Copyright 2010
Definition
Cervical carcinoma is a malignant disease of the uterine cervix.
Most cases of cervical carcinoma are caused by infection with the human papilloma virus (HPV).
The result is uncontrolled growth of the cervical epithelium.
The structural changes are characterized by proliferation of malignant squamous epithelial cells at the junction between the outer cervix and the endocervical canal.
The functional changes may be minimal, but in advanced cases can be characterized by abnormal bleeding or obstruction of the endocervical canal.
The PAP smear is an extremely effective screening tool for pre-malignant lesions of the cervix and allows many cases of cervical carcinoma to be prevented. As a result, most women in the U.S. present clinically while still asymptomatic during screening pap smears. However, in developing countries, where routine screening is less accessable, women with advanced disease can present with abnormal or post-coital bleeding or pain.
Diagnosis is made by biopsy after a positive pap smear and examination with colposcopy.
Imaging with MRI or CT can be used to evaluate the extent of advanced disease. Chest x-ray to look for distant metastasis is used for staging.
Treatment of pre-malignant lesions is local excision with loop electrosurgical excision procedure. Early disease can be treated with radiation therapy or radical hysterectomy with similar results. Advanced disease is treated with chemotherapy and radiation.