Clinical evaluation

A. Human papillomavirus is the most important factor contributing to the development of cervical intraepithelial neoplasia and cervical cancer. Other epidemiologic risk factors associated with cervical intraepithelial neoplasia and cervical cancer include history of sexual intercourse at an early age, multiple sexual partners, sexually transmitted diseases (including chlamydia), and smoking. Additional risk factors include a male partner or partners who have had multiple sexual partners; previous history of squamous dysplasias of the cervix, vagina, or vulva; and immunosuppression.

B. The signs and symptoms of early cervical carcinoma include watery vaginal discharge, intermittent spotting, and postcoital bleeding. Diagnosis often can be made with cytologic screening, colposcopically directed biopsy, or biopsy of a gross or palpable lesion. In cases of suspected microinvasion and early-stage cervical carcinoma, cone biopsy of the cervix is indicated to evaluate the possibility of invasion or to define the depth and extent of microinvasion. Cold knife cone biopsy provides the most accurate evaluation of the margins.

C. Histology. The two major histologic types of invasive cervical carcinomas are squamous cell carcinomas and adenocarcinomas. Squamous cell carcinomas comprise 80% of cases, and adenocarcinoma or adenosquamous carcinoma comprise approximately 15%.

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