Cervical Cancer

Definition

Cervical cancer is a malignancy of the uterine cervix, usually arising from the epithelial cells of the cervical transformation zone.

• Most common histology: Squamous cell carcinoma (~70–80%)
• Other types: Adenocarcinoma (~20%), adenosquamous, neuroendocrine

Etiology

• Human papillomavirus (HPV) infection is the primary cause
  • High-risk types: HPV 16, 18 (>70% of cases)
• Persistent HPV infection → dysplasia → carcinoma in situ → invasive cancer

Epidemiology

• Fourth most common cancer in women worldwide
• Peak incidence: 40–50 years
• Strongly associated with lack of screening

Risk Factors

• HPV infection (persistent, high-risk types)
• Early sexual activity, multiple sexual partners
• Smoking
• Immunosuppression (HIV, organ transplant)
• Long-term use of oral contraceptives

Clinical Features

• Early-stage: Often asymptomatic
• Symptoms when present:
  • Abnormal vaginal bleeding (intermenstrual, postcoital, postmenopausal)
  • Vaginal discharge
  • Pelvic pain in advanced disease
• Advanced disease: Urinary or bowel symptoms due to local invasion

Diagnostics

• Screening: Pap smear, HPV DNA testing
• Colposcopy and biopsy: Confirm histology
• Imaging: MRI, CT, or PET/CT for staging and lymph node involvement
• FIGO staging guides treatment

Treatment (Oncology Pharmacy Focus)

Early-stage (IA–IB1)

• Surgery: Radical hysterectomy with pelvic lymphadenectomy
• Fertility-sparing options: Conization or radical trachelectomy

Locally advanced (IB2–IVA)

• Concurrent chemoradiation:
  • External beam radiotherapy (EBRT) + brachytherapy
  • Chemotherapy: Weekly cisplatin (40 mg/m² IV) as a radiosensitizer

Metastatic / Recurrent

• Systemic therapy:
  • Platinum-based chemotherapy ± bevacizumab
    • Cisplatin or carboplatin + paclitaxel
    • Bevacizumab for eligible patients
• Immunotherapy: Pembrolizumab for PD-L1 positive tumors

Supportive Care

• Anti-emetics, hydration, pain management
• Monitor for myelosuppression, nephrotoxicity, neuropathy (depending on regimen)
• Management of radiation-induced toxicities

Prognosis

• Early-stage: Excellent, 5-year survival >90%
• Locally advanced: 5-year survival ~60–70%
• Metastatic: Poor prognosis, 5-year survival <20%

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