Cancer of the cervix is predominantly squamous cell cancer and also includes adenocarcinomas. It is less common than it once was because of early detection by the Pap smear, but it remains the third most common reproductive cancer in women and is estimated to affect more than 13,000 women in the United States every year. Risk factors vary from multiple sex partners, early sexual debut (younger than 20 years), smoking, and family history of cervical cancer to chronic cervical infection (exposure to human papillomavirus [HPV]).

• Cervical cancer is most often asymptomatic. When discharge, irregular bleeding, or pain or bleeding after sexual intercourse occurs, the disease may be advanced.
• Vaginal discharge gradually increases in amount, becomes watery, and finally is dark and foul-smelling because of necrosis and infection of the tumor.
• Bleeding occurs at irregular intervals between periods or after menopause, may be slight (enough to spot undergarments), and is usually noted after mild trauma (intercourse, douching, or defecation). As disease continues, bleeding may persist and increase.
• Leg pain, dysuria, rectal bleeding, and edema of the extremities signal advanced disease.
• Nerve involvement, producing excruciating pain in the back and legs, occurs as cancer advances and tissues outside the cervix are invaded, including the fundus and lymph glands anterior to the sacrum.
• Extreme emaciation and anemia, often with fever due to secondary infection and abscesses in the ulcerating mass, and fistula formation may occur in the final stage.

• Screening should begin within 3 years of initiation of sexual intercourse or at 21 years of age.
• Pap smear and biopsy results may show severe dysplasia, high-grade epithelial lesion (HGSIL), or carcinoma in situ.
• Other tests may include x-rays, laboratory tests, special examinations (e.g., punch biopsy and colposcopy), dilation and curettage (D&C), CT scan, MRI, IV urography, cystography, positron emission tomography (PET), and barium x-ray studies.

Disease may be staged (usually the tumor, nodes, and metastases [TNM] system) to estimate the extent of the disease so that treatment can be planned more specifically and prognosis.

• Conservative treatments include monitoring, cryotherapy (freezing with nitrous oxide), laser therapy, loop electrosurgical excision procedure (LEEP), or conization (removing a cone-shaped portion of cervix).
• Simple hysterectomy is performed if preinvasive cervical cancer (carcinoma in situ) occurs when a woman has completed childbearing. Radical trachelectomy is an alternative to hysterectomy for women of childbearing age.
• For invasive cancer, surgery, radiation (external beam or brachytherapy), platinum-based agents, or a combination of these approaches may be used.
• For recurrent cancer, pelvic exenteration is considered.