National screening unit NZ guidelines

Patient handout - Cervical cancer - patient.co.uk

should be the diagnosis until proved otherwise for postcoital, intermenstrual or postmenopausal bleeding

• Common malignancy

• Incidence of invasive cervical cancer rises age 20-50 then remains steady

• SCC 85-90%

• Adenocarcinoma 10-15%

Facts/Figures

• almost unknown \<20yo; rare \<25yo

• 1:90 (Australia)

• On Average; a decade to develop from CIN

• Earlier age of first intercoursel greater chance of developing cervical cancer

Basic Pathology:

• Focus of attention = transformation zone

  • columnar cells lining endocervical cancel undergo metaplasia to squamous cells

    • squamocolumnar junction

      • may recede into endocervical canal

        • postmenopausal women

Cervical intraepithelial neoplasia

• "Cervical dysplasia"

• Bethesda system

• Have potential to become invasive

Natural history

• Dysplasia may:

  • return to normal

  • persist

  • progress to invasive cervical cancer

    • range from 1-30yrs

    • @ least 10 years on average therefore 2yrly smears ok

Clinical features

• Peak-incidence in sixth decade

• 80% due to SCC

• Risk factors

  • Age: increased after 55yo

  • Sexuality: Increased

    • multiple partners

    • Early age virginity

    • Early age first pregnancy

  • Viruses: After HSV2 or wart virus (probable)

  • Occupation: prostitutes

  • Parity: increased

  • SES: increased with low SES

Symptoms

• postcoital bleeding

• intermenstrual bleeding

• vaginal discharge

Mainly diagnosed routine screening

Examination

• Ulceration or mass on cervix

• Bleeds readily on contact - may be friable

Management

• Urgent gynaecological referral