Cervical Cancer

Cervical Cancer

Cervical cancer is one of the leading causes of cancer death in the world, particularly in developing countries.

Aetiology: Cervical cancer is strongly linked to 2 viruses: Herpes simplex 2 (HSV2) and human papillomavirus (HPV). Other risk factors include: multiple sexual partners, age (35-65) and smoking.

Pathophysiology: Early stages consists of dysplasia (starts mild), which occurs at the junction of columnar cells with squamous cells at the external os. The majority of cervical cancers arise from squamous cells. A pap smear test will reveal the signs of dysplasis before cancer has manifested. Invasive carcinomas appear as a protruding nodular mass or ulceration. As the carcinoma spreads into neighbouring tissues (including uterus and vagina), it may reach the connective tissue, bladder and rectum. Metastases to lymph or blood occurs rarely at late stages. Cervical Cancer

Clinical manifestations: Cervical cancer is asymptomatic in the early stages (but can be detected by a pap smear). Invasive cervical cancer may manifest as abnormal vaginal bleeding and discharge, as well as dyspareunia (painful intercourse) and postcoital bleeding

Diagnosis: A clinical history, physical pelvic examination and pap smear can diagnose cervical cancer, along with a cervical biopsy. Pelvic CT or MRI may be used to assess the extent of spread.

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Management: Management depends on the grading of the dysplastic changes. A loop electrosurgical excision procedure (LEEP) may be perform to diagnose and treat lesions. Surgery combined with radiation is the recommended treatment. Surgery ranges from: cryosurgery to hysterectomy. Radiation therapy may be external or internal (implants) depending on the invasiveness of the cancer. Prevention of cervical cancer can be achieved through HPV vaccination for girls before they become sexually active Cervical Cancer

Adina, a 43-year-old woman comes in for her first visit at your clinic. She is a Kunjen woman from Kowanyam, in far north Queensland. Her past medical history is notable for long-standing asthma. She takes budesonide (inhalation) most days and prednisolone (orally) for severe exacerbations; this has been the case for much of her adult life. She is married with six children; her husband is an interstate truck driver. Her first sexual contact was at age 14, and she has had six sexual partners in her lifetime, but took the pill to prevent pregnancy. She has been smoking one pack of cigarettes per day for the last 30 years. She reports vaginal bleeding, particularly after intercourse which has become painful; she thinks is related to vaginal dryness after menopause. Adina, also reports of fatigue, weight loss and pelvic pain over the past 2-3 months.

Adina is subsequently diagnosed with cervical cancer and is positive for human papilloma virus.

The rationale for this case-based assignment is to allow you to demonstrate your clinical reasoning skills developed in the course thus far, demonstrating your capacity to differentiate normal from abnormal and to identify appropriate (evidence based) investigations and treatment modalities associated with the assigned case-study. The purpose of this assessment is for you to determine how the risk factors and mechanisms of cell injury/adaptation/repair relate to the diagnosis within an assigned case-study scenario from one of the studied systems (nervous, immune or musculoskeletal). You will also apply your understanding of the pathophysiology for the diagnosed disease with its clinical manifestations, and identify appropriate (evidence based) diagnostic tests/physical assessments, and treatment modalities for this case; skills which are necessary in everyday practice. Cervical Cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.

When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection Cervical Cancer