Cervical Cancer

What it is

Overview

Cervical cancer is one of the most preventable cancers. Virtually all cases are caused by persistent infection with high-risk strains of human papillomavirus (HPV), primarily HPV-16 and HPV-18. The HPV vaccine and regular Pap test/HPV co-testing can prevent most cases and deaths. Despite this, cervical cancer remains the fourth most common cancer in women globally and kills about 4,000 American women per year.

Biology

How It Develops

HPV infects the transformation zone of the cervix and integrates viral oncoproteins E6 and E7 into the host cell genome. E6 degrades TP53 and E7 inactivates RB1, disabling the cell's two most critical tumor suppressor checkpoints. Over 10–15 years of persistent infection, normal cells progress through cervical intraepithelial neoplasia (CIN 1→2→3) to invasive carcinoma.

Warning signs

Symptoms

• —Early: often no symptoms (detected by screening)
• —Abnormal vaginal bleeding (after sex, between periods, after menopause)
• —Unusual vaginal discharge
• —Pelvic pain or pain during intercourse
• —Advanced: leg swelling, back pain, difficulty urinating

Detection

Diagnosis Methods

• —Pap smear and HPV co-testing (screening)
• —Colposcopy with directed biopsy
• —LEEP or cone biopsy for CIN diagnosis/treatment
• —MRI pelvis for local staging
• —PET-CT for lymph node and distant staging

Medical care

Treatment Options

• —Surgery: LEEP, conization (early/precancerous), radical hysterectomy (Stage I)
• —Radiation therapy: external beam + brachytherapy (definitive for locally advanced)
• —Concurrent cisplatin chemotherapy (radiosensitizer)
• —Bevacizumab for metastatic disease
• —Pembrolizumab (for PD-L1+ and recurrent/metastatic disease)
• —HPV vaccination (prevention — Gardasil 9)

Data

Statistics

Prevention

Risk Factors

• —HPV infection (necessary cause in virtually all cases)
• —Multiple sexual partners
• —Smoking
• —Immunosuppression (HIV, transplant)
• —Long-term oral contraceptive use
• —Low socioeconomic status (barriers to screening)

Further reading

Resources