Cervical cancer is the fourth most common gynecologic cancer worldwide and the second most common cancer during pregnancy. Globally, there are high incidence and mortality rates with this cancer, especially in developing countries. The incidence and death rate is not as high within the United States. However, given the preventability of this cancer, attention should be focused on identifying risk factors, prioritizing primary prevention, conducting screening and early detection, and performing tertiary prevention. The most common risk factor is the persistence of high-risk human papillomavirus infection, and vaccination should be encouraged. Cervical cancer screening methods include a cervical cytology test alone, a high-risk human papillomavirus test alone, or a combination of both known as cotesting. When an abnormal result is identified, American Society for Colposcopy and Cervical Pathology guidelines should be followed for management and follow-up. Most general gynecologists are unlikely to manage gynecologic malignancies; therefore, if a malignant lesion is identified, prompt referral to gynecologic oncology is required for management. Magnetic resonance imaging of the pelvis, computed tomography, and 18F-fluorodeoxyglucose positron emission tomography can help identify spread of the malignant lesion with other crucial prognostic factors. Management of cervical cancer depends on the stage of disease and the patient’s desire for future fertility. Select patients with appropriate counseling can be candidates for fertility sparing options, if interested in childbearing. Treatment options can include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. The 5-year survival rate is approximately 68.0% overall, but it ultimately depends on the cancer’s stage. Given the type of treatment that is provided, survivorship care will require a multidisciplinary approach.
Case 1. AP is a 35-year-old cisgender woman who presents to your office to establish care. She does not have a regular source of care and has never had a gynecologic examination. She has been sexually active with three partners in the past and has never been pregnant. She does not smoke and otherwise states she is healthy.
Epidemiology
Globally, cervical cancer is the fourth most common gynecologic cancer and the second most common cancer during pregnancy. There are high incidence and mortality rates notable in developing countries.1 Within the United States in 2024, there were approximately 13,820 new cases of cervical cancer diagnosed with an estimated 4,360 deaths from the disease.2 New cases occurred at a rate of 7.6 per 100,000 women per year with a lifetime risk of developing cervical cancer of approximately 0.6%. The median age at diagnosis is 50 years with more than 45% of cases diagnosed between 35 and 54 years of age. The median age at death is reported to be 59 years with the highest percentage of cervical cancer deaths (23.5%) occurring among those 55 to 64 years of age.2 In the United States, the 5-year survival rate is approximately 68.0% overall, but it ultimately depends on the cancer’s stage.
The most common types of cervical cancer are squamous cell carcinoma and adenocarcinoma. In a review of cervical cancer incidence during 1975-2018, squamous cell carcinoma accounted for 68.5% of cases and adenocarcinoma accounted for 14.7%.3 Adenosquamous carcinoma comprises 3.3% of cases of cervical cancer, and other rare types of cervical carcinoma such as clear cell and small cell carcinoma are uncommon.
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