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Cervical cancer is the third most common type of gynecological cancer in the US after endometrial and ovarian cancer. The mortality and incidence of cervical cancer have significantly declined since the introduction of routine Papanicolaou-test screening (Pap smear) and human papillomavirus (HPV) vaccination. The most common histological type of cervical cancer is squamous cell carcinoma. In most cases, it arises from infection with high-risk HPV. Consequently, the risk factors for cervical cancer are, for the most part, identical to those for HPV (e.g., early onset of sexual activity, multiple sexual partners, history of STDs, and immunosuppression). Affected individuals are typically asymptomatic during early stages of the disease. Advanced cervical cancer typically manifests with vaginal bleeding, pelvic pain, and/or lower back pain. The development of cervical carcinoma is preceded by a premalignant epithelial dysplasia called “cervical intraepithelial neoplasia” (CIN), a type of premalignant epithelial dysplasia. The premalignant stages are screened with HPV tests (HPV DNA tests) and cytological investigation (Pap smear). Pap smears detect atypical squamous or glandular cells and, in some cases, also permit grading underlying intraepithelial lesions as low-grade (CIN I) or high-grade (CIN II/CIN III), based on the degree of atypia. Recommendations for colposcopy, treatment, and surveillance are based on a patient's risk of developing CIN III or higher. This risk is determined by current screening results and past medical history (including unknown history). High-grade intraepithelial lesions warrant colposcopy with cervical biopsy to determine the grade of CIN and diagnose invasive cervical cancer. Lesions consisting of a high-grade CIN may be excised using conization. The treatment of invasive cervical cancer involves a combination of surgery, radiation therapy, and/or chemotherapy, depending on the stage of the disease. Given that most patients are asymptomatic at early stages, primary (i.e., vaccination) and secondary (i.e., screening) prevention are particularly important. In the US, primary HPV testing is recommended for individuals between the ages of 25-65 years every 5 years. If this type of testing is not available, individuals should be screened with co-testing (HPV testing combined with a Pap smear) every 5 years or with a Pap smear every 3 years. Vaccination against HPV is currently approved for individuals aged 9-26 years.
#cervicalcancer #cervicalcarcinoma #gynaecology #cervix #cervicalca
Негізгі бет 49. Cervical Cancer : Etiology, Clinical features, Diagnosis and Treatment / OBG Lectures
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