Cervical cancer is both preventable and curable. The pre-invasive phase of cervical cancer has been recognized for over 100 years. In 1886, Sir John Williams presented the Harveian Lectures where he described eight cases of cervical cancer, one of which was equivalent to carcinoma in situ or cervical intra-epithelial neoplasia (CIN) III. Colposcopy was described during the 1920s and then refined over the ensuing years, particularly in relation to optics and the light source.
Cervical cancer has a long natural history with a prolonged pre-cancerous phase that is easily detectable and treatable. Exfoliative cervical cytology remains the mainstay for screening of pre-cancerous lesions, CIN. Assessment of women presenting with abnormal cervical cytology and the selection of those requiring treatment relies mainly on colposcopic impression of the cervical transformation zone and histological appraisal of directed punch biopsies. There is variation in assessment of the cytology, colposcopy and histology, and therefore ‘final’ diagnosis should be a marriage of all three disciplines.
The need to maximize clinical resources, manage patients more quickly and more effectively, limit post-operative complications and preserve reproductive function has led to the popularity of local excisional methods for cervical pre-malignancy. Although the cure rates for all local ablative and excisional methods is in excess of 90% after one treatment, the excisional methods provide a more reliable histopathological diagnosis and the patient may be treated at the initial visit. Cure rates for CIN correlate principally with geographical extent.
In excess of 95% of cervical cancer cases are associated with oncogenic types of human papilloma virus. Important advances have been made recently to develop recombinant vaccines to prevent and treat this infection. Clinical trials on preventive and therapeutic vaccines are underway with encouraging reports.
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