By R. Steve Bass, M.D.
About 16,000 women in the United States develop cervical cancer each year. Roughly 5,000 deaths from cervical cancer will occur in a given year. Patients are most likely to be diagnosed in their mid to late 40s. At the time of presentation and diagnosis, 45 percent of cases are localized, 34 percent have regional spread and 10 percent have widely spread disease.
The risk of developing cervical cancer is dropping significantly due to development and implementation of effective screening techniques that identify and remove preinvasive lesions.
Increases in mortality rates in young women have been noted in Canada, Great Britain, New Zealand and Australia. This increase appears to be due in part to changes in the classification of lesions, but is also likely attributable to sexual transmission of human papilloma virus (HPV), which is a contributing factor in the development of cervical cancer. Two strains of HPV are considered to have high malignant potential, while 15 other strains have a moderate malignant potential.
The epidemiologic characteristics of HPV growth resemble those of cervical cancer and support the theory that infection with this virus can lead to the development of cervical cancer. Herpes simplex virus type II appears to be a potential co-factor with HPV and the initiation of malignant degeneration of premalignant lesions.
Other risk factors include early age of initiation of sexual activity and multiple sexual partners. Cigarette smoking has been implicated as possibly doubling the potential incidence of cervical carcinoma, and the nonsteroidal estrogen compound DES carries malignant potential.
Cervical cancer typically presents with abnormal vaginal bleeding and/or pelvic pain or discomfort. The cervix is sandwiched between the bladder and ureters anteriorly, and the rectum and sigmoid colon posteriorly. The cervix is, of course, the lower portion of the uterus which is attached to the bones of the pelvis by pelvic ligaments and muscles.