Cervical Cancer

Papanicolaou smears decrease the incidence and mortality of cervical cancer. Give female patients a Pap smear if they are due, even if they present with an unrelated complaint. Follow up any dysplastic Pap smear with colposcopy-directed biopsies and endocervical curettage. If the Pap smear shows microinvasive cancer, proceed to conization. Frankly invasive cancer needs surgery and/or radiation.

Risk factors for cervical cancer:

1. <20 years old at first coitus, pregnancy, or marriage

2. Multiple sexual partners (role of human papillomavirus and possibly herpes) or coitus with a promiscuous person

3. Smoking

4. Low socioeconomic status

5. High parity (which protects against endometrial cancer) Important points:

1. Invasive cervical cancer begins in the transformation zone and usually presents with vaginal bleeding or discharge (may be postcoital, intermenstrual spotting, or abnormal menstrual bleeding).

2. Treat with surgery and/or radiation.

3. Maternal, exposure to diethylstilbestrol causes daughters to get clear cell cancer of the cervix or vagina.

Postmenopausal bleeding is cancer until proved otherwise; endometrial cancer is the most common cancer If) present in this fashion (fourth most common cancer in women). Get an endometrial biopsy for any patient with postmenopausal bleeding (as well as a Pap smear and endocervical curettage). Any woman with unexplained gynecologic bleeding that persists needs a Pap smear, endocervical curettage, and endometrial biopsy.

Risk factors for endometrial cancer:

1. Obesity

2. Nulliparity

3. Late menopause

4. Diabetes mellitus

5. Hypertension

6. Gallbladder disease

7. Chronic, unopposed estrogen stimulation, as in polycystic ovary/Stein-Levenlbal syndrome, estrogen-secreting neoplasm (granulosa-theca cell, tumor), and estrogen replacement (increases risk of cancer only if taken without progesterone).

important points:

1. Oral contraceptives have bceir shown to reduce the incidence of uterine as well as ovarian cancer.

2. Most uterine cancer is adenocarcinoma and spreads by direct extension.

3. Treat, with surgery and radiation.

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