The most common histologic type of cervical cancer is squamous, and the relative and absolute incidence of adenocarcinoma is increasing; both histologies are caused by HPV infection.
Cervical cancer is clinically staged, although modern radiographic modalities such as computed tomography, magnetic resonance imaging, ultrasound, or positron emission tomography may be beneficial for individual treatment planning.
Treatment of cervical cancer is based on stage of disease. Early stage disease (stages I to IIA) can be treated with either radical surgery or radiation therapy. Advanced stage disease (stages IIB to IV) is best treated with chemoradiation.
Vaginal cancer is a rare disease with many similarities to cervical cancer. Radiation therapy is the mainstay of treatment for most patients; however, select patients may be treated with radical surgery.
Cervical cancer ranks as the third most common gynecologic neoplasm in the United States, behind cancer of the corpus and ovary, mainly as a result of the effectiveness of screening programs. Worldwide, cervical carcinoma continues to be a significant health care problem. In developing countries, where health care resources are limited, cervical carcinoma is the second most frequent cause of cancer death in women. Because cervical cancer is preventable, it is imperative that gynecologists and other primary health care providers to women be familiar with vaccination programs, screening techniques, diagnostic procedures, and risk factors for cervical cancer and management of preinvasive disease. Vaginal cancer is a rare tumor that shares an epidemiology and risk factor profile that is similar to cervical cancer.
Invasive cancer of the cervix is considered a preventable disease because it has a long preinvasive state, cervical cytology screening programs are currently available, and the treatment of preinvasive lesions is effective. In spite of the preventable nature of this disease, 12,710 new cases of invasive cervical cancer resulting in 4290 deaths were anticipated in the United States in 2011 (1). Nationally, the lifetime probability of developing cervical cancer is 1:128. Although screening programs in the United States are well established, it is estimated that 30% of cervical cancer cases will occur in women who have never had a Papanicolaou (Pap) test. In developing countries, this percentage approaches 60% (2). Nevertheless, the worldwide incidence of invasive disease is decreasing, and cervical cancer is being diagnosed earlier, leading to better survival rates (1,3). The mean age for cervical cancer in the United States is 47 years, and the distribution of cases is bimodal, with peaks at 35 to 39 years and 60 to 64 years of age (1).
There are numerous risk factors for cervical cancer: young age at first intercourse (younger than 16 years), multiple sexual partners, cigarette smoking, race, high parity, low socioeconomic status, and chronic immune suppression. The relationship to oral contraceptive use was debated. Some investigators proposed that use of oral contraceptives might increase the incidence of cervical glandular abnormalities; however, this hypothesis was not consistently supported (4,5). Many of these risk factors are linked to sexual activity and exposure to sexually transmitted diseases. Infection with the herpes virus was thought to be the initiating event in cervical cancer; however, infection with human papillomavirus (HPV) was determined to be the causal agent in the development of cervical cancer, with herpes virus and Chlamydia trachomatis likely acting as cofactors. The role of human immunodeficiency virus (HIV) in cervical cancer is mediated through immune suppression (4). The Centers for Disease Control and Prevention described cervical cancer as an acquired immune deficiency syndrome (AIDS)–defining illness in patients infected with HIV (6).