cervical cancer, a neoplasm of the uterine cervix that can be detected in the early, curable stage by the Papanicolaou (Pap) test. The exact cause is unknown, but factors that may be associated with the development of cervical cancer are coitus at an early age, relations with many sexual partners, genital herpesvirus infections (such as cytomegalovirus), human papillomavirus (HPV), multiparity, and poor obstetric and gynecological care. Cervical dysplasia may regress, persist, or progress to clinical disease, but carcinoma in situ is considered to be a precursor of invasive carcinoma. About 90% of cervical tumors are squamous cell carcinomas, fewer than 10% are adenocarcinomas, and others are mixtures of these kinds, or, in rare cases, sarcomas. Cervical cancer invades the tissues of adjacent organs and may metastasize through lymphatic channels to distant sites, including the lungs, bone, liver, brain, and paraaortic nodes. ▪ OBSERVATIONS: Early cervical neoplasia is usually asymptomatic, but there may be a watery vaginal discharge or occasional spotting of blood; advanced lesions may cause a dark, foul-smelling vaginal discharge, leakage from bladder or rectal fistulas, anorexia, weight loss, and back and leg pains. Pap smears of cervical cells are highly important in screening, but definitive diagnoses are based on colposcopic examination and cytological study of specimens obtained by biopsy. ▪ INTERVENTIONS: Treatment depends on the kind and the extent of the malignancy, the age of the woman, and her general health. Also considered are her wishes in regard to maintaining her reproductive function. Carcinoma in situ may be treated by excisional conization or cryosurgery. Invasive tumors may be treated with radiotherapy or hysterectomy. Chemotherapy has a mainly palliative role. ▪ PATIENT CARE CONSIDERATIONS: Vaccination against HPV types 16 and 18, which are responsible for most cervical cancer cases, is now recommended for young women as a preventive measure.
