Cervical cancer

Aetiopathogenesis

Risk factors

• The necessary factor: persistent infection with a high-risk HPV type — without HPV there is essentially no cervical cancer.
• Smoking raises the risk because carcinogens are detectable in cervical mucus and local immunity is weakened.

Clinical features

Symptoms — and why they come late

• Early stages are as a rule entirely asymptomatic.
• Later: contact or postcoital bleeding, foul-smelling, meat-water coloured discharge, intermenstrual and postmenopausal bleeding.
• Advanced: flank pain with hydronephrosis, leg oedema, sciatic pain, bladder and bowel symptoms.

Histology

• Most common type: squamous cell carcinoma.
• The proportion of adenocarcinomas is rising because they grow endocervically and are less accessible to cytology.

Diagnosis

How staging works today

• Since the 2018 revision, FIGO staging of cervical cancer is also imaging- and pathology-based, no longer purely clinical — and nodal status is included.
• Staging work-up: clinical examination, pelvic MRI, CT of chest/abdomen or PET-CT, cystoscopy/rectoscopy if indicated.

Typical imaging findings

• Colposcopy: The cervix is replaced by an irregularly nodular, cauliflower-like tissue mass in which the os can no longer be identified. Its surface is friable and bleeds on contact, with necrotic material in several places.
• Colposcopy: An irregularly raised, whitish-grey area with a friable surface lies on the cervix and bleeds at the lightest touch. The os can no longer be reliably identified in this area and the tissue looks broken down.

Keep learning in the app

Further reading (selection)

1. StatPearls: Cervical Cancer (NCBI Bookshelf)
2. WHO fact sheet: Human papillomavirus and cancer
3. DocCheck Flexikon, Zervixkarzinom
4. DocCheck Flexikon, FIGO-Klassifikation

Cross-references