Cervical cancer natural history, complications and prognosis: Difference between revisions
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==Natural history== | ==Natural history== | ||
*Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%.<ref name="YuanWang1999">{{cite journal|last1=Yuan|first1=Chiou-Chung|last2=Wang|first2=Peng-Hui|last3=Lai|first3=Chiung-Ru|last4=Tsu|first4=En-Jie|last5=Yen|first5=Ming-Shyen|last6=Ng|first6=Heung-Tat|title=Recurrence and Survival Analyses of 1,115 Cervical Cancer Patients Treated with Radical Hysterectomy|journal=Gynecologic and Obstetric Investigation|volume=47|issue=2|year=1999|pages=127–132|issn=0378-7346|doi=10.1159/000010076}}</ref> | *Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%.<ref name="YuanWang1999">{{cite journal|last1=Yuan|first1=Chiou-Chung|last2=Wang|first2=Peng-Hui|last3=Lai|first3=Chiung-Ru|last4=Tsu|first4=En-Jie|last5=Yen|first5=Ming-Shyen|last6=Ng|first6=Heung-Tat|title=Recurrence and Survival Analyses of 1,115 Cervical Cancer Patients Treated with Radical Hysterectomy|journal=Gynecologic and Obstetric Investigation|volume=47|issue=2|year=1999|pages=127–132|issn=0378-7346|doi=10.1159/000010076}}</ref><ref name="B.K.B.2016">{{cite journal|last1=B.K.|first1=Vishma|last2=B.|first2=Prakash|last3=Kulkarni|first3=Praveen|last4=M.|first4=Renuka|title=Survival and prognostic factors for cervical cancer: a hospital based study in Mysuru, India|journal=International Journal of Community Medicine and Public Health|year=2016|pages=218–223|issn=2394-6032|doi=10.18203/2394-6040.ijcmph20151566}}</ref> | ||
*However most CIN spontaneously regress. Left untreated, about 70% of CIN-1 will regress within one year, and 90% will regress within two years. About 50% of CIN 2 will regress within 2 years without treatment. | *However most CIN spontaneously regress. Left untreated, about 70% of CIN-1 will regress within one year, and 90% will regress within two years. About 50% of CIN 2 will regress within 2 years without treatment. | ||
*Progression to cervical cancer in situ (CIS) occurs in approximately 11% of [[cervical intraepithelial neoplasia]](CIN1) and 22% of [[cervical intraepithelial neoplasia]](CIN2). Progression to invasive cancer occurs in approximately 1% of [[cervical intraepithelial neoplasia]] (CIN1), 5% in [[cervical intraepithelial neoplasia]] (CIN2) and at least 12% in [[cervical intraepithelial neoplasia]] (CIN3) | *Progression to cervical cancer in situ (CIS) occurs in approximately 11% of [[cervical intraepithelial neoplasia]](CIN1) and 22% of [[cervical intraepithelial neoplasia]](CIN2). Progression to invasive cancer occurs in approximately 1% of [[cervical intraepithelial neoplasia]] (CIN1), 5% in [[cervical intraepithelial neoplasia]] (CIN2) and at least 12% in [[cervical intraepithelial neoplasia]] (CIN3) | ||
*In advanced disease, [[metastasis|metastases]] may be present in the [[abdomen]], [[lung]]s. | *In advanced disease, [[metastasis|metastases]] may be present in the [[abdomen]], [[lung]]s. | ||
*The patient may present with dyspnea, cough with blood-stained sputum, persistent pain or discomfort in the chest, edema hands/feet. | *The patient may present with dyspnea, cough with blood-stained sputum, persistent pain or discomfort in the chest, edema hands/feet. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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%.
Natural history
- Prognosis is generally good, and the 5 year survival rate of patients with cervical cancer is approximately 67.9%.[1][2]
- However most CIN spontaneously regress. Left untreated, about 70% of CIN-1 will regress within one year, and 90% will regress within two years. About 50% of CIN 2 will regress within 2 years without treatment.
- Progression to cervical cancer in situ (CIS) occurs in approximately 11% of cervical intraepithelial neoplasia(CIN1) and 22% of cervical intraepithelial neoplasia(CIN2). Progression to invasive cancer occurs in approximately 1% of cervical intraepithelial neoplasia (CIN1), 5% in cervical intraepithelial neoplasia (CIN2) and at least 12% in cervical intraepithelial neoplasia (CIN3)
- In advanced disease, metastases may be present in the abdomen, lungs.
- The patient may present with dyspnea, cough with blood-stained sputum, persistent pain or discomfort in the chest, edema hands/feet.
- Once the cancer spreads to the other organs, it is most likely fatal.
Complications
Advanced stage of cervical cancer can cause varieties of complications, some of these are include:[3]
- Pain
- Vaginal hemorrhage
- Enterovaginal, rectovaginal, and vesico- or ureterovaginal fistulas
- Renal failure and/or uremia
- Malnutrition
- Anemia
- Mental depression
Prognosis
The prognosis for patients with cervical cancer is markedly affected by the extent of disease at the time of diagnosis. Majority of cervical cancer cases can be detected early through the use of screening by Pap test and HPV DNA testing.
- Prognostic Factors
- Clinical stage
- Gynecologic Oncology Group identified the following variables that were significant for progression-free interval and survival:
- Periaortic and pelvic lymph node status.
- Tumor size
- Patient age
- Performance status
- Bilateral disease
- Clinical stage
- Other prognostic factors
- Other prognostic factors that may affect outcome include the following:
- 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.
- Number of cells in S phase: The number of cells in S phase may also have prognostic significance in early cervical carcinoma.
- HPV-18 DNA: HPV-18 DNA has been found to be an independent adverse molecular prognostic factor. Two studies have shown a worse outcome when HPV-18 was identified in cervical cancers of patients undergoing radical hysterectomy and pelvic lymphadenectomy.
- A polymorphism in the Gamma-glutamyl hydrolase enzyme, which is related to folate metabolism, has been shown to decrease response to cisplatin, and as a result is associated with poorer outcomes.
Refrences
- ↑ Yuan, Chiou-Chung; Wang, Peng-Hui; Lai, Chiung-Ru; Tsu, En-Jie; Yen, Ming-Shyen; Ng, Heung-Tat (1999). "Recurrence and Survival Analyses of 1,115 Cervical Cancer Patients Treated with Radical Hysterectomy". Gynecologic and Obstetric Investigation. 47 (2): 127–132. doi:10.1159/000010076. ISSN 0378-7346.
- ↑ B.K., Vishma; B., Prakash; Kulkarni, Praveen; M., Renuka (2016). "Survival and prognostic factors for cervical cancer: a hospital based study in Mysuru, India". International Journal of Community Medicine and Public Health: 218–223. doi:10.18203/2394-6040.ijcmph20151566. ISSN 2394-6032.
- ↑ Schmitz, Herbert E.; Isaacs, John H. (1957). "Complications of Advanced Cervical Cancer and Their Management". Radiology. 69 (3): 324–329. doi:10.1148/69.3.324. ISSN 0033-8419.