Cancers of the Cervix, Vulva, and Vagina
Anuja Jhingran, Anthony H. Russell, Michael V. Seiden, Linda R. Duska, Anne Kathryn Goodman, Susanna I. Lee, Subba R. Digumarthy and Arlan F. Fuller, Jr.
Summary of Key Points
Incidence
• An estimated 12,170 new cases of invasive cervical cancer were anticipated in 2012 in the United States, with 4220 deaths projected.
• Seventy-five percent to 80% are squamous cell carcinomas.
• Since the advent of cytologic screening in the 1940s, the incidence of cervical cancer has been decreasing; however, a steady increase in the incidence of preinvasive disease of the cervix has occurred.
Etiology
• Associated risk factors include race, early age at first coitus, multiple sexual partners, multiparity, lower socioeconomic standing, cigarette smoking, history of sexually transmitted diseases, immunosuppression, and oral contraceptive use.
• Strong association with human papillomavirus (HPV).
• HPV serotypes 16, 18, 31, 33, 45, and 56 account for more than 80% of all invasive cervical cancers.
Evaluation and Staging
• Screening for cervical cancer historically has been done with the Papanicolaou (Pap) smear and pelvic examination.
• Testing for DNA of high-risk oncogenic HPV may be used to triage atypical smears and to reduce the frequency of cytologic screening.
• Biopsies should be performed of gross lesions.
• Patients without gross lesions but with abnormal cytology should undergo colposcopy with directed biopsies and endocervical curettage (ECC) or brushing.
• Once a diagnosis of cancer is made, the patient requires a complete history and physical examination, including bimanual and rectovaginal examination, as well as supraclavicular and groin lymph node examination.
• Cervical cancer is staged clinically, not surgically.
