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27 CERVICAL CANCERPeter Argenta M.D.

1. Differentiate cervical dysplasia, carcinoma in situ, and cervical cancer.

Cervical dysplasia refers to a neoplastic process that has not violated the basement membrane. For thisreason it is also called cervical intraepithelial neoplasia. Carcinoma in situ refers to high-grade dysplasiainvolving the full thickness of the epithelium, usually with marked nuclear atypia. The term "cancer" impliesthat there has been invasion through the basement membrane. Untreated carcinoma in situ progresses tocancer in about 15-33% of patients if follow-up is extended to 10 years.

2. What causes cervical cancer?

Extensive evidence indicates that infection with certain high-risk subtypes of human papilloma virus (HPV)(types 16, 18, 31, 45, 51-53, 58, or 58) is an important etiologic event. Though the exact mechanism ofmalignant transformation has not been entirely elucidated, it is clear that HPV oncoproteins E6 and E7impair proliferation inhibition by blocking the function of the p53 and retinoblastoma tumor suppressorpathways.

Increased incidence of cervical cancer is seen with: lower socioeconomic status, early age of first coitus,higher numbers of sexual partners or spouses with high numbers of sexual partners, and cigarettesmoking. Most recently cervical cancer has been associated with autoimmune deficiency, with increasedincidence seen in patients after organ transplant, and in those with HIV/AIDS disease. In fact, cervicalcancer has become an "AIDS-defining" condition.

3. How many people get cervical cancer?

In the United States, it is estimated that 10,500 women got cervical cancer during 2004, making it the 11thmost common cancer diagnosed. Worldwide, the incidence approaches 500,000 cases/year and half ofthese patients will die of their disease, making it among the leading causes of cancer death for women inmany developing nations.

4. Is the incidence of cervical cancer increasing or decreasing? Why?

Decreasing. There is solid evidence that the incidence of cervical cancer has decreased steadily in areaswhere screening programs are employed. These programs, in general, improve detection of preinvasivedisease and allow for therapeutic intervention. The risk may be reduced in an individual by 90% whenregular screening is employed. Additionally, patients who are screened regularly are much more likely topresent with an early-stage lesion if cancer is detected.

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