Cervical cancer natural history, complications and prognosis
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Cervical cancer is the most common cancer mainly among women in developing countries, there is an estimate of almost 260,000 deaths annually, about 80% occurred in developing countries. Common complications of cervical cancer include pain, vaginal bleeding, fistula and renal failure. Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 70%. Studies has proven that there is an association between age of the patients and socioeconomic status of women with higher incidence of infection with high risk HPV in underserved poulation in the US.
- Cervical cancer is the most common cancer mainly among women in developing countries, there is an estimate of almost 260,000 deaths annually, about 80% occurred in developing countries.
- Infection by high risk strain of oncogenic HPV types is an established cause of neoplastic lesions of the cervix, vagina and vulva, anus, penis and oropharynx. HPV 16 and 18, are the most common cause of approximately 70% of all cervical cancers worldwide. HPV is highly transmissible through direct skin to skin contact and intercourse, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer.
- Since the identification of HPV as main cause of cervical cancer, prevention strategies had been developed by the introduction of HPV testing and cytology screening and utilizing HPV vaccines in preadolescent girls and young women whom are at greater risk.
- The most important risk factors associated with the infection by HPV are sexual intercourse at early age at the start of the first sexual relationships, having high number of sexual partners throughout life, or women being with men having multiple sexual partners. Male circumcision and use of condoms are factors that can reduce, but not preventing the transmission of human papilloma virus.
- There is an association between age and socioeconomic status of women in underserved areas of the US and higher incidence of infection with HPV. 
Advanced stage of cervical cancer can cause varieties of complications, some of these are include:
- Vaginal hemorrhage
- Enterovaginal, rectovaginal, and vesico- or ureterovaginal fistulas
- Renal failure and/or uremia
- Mental depression
- The prognosis for patients with cervical cancer is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%, this is heavily because of annual screening wiht Pap smear and introduction of new preventive methods like HPV vaccination to decrease the mortality and incidence rates.
- Majority of cervical cancer cases can be detected early through the use of screening by Pap test and HPV DNA testing.
- Prognosis of cervical cancer depends upon the clinical stage of the disease and distant metastasis.
- Patient age
- Maximum tumor diameter of ≥6 cm
- Pelvic lymph node enlargement, and distant metastasis
- Pretreatment hemoglobin level
- Concurrent chemoradiotherapy, increases survival rate significantly in patients with advanced stage of cervical cancer in comparison with those receiving radiation therapy alone
- Overal treatment period
- Clinical stage
- Human immunodeficiency virus (HIV) status: Women with HIV have more aggressive and advanced disease and a poorer prognosis.
- C-myc overexpression: A study of patients with known invasive squamous carcinoma of the cervix found that overexpression of the C-myc oncogene was associated with a poorer prognosis.
- HPV-18 DNA has been found to be an independent adverse molecular prognostic factor, studies have shown a worse outcome when HPV-18 was identified in cervical cancers of patients undergoing radical hysterectomy and pelvic lymphadenectomy.
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