Cervical Cancer

Causative Factors

Pathophysiology

Risk Factors

Diagnostic Testing
&
Common Findings

Treatments

Signs & Symptoms

Mostly asymptomatic
(Danhausen, Phillippi, & McCance, 2019)

If any symptoms at all,
abnormal vaginal bleeding or discharge

HPV infection
Multiple sexual partners
Smoking
Weak immune system
Having chlamydia or gonorrhea
Long-term oral birth control use
3 or more full term pregnancies
Maternal use of Diethylstilbestrol (DES)
Family history of cervical cancer
Vaginal douche use
(American Cancer Society, 2020; Danhausen, Phillippi, & McCance, 2019)

Advanced stages may include urinary/rectal symptoms, pelvic/back pain, or anemia
(Danhausen, Phillippi, & McCance, 2019)

According to Danhausen, Phillippi, and McCance (2019), this cancer is almost exclusively caused by a HPV infection.

The HPV has two proteins (E6 and E7) that turn off tumor suppressor genes, such as p53 and Rb, allowing the cells in the cervical lining to grow excessively (American Cancer Society, 2020)

When a female is infected with a high-risk type of cervical human papillomavirus (HPV) (such as type 16, 18, 31, & 33), precancerous cell changes (or cervical dysplasia) may occur. Advanced forms of these changes, called cervical intraepithelial carcinoma (CIN) and cervical in situ (CIS), are considered preinvasive lesions. They develop in the transformation zone, where the squamous epithelium and columnar epithelial cell layers meet within the cervix
(Danhausen, Phillippi, & McCance, 2019)

HPV may cause the up-regulation of the E6 oncoprotein in certain genetic sequences, resulting in increased vascular epidermal growth factor production. This promotes blood vessel growth for the tumor.
(Danhausen, Philippi, & McCance, 2019)

HPV strains 16 & 18 cause 70% of cervical cancer cases
(Danhausen, Philippi, & McCance, 2019)

There are 3 types:
(American Cancer Society, 2020)

Squamous Cell Carcinomas

Adenocarcinoma

Adenosquamous carcinomas or mixed carcinomas

Most common type (9/10 cases). Occurs in the transformation zone of cervical lining

Occurs in the endocervix

Mixture of the other types

Relationship to INFECTION

Most HPV infections resolve on their own or the cellular lesions remain preinvasive or non-cancerous.

In other situations, the abnormal cellular changes, which create high rates of cell division and increased presence of local mutagens, progress to invasive carcinoma and metastasis (Rote, 2019)

According to Rote (2019), majority of all cervical cancer cases are caused by a viral infection of HPV

Progression to cancer from preinvasive lesions is more common in patients with chronic HPV infections. The viral DNA changes the DNA of the infected cervical basal cell and causes viral oncogene production
(Rote, 2019)

Those with coexisting, active HIV, chlamydia or gonorrhea infections are also are higher risk of progressing HPV infections (Danhausen, Phillippi, & McCance, 2019)

Papanicolaou (Pap) Test
Examines epithelial scrapings for dysplasia. Early detection of atypical cells occurs when test is done preventatively (Rote, 2019)

Per American Cancer Society (2020), females between 25-65 years old should have this done every 3 years

HPV Test
Detects for virus - which can be detected for more than a decade before any cellular changes occur (Danhausen, Phillippi, & McCance, 2019)

American Cancer Society (2020) recommends females between 25 and 65 have this done every 5 years if available.


Is also performed if a Pap test is abnormal for females between 21 and 29 (Danhausen, Phillippi, & McCance, 2019)

Colposcopy
Cervix is covered with vinegar and visually examined under magnification to assess for aceto-white areas, epithelial changes or presence of abnormal vascular changes. Biopsies are obtained if indicated (Danhausen, Phillippi, & McCance, 2019)

Only performed if dysplasia is detected during cervical cytologic exam

Biopsy
Abnormal tissue is taken during colposcopy to evaluate and diagnose extent of lesion

Most effective cancer-screening test developed to date
(Rote, 2019)

Dependent on stage of cancer, size/location of lesion, and degree of metastatic spread (Danhausen, Phillippi, & McCance, 2019)

Surgery, lymphangiography, CT scan, MRI, and ultrasound can be used to determine (extent of) metastisis (Danhausen, Phillippi, &McCance, 2019)

Surgical Interventions
(reserved for severe cases)
Hysterectomy
Pelvic Lymphadenectomy
Pelvic Exenteration

Procedural Interventions

Ablation

Killing of abnormal cells from cervix

Preferred for mild forms of dysplasia

Different types
Cryotherapy
Cold coagulation
Carbon dioxide laser
Electrocoagulation

Excision

Physical removal of abnormal tissue

Different types
Conization
Loop electrosurgical excision procedure (LEEP)

Radiation

High energy rays are used to kill abnormal cells

Used alone, after surgical intervention, or with chemotherapy (American Cancer Society, 2020)

Different types
External beam radiation
Brachytherapy

Chemotherapy

Anti-cancer drugs given intravenously or orally (American Cancer Society, 2020)

Preferred to be given in conjunction with radiation

Common drugs
Cisplatin
Carboplatin
Paclitaxel (Taxol)
Topotecan

Medication

Pembrolizumab (Keytruda) given as a form of immunotherapy and helps to stimulate patient's immune system (American Cancer Society, 2020)

Bevacizumab (Avastin) is given to inhibit blood vessel growth that feeds the cancerous lesions (American Cancer Society, 2020)