Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis
- Michael Frumovitz, MD, MPH
Michael Frumovitz, MD, MPH
- Associate Professor of Gynecologic Oncology
- MD Anderson Cancer Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Deputy Editor – Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
Cancer of the uterine cervix is the third most common gynecologic cancer diagnosis and cause of death among gynecologic cancers in the United States . Cervical cancer has lower incidence and mortality rates than uterine corpus and ovarian cancer, as well as many other cancer sites. These rankings are similar to global estimates for other developed countries . Unfortunately, in countries that do not have access to cervical cancer screening and prevention programs, cervical cancer remains the second most common type of cancer (17.8 per 100,000 women) and cause of cancer deaths (9.8 per 100,000) among all types of cancer in women.
Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7 percent of cervical cancers . The most common histologic types of cervical cancer are squamous cell (69 percent of cervical cancers) and adenocarcinoma (25 percent) .
The epidemiology, risk factors, clinical manifestations, and diagnosis of invasive cervical cancer will be reviewed here. Screening and prevention, staging, and the management of cervical cancer and preinvasive disease are discussed separately. (See "Screening for cervical cancer" and "Invasive cervical cancer: Staging and evaluation of lymph nodes" and "Management of early-stage cervical cancer" and "Management of locally advanced cervical cancer" and "Cervical intraepithelial neoplasia: Management of low-grade and high-grade lesions".)
EPIDEMIOLOGY AND RISK FACTORS
Incidence and mortality — Globally, cervical cancer accounted for an estimated 528,000 new cancer cases worldwide and for 266,000 deaths in 2012 .
Global incidence and mortality rates depend upon the presence of screening programs for cervical precancer and cancer and of human papillomavirus (HPV) vaccination, which are most likely to be available in developed countries. Due to these interventions, there has been a 75 percent decrease in the incidence and mortality of cervical cancer over the past 50 years in developed countries [6,7].
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- EPIDEMIOLOGY AND RISK FACTORS
- Incidence and mortality
- Age distribution
- Risk factors
- ROUTES OF SPREAD
- CLINICAL MANIFESTATIONS
- Physical examination
- Cervical cytology
- Cervical biopsy and colposcopy
- Other diagnostic modalities
- Differential diagnosis
- SCREENING AND PREVENTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS