Cervical cancer

Cervical cancer arises from the cervix due to abnormal cell growth that can invade or spread to other parts of the body. Early stages often present no symptoms, but later stages may include abnormal vaginal bleeding, pelvic pain, and pain during sexual intercourse.

Causes and Risk Factors

Human papillomavirus (HPV) infection is the primary cause of cervical cancer, responsible for over 90% of cases. HPV types 16 and 18 are particularly high-risk, causing around 75% of global cases. Other contributing factors include smoking, a weak immune system, long-term use of birth control pills, starting sexual activity at a young age, and having multiple sexual partners.

In most cases, cells infected with the HPV heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.

Signs and Symptoms

Early stages of cervical cancer often lack symptoms. As the disease progresses, symptoms may include:

Vaginal bleeding, especially after sexual intercourse
Pelvic pain
Pain during sexual intercourse
Vaginal discharge

Advanced stages may present with symptoms such as loss of appetite, weight loss, fatigue, back pain, leg pain, swollen legs, heavy vaginal bleeding, and even leakage of urine or faeces from the vagina.

Diagnosis

Diagnosis typically begins with cervical screening methods like the Pap test or HPV DNA testing. If abnormalities are detected, a biopsy is performed through colposcopy, which involves a magnified visual inspection of the cervix. Imaging techniques like MRI, CT scans, and ultrasounds are used to assess the spread of the cancer.

Cervical cancer seen on a T2-weighted sagittal MR image of the pelvis

Treatment

Treatment varies based on the stage of cancer and includes surgery, chemotherapy, radiation therapy, and immunotherapy. Early-stage cancer (IA1) may be treated effectively by surgical techniques like loop electrical excision procedure or cone biopsy. Advanced stages (IIB-IVA) are often treated with radiation therapy and cisplatin-based chemotherapy.

Cervical cryotherapy

Prognosis

Prognosis largely depends on the stage at diagnosis. Early-stage cervical cancer has a five-year survival rate of about 92%, whereas the overall survival rate across all stages is approximately 66%. Survival rates decrease significantly for advanced stages.

Prevention

Screening

Regular cervical screening has dramatically reduced the incidence and mortality of cervical cancer. Pap tests can detect precancerous changes, allowing for early intervention. In the UK, cervical screening is recommended every three years for women aged 25-49 and every five years for women aged 50-64.

Cervical screening test vehicle in Taiwan

HPV Vaccination

HPV vaccines like Gardasil and Cervarix can prevent infection with high-risk HPV strains. These vaccines are most effective when administered before the onset of sexual activity, typically between ages 9 to 26.

Epidemiology

Worldwide, cervical cancer is the fourth most common type of cancer and the fourth leading cause of cancer-related deaths in women. In 2018, about 570,000 new cases were diagnosed, with over 300,000 deaths. It is most prevalent in developing countries due to limited access to screening and vaccination.

Age-standardised death from cervical cancer per 100,000 inhabitants in 2004

Self-assessment MCQs (single best answer)

What is the primary cause of cervical cancer?

Smoking

Human papillomavirus (HPV) infection

Long-term use of birth control pills

Starting sexual activity at a young age

Having multiple sexual partners

Which HPV types are considered high-risk, causing around 75% of global cervical cancer cases?

HPV 6 and 11

HPV 16 and 18

HPV 31 and 33

HPV 45 and 52

HPV 58 and 59

What is a common symptom of advanced-stage cervical cancer?

No symptoms

Vaginal bleeding after sexual intercourse

Pelvic pain

Pain during sexual intercourse

All of the above

Which diagnostic method is commonly used to obtain a visual inspection of the cervix?

Pap test

Colposcopy

MRI

CT scan

Ultrasound

What is the five-year survival rate for early-stage cervical cancer (IA1)?

50%

66%

75%

85%

92%

Which treatment is often combined with radiation therapy for advanced cervical cancer stages (IIB-IVA)?

Surgery

Immunotherapy

Cisplatin-based chemotherapy

Loop electrical excision procedure

Cone biopsy

How often is cervical screening recommended for women aged 25-49 in the UK?

Every year

Every two years

Every three years

Every four years

Every five years

At what age range are HPV vaccines most effective?

0-8 years

9-26 years

27-35 years

36-45 years

46-55 years

What is the global prevalence ranking of cervical cancer among women?

First

Second

Third

Fourth

Fifth

Which of the following contributes significantly to the higher prevalence of cervical cancer in developing countries?

Limited access to screening

Limited access to vaccination

High rates of smoking

Both A and B

Both B and C

Dentaljuce

Dentaljuce provides Enhanced Continuing Professional Development (CPD) with GDC-approved Certificates for dental professionals worldwide.

Founded in 2009 by the award-winning Masters team from the School of Dentistry at the University of Birmingham, Dentaljuce has established itself as the leading platform for online CPD.

With over 100 high-quality online courses available for a single annual membership fee, Dentaljuce offers comprehensive e-learning designed for busy dental professionals.

The courses cover a complete range of topics, from clinical skills to patient communication, and are suitable for dentists, nurses, hygienists, therapists, students, and practice managers.

Dentaljuce features Dr. Aiden, a dentally trained AI-powered personal tutor available 24/7 to assist with queries and provide guidance through complex topics, enhancing the learning experience.

Check out our range of courses, or sign up now!