Cancer of the cervix

Cancer of the cervix accounts for around 20% of cancers in women. It is associated with sexual activity being increased in women starting intercourse at an early age and having multiple partners. It is more common in women who are or who have been married than in single women. There is some evidence that the male partner is implicated, being associated with partners of lower socio-economic groups and the identification of high risk males who have more than one partner who develops cervical cancer.

The local spread in all directions occur. Lymph node spread occurs relatively early being identified in 15% of stage one tumor. From paracervical nodes there is spread to internal and external iliac nodes, presacral and obturator nodes. Blood borne metastasis occur affecting in particular the lungs, liver and bones.

A symptomatic presentation as a result of an abnormal cervical smear maybe brought about by vaginal bleeding particularly after intercourse maybe expected. Vaginal discharge maybe brought about. Local pain is unusual unless there is extensive pelvic infiltration. Renal failure is a recognized presentation due to bilateral ureteric obstruction. Other symptoms of local spread may include haematuria or rectal bleeding.

The pelvic and para-aortic lymphadenopathy may cause low back and sacral pain. General symptoms of malignancy including anorexia, malaise and weight loss may also be present.

Pelvic examination is mandatory at which the tumor will usually be apparent at the cervix as a proliferative or ulcerative growth or a diffused infiltration.