Snapshot A 46-year-old woman presents to her gynecologist due to abnormal vaginal bleeding. She notices bleeding after intercourse and in between her menstrual cycles, which occurs every 28 days. This is the first time she has established care with a gynecologist. On pelvic examination, there is 2-cm exophytic mass originating in the cervix. Cervical biopsy demonstrates squamous cell carcinoma. Introduction Overview cancer that typically arises from the transformation zone of the cervix Preventive HPV vaccine indication login to view 1 more bullet not recommended during pregnancy Epidemiology Incidence third most common cause of malignancy in women first is endometrial and second is ovarian average age of presentation is 45 years of age Risk factors human papillomavirus (HPV) infection double-stranded DNA oncovirus especially HPV-16 and HPV-18 multiple sexual partners current smoking immunosuppression ETIOLOGY Pathophysiology HPV infects the immature basal layer of the cervical epithelium in areas of epithelial breaks, leading to basal cell replication through the synthesis of oncogenic proteins E6 and E7 login to view 3 more bullets persistent HPV leads to squamous intraepithelial lesions graded as login to view 14 more bullets cervical carcinoma squamous cell carcinoma is the most common (~80% of cases) login to view 1 more bullet adenocarcinoma is the second most common (~15% of cases) Associated conditions HIV HPV Presentation Symptoms asymptomatic in early stages vaginal bleeding can be post-coital, intermenstrual, postmenopausal, or spontaneous bladder outlet obstruction in advanced lesions pelvic pain hematuria renal failure Physical exam pelvic exam superficial ulceration exophytic tumor in some cases indurated cervix may be found Studies Invasive studies pap smear cells from the transformation zone of the cervix are collected and placed on a slide login to view 1 more bullet indications login to view 4 more bullets management login to view 20 more bullets colposcopy allows for a magnified view of the cervix login to view 1 more bullet indication login to view 3 more bullets cervical conization indication login to view 1 more bullet Differential Cervicitis differentiating factors inflammation of the cervix, most commonly secondary to sexually transmitted infections (e.g., chlamydia and gonorrhea) Treatment Treatment is based on the staging, nodal status, and pathology e.g., ≤ 4 cm tumor confined to the cervix is managed with surgical resection or radiation