.
FIG. 3.85. Recurrent cervical carcinoma with vesicovaginal fistula. Fat-suppressed, gadolinium-enhanced T1-weighted image of pelvis demonst...
Figure 6.15 Atypical squamous cells of undetermined significance (ASC-US). This Pap smear shows superficial-type squamous cells with mild nuclear enlargement and hyperchromasia. These features are suggestive but not diagnostic of a low-grade squamous intraepithelial lesion.
Figure 6.15 Atypical squamous cells of undetermined significance (ASC-US). This Pap smear shows superficial-type squamous cells with mild n...
Figure 6.16 Low-grade squamous intraepithelial lesion (Pap smear). These lesions show mildly dysplastic squamous cells with nuclear enlargement, hyperchromasia, and irregular nuclear contours that are more pronounced than in Figure 6.15.
Figure 6.16 Low-grade squamous intraepithelial lesion (Pap smear). These lesions show mildly dysplastic squamous cells with nuclear enlarge...
Figure 6.17 High-grade squamous intraepithelial lesion (Pap smear). The dysplastic cells seen in the center show a high nuclear-to-cytoplasmic ratio.
Figure 6.17 High-grade squamous intraepithelial lesion (Pap smear). The dysplastic cells seen in the center show a high nuclear-to-cytoplas...
Figure 6.18 High-grade squamous intraepithelial lesion (Pap smear). A cluster of overlapping, markedly dysplastic cells forms a sheet. Note single, severely dysplastic cells.
Figure 6.18 High-grade squamous intraepithelial lesion (Pap smear). A cluster of overlapping, markedly dysplastic cells forms a sheet. Note...
Pap smear 1. Close up view of cross section of upper vagina and cervix with applicator inserted into the endocervical canal. Arrows indicate a clockwise rotation to obtain sample.
Pap smear 1. Close up view of cross section of upper vagina and cervix with applicator inserted into the endocervical canal. Arrows indica...
Pap smear 2. Close up view of cross section of upper vagina and cervix with wooden or plastic spatula pressed against cervix, longer end introduced slightly into os. Arrow indicates rotation to obtain ectocervical sample.
Pap smear 2. Close up view of cross section of upper vagina and cervix with wooden or plastic spatula pressed against cervix, longer end in...
Figure 21-12 Pap smears. A: Normal. Large, flat cells with small nuclei. B: Dysplasia. Large, dark nuclei indicate damaged DNA; cytoplasmic halo indicates human papillomavirus (HPV) effect. C: Malignant. Compact cells with huge, irregular, dark nuclei indicate malignancy.
Figure 21-12 Pap smears. A: Normal. Large, flat cells with small nuclei. B: Dysplasia. Large, dark nuclei indicate damaged DNA; cytoplasmic...
Figure 6-16 Pap smear of the cervix. Many normal cells are present, which have small, uniform nuclei. Also present are clumps of malignant cells, which have large, dark nuclei.
Figure 6-16 Pap smear of the cervix. Many normal cells are present, which have small, uniform nuclei. Also present are clumps of malignant ...
Normal cervical Papanicolaou (Pap) smear. Large squamous cells from the superficial, and intermediate layers of the epithelium are illustrated. The cells have abundant cytoplasm, which varies in staining from pink to blue. The nuclei are small, and the nuclear-cytoplasmic ratio is low. The most superficial cells have pyknotic nuclei (arrows).
Normal cervical Papanicolaou (Pap) smear. Large squamous cells from the superficial, and intermediate layers of the epithelium are illustra...
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