Cervical Cancer for PA
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Cervical Cancer for the Physician Assistant Licensing Exam
Definition and Epidemiology
- Definition
- Cervical cancer is a malignancy arising from the cervix, most commonly in the transformation zone where squamous and columnar epithelium meet.
- Primary types include squamous cell carcinoma (80%) and adenocarcinoma (15%).
- Epidemiology
- Fourth most common cancer in women worldwide, especially prevalent in low-resource countries.
- Decreased incidence in developed countries due to HPV vaccination and screening programs.
Risk Factors
- HPV Infection:
- High-risk HPV types, especially 16 and 18, cause nearly all cases of cervical cancer.
- Smoking:
- Increases risk due to immune suppression and carcinogenic compounds in cervical mucus.
- Immunosuppression:
- Conditions like HIV or immunosuppressive therapies increase susceptibility to HPV infections and cancer progression.
- Early Sexual Activity and Multiple Partners:
- Increase exposure to HPV.
- Prolonged Oral Contraceptive Use:
- Slightly elevates risk, but risk declines after stopping.
Clinical Manifestations
- Early Disease:
- Asymptomatic, often detected through routine screening (Pap smear).
- Advanced Disease:
- Symptoms include abnormal vaginal bleeding (postcoital, intermenstrual), pelvic pain, and increased discharge.
- Bladder or bowel symptoms may arise if cancer invades adjacent organs.
Diagnosis
- Screening:
- Pap Smear: Cytology screening every 3 years from age 21-29 and co-testing (Pap + HPV) every 5 years from age 30-65.
- HPV DNA Testing: Detects high-risk HPV strains and is often combined with Pap smears for enhanced detection.
- Colposcopy with Biopsy:
- Indicated for abnormal Pap results; provides histologic confirmation.
Treatment
- Early-Stage Disease:
- Conization or Hysterectomy: Standard options, especially for fertility preservation in microinvasive cases.
- Locally Advanced Disease:
- Radiation with Concurrent Chemotherapy: Standard for regional spread, typically using cisplatin-based therapy.
- Advanced Disease:
- Systemic Chemotherapy: Palliative management in metastatic cases.
Key Points
- Cervical Cancer is mostly caused by HPV, particularly types 16 and 18.
- Risk Factors: HPV infection, smoking, immunosuppression, and long-term oral contraceptive use.
- Symptoms: Asymptomatic in early stages; advanced disease presents with abnormal bleeding, pain, and discharge.
- Diagnosis: Relies on Pap smear, HPV testing, and colposcopy with biopsy for confirmation.
- Treatment: Early stages are managed surgically, while advanced cases may require chemoradiation.