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Clinical presentation of invasive cervical cancer

The clinical  presentation and pattern of growth of  invasive cervical  cancer  is variable. The tumour  may be have a polypoid or papillomatous  appearance  or it may be flat or ulcerating. Initially most cancers spread locally- upward into the body of the uterus, downward into the vagina or laterally into the pelvic folds. Eventually the tumour may involve the bladder  or rectum and metastatic spread to the liver and other organs occurs. Involvement of the pelvic lymphnodes occurs early in the disease and is associated with a poor prognosis.

The cancers are  most commonly diagnosed in women aged 45-65 however they have been described in very young women and an age range of 20-85 has been recorded for these cancers. Women with invasive cervical cancer are often  asymptomatic in the early stage of the disease; they  may  present with post coital, intermenstrual, or post menopausal bleeding, back ache or haematuria when the tumour is at an advanced stage.

Radical hysterectomy surgical specimen from woman with invasive cervical cancer. The cervix is ulcerated and infiltrated by tumour. Biopsy confirmed invasive squamous carcinoma.


Staging invasive cervical cancer

Stage FIGO: Description
0 Preinvasive carcinoma (CIN3 or carcinoma in situ)
I Cervical carcinoma confined to uterus (extension to corpus disregarded)
Ia Invasive carcinoma diagnosed only by microscopy
Ia1 Stromal invasion <3mm depth and <7mm horizontal spread
Ia2 Stromal invasion >3mmbut >5mm and  <7mm horizontal spread
IB Clinically visible lesion confined to cervix or microscopic lesion >1A2
IB1 Clinically visible lesion <4cm in greatest dimension
IB2 Clinically visible lesion >4cm in greatest dimension
II Tumour invades beyond uterus but not to pelvic wall or lower third of vagina
IIA Without parametrial invasion
IIB With parametrial invasion
III Tumour extends to pelvic wall and/or involves lower third of vagina and /or causes hydronephrosis or non functioning kidney
IIIA Tumour  involves lower third of vagina  but no extension to pelvic wall
IIIB Tumour extends to pelvic wall and /or causes hydronephosis or non functioning kidney
IVA Tumour invades mucosa of bladder or rectum and / or extends beyond true pelvis
IVB Distant metastasis



Treatment of an invasive cervical carinoma

However in women that have early stage cancer of the cervix, trachelectomy may be used as a fertility saving treatment. A radical trachelectomy is a surgical procedure; whereby the cervix, the upper part of the vagina, the parametrial tissue (tissue around the lower end of the uterus), and the pelvic lymph nodes are removed. The uterus (the womb) and the ovaries are not removed and so it is still possible to have children.  
This is done in early cervical cancer; the aim being to preserve fertility. This treatment has been developed in recent years by gynaecological oncologists in specialist centres around the world. It is done vaginally and through small incisions in the abdomen using a laparoscope, (key hole surgery).

More advanced cancers may require  radiotherapy and /or chemotherapy.  The clinical stage at time of diagnosis also affects the prognosis (chances of survival) for the patient.