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INTRODUCTION

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Squamous cell carcinoma of the uterine cervix comprises an estimated 80% of all cervical cancers. The other histologies include adenocarcinoma (15%) and adenosquamous carcinomas (3%–5%), with only a small fraction of all cervical cancers having neuroendocrine or small cell histology. This chapter will focus on the diagnosis and management of primary squamous cell carcinoma of the uterine cervix. Amongst all malignancies, cervical cancer is the second most common cancer affecting women, with an estimated 52% case-fatality rate (1). Worldwide, cervical cancer is the most common gynecologic malignancy, accounting for 529,800 new cases (9%) and 273,200 deaths (8%) (1, 2). In developed countries, cervical cancer ranked tenth most common type of cancer in women (9.0/100,000 women) and below the top 10 causes of cancer mortality (3.2/100,000 deaths) (3). An estimated 86% of new cervical cancer cases are seen in the developing world, ranking as the second most common type of cancer (17.8/100,000 women) and cause of cancer deaths (99.8/100,000 deaths) (3). The highest incidence rates worldwide are observed in sub-Saharan Africa, Latin America and the Caribbean, South-Central Asia, and Southeast Asia (1). One-third of the cervical cancer burden in the world is experienced in South-Central Asia. Lastly, although cervical cytology is an excellent screening instrument for pre-invasive disease, the false negative rate for detecting invasive carcinoma is relatively high, reportedly 50%.

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INCIDENCE

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The incidence of invasive cervical cancer is related to age, with a mean age at the time of diagnosis of 48 years in the United States (3). The reported age-adjusted incidence of cervical cancer in the United States in girls under 20 years of age is 0.1 per 100,000, 1.5 per 100,000 in women aged 20–24 years, and 11.0 per 100,000 for women aged 30 to over 85 years (3).

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EPIDEMIOLOGY

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Patients with squamous cell carcinoma of the cervix share the same risk factors as patients with cervical intraepithelial neoplasia or dysplasia (4). These factors include:

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  • Early onset of sexual activity

  • Multiple sexual partners

  • High-risk sexual partners

  • History of sexually transmitted diseases

  • Tobacco use

  • Multiparity

  • Low socioeconomic status

  • Immunosuppression

  • Previous history of vulvar or vaginal dysplasia

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Perhaps the most significant risk factor for developing squamous cell cervical cancer is lack of cervical cytological screening. It is critical to underscore that infection with certain subtypes of the human papillomavirus (HPV) has been identified as the central causative factor in the development of cervical neoplasia (4). High-risk oncogenic types can be detected in almost all cervical cancers (4). Although most HPV infections are transient, chronic persistent HPV infection with the oncogenic subtypes is the central causative factor in the development of cervical neoplasia. The virus alone, however, is not sufficient to cause cervical neoplasia or cancer (4).

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