creation date: 2026-11-01 13:55
tags: Pathologies
Cervical Cancer
Background
Definitions
Cervical cancer is a cancer of the uterine cervix
Etiology & Risk Factors
Cervical cancer originates lesions most commonly due to HPV infections.
- HPV 18/45: highest risk of Ca if present
- HPV 16: most common HPV type
The biggest risk factor for developing cervical cancer is poor HPV/cervical screening. Risk factors of HPV-related cancers include:
- Early onset of sexual activity
- Multiple sexual partners
- High-risk sexual partner
- History of STIs
- Early age at first birth and increasing parity
- History of vulvar or vaginal squamous intraepithelial neoplasia
- Immunosuppresion
Less commonly (5-10%), cervical cancer can originate independently from HPV.
Pathogenesis
Repeated damage from HPV infection cause atypical cells to form. This occurs within the transformation zone between the squamous cells and the columnar cells. This transformation zone is demarcated by the SCJ and the old SCJ, where metaplasia occurs.
This zone resides at the ectocervix and possibly into the endocervix.
Clinical Presentation
Signs & Symptoms
The first signs of atypical changes typically occurs with HPV screening.
History & Physical Exam
Diagnosis
Criteria
Diagnosis of cervical cell changes are made via HPV screening and reflexive cytology. Lesions are confirmed with colposcopy which is indicated if:
- HPV 18/45 or 16
- Other HPV variants with cytology findings
Colposcopy can confirm atypical cells with:
- Acetic acid: whitening of lesion
- Lugol’s: no uptake of brown with lesion
Work-up
Screening
HPV testing is indicated for females age ≥25 unless not sexually active
Differential
Red Flags / Complications
Management
For patients with HSIL, excision/LEEP is indicated. Follow up after removal to confirm lesion doesn’t return.
For LSIL, management primarily consist of monitoring, as 90% of LSIL revert back to normal cells.
References
Tools / Guidelines
OCSP 2025 Screening Information