Chapter 87 Anuja Jhingran, Anthony H. Russell, Michael V. Seiden, Linda R. Duska, Anne Kathryn Goodman, Susanna I. Lee, Subba R. Digumarthy and Arlan F. Fuller, Jr. • An estimated 12,170 new cases of invasive cervical cancer were anticipated in 2012 in the United States, with 4220 deaths projected. • Seventy-five percent to 80% are squamous cell carcinomas. • Since the advent of cytologic screening in the 1940s, the incidence of cervical cancer has been decreasing; however, a steady increase in the incidence of preinvasive disease of the cervix has occurred. • Associated risk factors include race, early age at first coitus, multiple sexual partners, multiparity, lower socioeconomic standing, cigarette smoking, history of sexually transmitted diseases, immunosuppression, and oral contraceptive use. • Strong association with human papillomavirus (HPV). • HPV serotypes 16, 18, 31, 33, 45, and 56 account for more than 80% of all invasive cervical cancers. • Screening for cervical cancer historically has been done with the Papanicolaou (Pap) smear and pelvic examination. • Testing for DNA of high-risk oncogenic HPV may be used to triage atypical smears and to reduce the frequency of cytologic screening. • Biopsies should be performed of gross lesions. • Patients without gross lesions but with abnormal cytology should undergo colposcopy with directed biopsies and endocervical curettage (ECC) or brushing. • Once a diagnosis of cancer is made, the patient requires a complete history and physical examination, including bimanual and rectovaginal examination, as well as supraclavicular and groin lymph node examination. • Cervical cancer is staged clinically, not surgically.
Cancers of the Cervix, Vulva, and Vagina
Summary of Key Points
Incidence
Etiology
Evaluation and Staging
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Cancers of the Cervix, Vulva, and Vagina
