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Cervical cancer

Cervical cancer
Location of cervical cancer and an example of normal and abnormal cells
Pronunciation
SpecialtyOncology
SymptomsEarly: none[2]
Later: vaginal bleeding, pelvic pain, pain during sexual intercourse[2]
Usual onsetOver 10 to 20 years[3]
TypesSquamous cell carcinoma, adenocarcinoma, others[4]
CausesHuman papillomavirus infection (HPV)[5][6]
Risk factorsSmoking, weak immune system, birth control pills, starting sex at a young age, many sexual partners or a partner with many sexual partners[2][4][7]
Diagnostic methodCervical screening followed by a biopsy[2]
PreventionRegular cervical screening, HPV vaccine, sexual intercourse with condoms,[8][9] sexual abstinence
TreatmentSurgery, chemotherapy, radiation therapy, immunotherapy[2]
PrognosisFive-year survival rate:
68% (US)
46% (India)[10]
Frequency604,127 new cases (2020)[11]
Deaths341,831 (2020)[11]

Cervical cancer is a cancer arising from the cervix or in any layer of the wall of the cervix.[2] It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.[12] Early on, typically no symptoms are seen.[2] Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse.[2] While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.[13]

Virtually all cervical cancer cases (99%) are linked to genital human papillomavirus infection (HPV);[14][5][6] most who have had HPV infections, however, do not develop cervical cancer.[3][15] HPV 16 and 18 strains are responsible for approximately 70% of cervical cancer cases globally and nearly 50% of high grade cervical pre-cancers.[16][17] Minor risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners.[2][4] Genetic factors also contribute to cervical cancer risk.[18] Cervical cancer typically develops from precancerous changes called cervical intraepithelial neoplasia over 10 to 20 years.[3] About 90% of cervical cancer cases are squamous cell carcinomas, 10% are adenocarcinoma, and a small number are other types.[4] Diagnosis is typically by cervical screening followed by a biopsy.[2] Medical imaging is then done to determine whether or not the cancer has spread.[2]

HPV vaccination is the most cost-effective public health measure against cervical cancer.[14] There are six licensed HPV vaccines.[16] They protect against two to seven high-risk strains of this family of viruses and may prevent up to 90% of cervical cancers.[9][19][20] By the end of 2023, 143 countries (74% of WHO member states) provided the HPV vaccine in their national immunization schedule for girls.[21] As of 2022, 47 countries (24% of WHO member states) also did it for boys.[22]: 654  As a risk of cancer still exists, guidelines recommend continuing regular Pap tests.[9] Other methods of prevention include having few or no sexual partners and the use of condoms.[8] Cervical cancer screening using the Pap test or acetic acid can identify precancerous changes, which when treated, can prevent the development of cancer.[23] Treatment may consist of some combination of surgery, chemotherapy, and radiation therapy.[2] Five-year survival rates in the United States are 68%.[24] Outcomes, however, depend very much on how early the cancer is detected.[4]

Worldwide, cervical cancer is both the fourth-most common type of cancer and the fourth-most common cause of death from cancer in women, with over 660,000 new cases and around 350,000 deaths in 2022.[3][25] This is about 8% of the total cases and total deaths from cancer.[26] 88% (2020 figure) of cervical cancers and 90% of deaths occur in low- and middle-income countries and 2% (2020 figure) in high-income countries.[22]: 650 [27][3][28] Of the 20 hardest hit countries by cervical cancer, 19 are in Africa.[29] In low-income countries, it is one of the most common causes of cancer death with an incidence rate of 47.3 per 100,000 women.[30][23] In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer.[31] Expected scenarios for the reduction of mortality due to cervical cancer worldwide (and specially in low-income countries) have been reviewed, given assumptions with respect to the achievement of recommended prevention targets using triple-intervention strategies defined by WHO.[32] In medical research, the most famous immortalized cell line, known as HeLa, was developed from cervical cancer cells of a woman named Henrietta Lacks.[33]

17 November is the Cervical Cancer Elimination Day of Action.[34] The date marks the day in 2020 when WHO launched the Global strategy to accelerate the elimination of cervical cancer as a public health problem, with a resolution passed by 194 countries.[34] To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below 4 per 100 000 women.[35][36]

  1. ^ "CERVICAL | meaning in the Cambridge English Dictionary". dictionary.cambridge.org. Retrieved 5 October 2019.
  2. ^ a b c d e f g h i j k l "Cervical Cancer Treatment (PDQ®)". NCI. 14 March 2014. Archived from the original on 5 July 2014. Retrieved 24 June 2014.
  3. ^ a b c d e World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.12. ISBN 978-92-832-0429-9.
  4. ^ a b c d e "Cervical Cancer Treatment (PDQ®)". National Cancer Institute. 14 March 2014. Archived from the original on 5 July 2014. Retrieved 25 June 2014.
  5. ^ a b Kumar V, Abbas AK, Fausto N, Mitchell RN (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 718–721. ISBN 978-1-4160-2973-1.
  6. ^ a b Kufe D (2009). Holland-Frei cancer medicine (8th ed.). New York: McGraw-Hill Medical. p. 1299. ISBN 978-1-60795-014-1. Archived from the original on 1 December 2015.
  7. ^ Bosch FX, de Sanjosé S (2007). "The epidemiology of human papillomavirus infection and cervical cancer". Disease Markers. 23 (4): 213–227. doi:10.1155/2007/914823. PMC 3850867. PMID 17627057.
  8. ^ a b "Cervical Cancer Prevention (PDQ®)". National Cancer Institute. 27 February 2014. Archived from the original on 6 July 2014. Retrieved 25 June 2014.
  9. ^ a b c "Human Papillomavirus (HPV) Vaccines". National Cancer Institute. 29 December 2011. Archived from the original on 4 July 2014. Retrieved 25 June 2014.
  10. ^ "Global Cancer Facts & Figures 3rd Edition" (PDF). 2015. p. 9. Archived (PDF) from the original on 22 August 2017. Retrieved 29 August 2017.
  11. ^ a b Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (May 2021). "Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries". CA: A Cancer Journal for Clinicians. 71 (3): 209–249. doi:10.3322/caac.21660. PMID 33538338. S2CID 231804598.
  12. ^ "Defining Cancer". National Cancer Institute. 17 September 2007. Archived from the original on 25 June 2014. Retrieved 10 June 2014.
  13. ^ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstetrics and Gynecology International. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
  14. ^ a b "Immunizing against HPV". World Health Organization. Retrieved 6 October 2024.
  15. ^ Dunne EF, Park IU (December 2013). "HPV and HPV-associated diseases". Infectious Disease Clinics of North America. 27 (4): 765–778. doi:10.1016/j.idc.2013.09.001. PMID 24275269.
  16. ^ a b "Human papillomavirus vaccines (HPV)". World Health Organization. Archived from the original on 7 August 2024. Retrieved 29 September 2024.
  17. ^ "Cervical cancer". www.who.int. Retrieved 13 May 2022.
  18. ^ Ramachandran D, Dörk T (October 2021). "Genomic Risk Factors for Cervical Cancer". Cancers. 13 (20): 5137. doi:10.3390/cancers13205137. PMC 8533931. PMID 34680286.
  19. ^ "FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV". U.S. Food and Drug Administration. 10 December 2014. Archived from the original on 10 January 2015. Retrieved 8 March 2015.
  20. ^ Tran NP, Hung CF, Roden R, Wu TC (2014). "Control of HPV Infection and Related Cancer Through Vaccination". Viruses and Human Cancer. Recent Results in Cancer Research. Vol. 193. pp. 149–171. doi:10.1007/978-3-642-38965-8_9. ISBN 978-3-642-38964-1. PMID 24008298.
  21. ^ "Immunization coverage". World Health Organization. 15 July 2024. Retrieved 6 October 2024.
  22. ^ a b World Health Organization (December 2022). "Human papillomavirus vaccines: WHO position paper (2022 update)". Weekly Epidemiological Record. 97 (50): 645–672. hdl:10665/365351.
  23. ^ a b World Health Organization (February 2014). "Fact sheet No. 297: Cancer". Archived from the original on 13 February 2014. Retrieved 24 June 2014.
  24. ^ "SEER Stat Fact Sheets: Cervix Uteri Cancer". NCI. National Cancer Institute. 10 November 2014. Archived from the original on 6 July 2014. Retrieved 18 June 2014.
  25. ^ WHO (5 March 2024). "Cervical cancer". WHIO. Retrieved 23 September 2024.
  26. ^ World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 1.1. ISBN 978-92-832-0429-9.
  27. ^ "WHO adds an HPV vaccine for single-dose use". World Health Organization. 4 October 2024. Retrieved 6 October 2024.
  28. ^ "Cervical cancer prevention and control saves lives in the Republic of Korea". World Health Organization. Retrieved 1 November 2018.
  29. ^ "WHO adds an HPV vaccine for single-dose use". World Health Organization. 4 October 2024. Retrieved 5 October 2024.
  30. ^ Donnez J (April 2020). "An update on uterine cervix pathologies related to infertility". Fertility and Sterility. 113 (4): 683–684. doi:10.1016/j.fertnstert.2020.02.107. PMID 32228872.
  31. ^ Canavan TP, Doshi NR (March 2000). "Cervical cancer". American Family Physician. 61 (5): 1369–1376. PMID 10735343. Archived from the original on 6 February 2005.
  32. ^ Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. (February 2020). "Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries". Lancet. 395 (10224): 591–603. doi:10.1016/S0140-6736(20)30157-4. PMC 7043006. PMID 32007142.
  33. ^ Carraher Jr CE (2014). Carraher's polymer chemistry (9th ed.). Boca Raton: Taylor & Francis. p. 385. ISBN 978-1-4665-5203-6. Archived from the original on 22 October 2015.
  34. ^ a b "Cervical Cancer Elimination Day of Action". World Health Organization. Retrieved 6 October 2024.
  35. ^ "Global partners cheer progress towards eliminating cervical cancer and underline challenges". World Health Organization. 17 November 2023. Retrieved 6 October 2024.
  36. ^ "Global strategy to accelerate the elimination of cervical cancer as a public health problem". World Health Organization. 17 November 2020. Retrieved 6 October 2024.

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