It is the cancer occurring in cervix which is the entrance of uterus. Since the incidence of cervical
cancer is the highest, Uterine cancer is usually called cervical cancer in Korea.
Cervical cancer is the representative cancer which can be cured through early diagnosis and early
treatment, and can be fully cured only if it is found early.
However, since it does not have subjective symptoms, regular gynecological examination and
consultation is required.
Progression to cervical cancer is slowly being made from the occurrence of epithelial dysplasia. It becomes cancer in situ
(stage 0 : cancer is confined to the epithelium of the cervix), and such cancer in situ progresses more so that it is developed to
invasive cancer as it invades the basement membrane.
However, since the process is very slow, it mostly takes more than 10 years to be transformed from cancer in situ to invasive
cancer. It takes more than 15 years to lead to the death due to invasive cancer if treatment is not given since the occurrence of
As screening tests for cervical cancer is performed more frequently, carcinoma in situ of uterine cervix which is the early stage
(stage 0) is found a lot so that the frequency of invasive cervical cancer is relatively reduced and mortality is reduced accordingly.
Causes & Risk Factors
- Human papilloma virus : HP(Human papilloma virus) is detected in approximately 85~90% of tissues or cells in cervical cancer.
However, since HPV is not detected in all patients with cervical cancer, it is conceptually different from venereal disease
- Those who have the medical history of infection of venereal disease
- Those who have more sex partners
- Those who have the lower age of first sexual contact
- Those who have spouse who has more sex partners
Symptoms & Clinical Findings
Cervical cancer is characterized by no specific symptoms until the disease significantly progresses.
In case of early cervical cancer, it does not have any symptoms at all, or it has mild symptoms such as increase of abnormal
light pink vaginal discharge as shown in cervicitis or vaginitis. As it progresses, a patient may experience vaginal bleeding after
intercourse, bleeding when abdominal pressure is increased during bowel movement, abnormal bleeding except menstruation
or fetid discharge.
This vaginal bleeding starts as petechiae in which vaginal discharge is stained with blood. It may have clear bleeding later.
In some cases, it may be considered irregular menstruation or it can be considered bleeding after menopause.
As it progresses to end stage, the amount of bleeding gets higher and a patient feels low back pain, pain of lower abdomen and
legs and underlying edema. Bowel movements and urinary disturbance may be accompanied.
However, since these symptoms are the phenomena commonly observed in stage 3(cancer has reached the pelvic wall) in which
cervical cancer is developed a lot, it is the most important to find cervical cancer through regular check-up.
- Pap smear(Pap smear sample) : It can be performed easily as a typical pap smear. It is the test with accuracy and no pain,
but it does not have 100% accuracy, which is the drawback.
- Colposcopy(cervicography) : Cervix is amplified up to 4~10 times to identify lesions. When it is combined with pap smear,
diagnosis of cervical cancer can be very accurate, which is the advantage.
- Biopsy : Part of tissue of cervix is taken out to perform biopsy to confirm the diagnosis of cervical cancer.
- HPV virus test : It is a molecular diagnostic to know whether a patient is infected with HPV virus which is the important factor of
occurrence of cervical cancer and it will be developed to cancer in a patient with lesion in previous stage of cancer in advance.
Epithelial dysplasia and carcinoma in situ of uterine cervix
There are two ways such as local destruction therapy and surgical therapy.
• Local destruction therapy is mostly used as treatment for patients who have light lesions like mild epithelial
dysplasia and young women who want to be pregnant.
• Surgical therapy is mostly used for severe epithelial dysplasia and carcinoma.
Invasive cervical cancer
Treatment of invasive cervical cancer includes surgical therapy and surgery and radiation therapy.
Each treatment is determined by considering the following cases.
• Extent of spread of disease(stage) : When invasion of cancer is confined to cervix and upper part of vagina,
the surgical therapy is performed. Prognosis is good, but the disease has reached the tissue next to uterus or
even more. The cure rate of radiation therapy is high.
• Age of patients : When the ovarian function is preserved in young women, surgical therapy to preserve ovary
in young women can be selected, because radiation therapy destroys the ovarian function.
From the end of stage 2 of cervical cancer
From the end of stage 2 of cervical cancer, radiation therapy is often given. When the tumor gets bigger or
it advances to the next stage, radiation therapy and chemotherapy can be performed at the same time.
Patient’s systemic health status and presence of other disorders
When patients have diabetes, thyroid disease, heart and kidney disease, radiation therapy can be preferentially
performed, because of high risk of anesthesia upon surgery.
When patients have inflammatory disease in pelvis, proper radiation irradiation cannot be given due to
intrauterine change caused by of myoma uteri. Surgical therapy can be selected as the primary treatment.
The prognosis is directly related to patients. Even though it is in the same clinical stage, it varies depending on the tumor size,
histologic grade, lymphatic or vascular invasion, metastasis of lymph node, depth of invasion and invasion into the body of uterus.
The five-year survival rate by clinical stages is 100% for stage 0, 90% for stage 1, 75% for stage 2 and 50% for stage 3, which is
the highest one among five cancer survival rates in Korea.
Typically, when invasive cancer recurs, 80% recurs within 2 years after the first treatment or 95% recurs within 5 years. Therefore,
follow-up is required by every three months for first 2 years and by every 6 months for up to 5 years. After 5 years, follow-up is
required every year