OG33.1-2 | Cervical Cancer — Summary & Reflection

KEY TAKEAWAYS

Cervical cancer is caused by persistent high-risk HPV infection (types 16 and 18 in ~70%), with E6/E7 oncoproteins targeting p53 and Rb respectively, and arises predominantly from the transformation zone. Squamous cell carcinoma is the most common histological type (70–80%), with adenocarcinoma making up 15–20%. Clinical features range from postcoital bleeding and abnormal discharge in early disease to pelvic pain, urinary/rectal symptoms, and lymphoedema in advanced disease. Diagnosis requires colposcopy-directed biopsy; staging uses MRI pelvis as the primary tool, supplemented by CT/PET-CT and cystoscopy/proctoscopy as indicated. FIGO 2018 staging classifies cervical cancer from IA (microinvasive) through IVB (distant metastases), with IB sub-divided into IB1 (≤2 cm), IB2 (>2–4 cm), and IB3 (>4 cm), and IIIC1/C2 capturing pelvic and para-aortic nodal disease (r = radiological, p = pathological). Management is stage-directed: microinvasive disease is managed by cone biopsy or simple hysterectomy; IB1–IB2 by radical (Wertheim's) hysterectomy or chemoradiation; IB3 through IVA by concurrent cisplatin-based chemoradiation with brachytherapy; IVB by palliative systemic chemotherapy. Prognosis declines steeply with stage, with lymph node involvement being the strongest prognostic factor.

REFLECT

In the clinical scenario at the start of this module, the 45-year-old woman had a 5 cm tumour with right parametrial induration extending to the pelvic side wall — placing her in Stage IIIB. This means radical surgery is not an option; her primary treatment will be concurrent chemoradiation. Consider: if a similar woman had been screened with a Pap smear two years earlier and found to have HSIL (CIN 3), and had undergone LEEP at that time, her cancer would most likely have been prevented entirely. Reflect on the opportunity cost of delayed or absent screening in resource-limited settings. What organisational and social barriers prevent women from accessing cervical screening in India, and what could a future clinician do — at the level of the clinic, community, and health system — to reduce the burden of this preventable cancer?