Cervical Cancer

Cervical Cancer
Case Studies
The patient, a 28-year-old woman, has been sexually active with multiple partners since she
was 14 years old. She is now married and wants to have children. She has intermittent
breakouts of vulvar ulcers/sores but no other complaints. Her pelvic examination during a
routine visit with her gynecologist was normal. She had a lump in her left breast.
Studies Results
Sexually transmitted
infections (STIs), p. 756
Herpes simplex test, p. 731 Positive for herpes simplex virus-2 (HSV-2) (normal:
negative)
No change in serology 4 weeks later
Cytomegalovirus, p. 200 No antibodies detected
Chlamydia, p. 722 No antibodies detected
Gonorrhea, p. 761 Culture negative
Syphilis serology, p. 473 No antibodies detected
Pap smear, p. 743
Adequacy of specimen Adequate
Category Epithelial abnormality
Epithelial cell
abnormalities
Squamous, atypical cells
Human papillomavirus (HPV)
testing, p. 745
Positive for HPV 16
Breast sonogram, p. 871 Benign fibroadenoma
Diagnostic Analysis
The patient was informed of her test results. Her herpes titers indicated that the disease was
rather chronic, not acute. No treatment was recommended. Because of her age,
mammograms were contraindicated. A breast ultrasound indicated the lesion was not
cancerous. A fibroadenoma is common in this age-group. Because of her positive HPV
results and suspicious Pap smear, further evaluation was recommended.
Studies Results
Colposcopy, p. 595 Several suspicious areas
Biopsy Squamous cell carcinoma
Cervical cone biopsy, p. 720 Invasive squamous cell carcinoma
Hysteroscopy, p. 614 No extension to the endocervical canal or uterus
Pelvic ultrasound, p. 887 No extension of tumor beyond the cervix
The patient was advised to have a radical hysterectomy. She refused because she wanted to
have a family. She began psychologic counseling for guilt over her past promiscuity, which
had increased her risk for cervical cancer. She became pregnant 1 year later and lost the
Case Studies 2
pregnancy during the second trimester. One year later, she developed a large pelvic mass,
which represented progressive, inoperable cervical cancer. Despite radiation therapy and
chemotherapy, she died at age 31 of cervical cancer.
Critical Thinking Questions
1. Why was mammography contraindicated for this patient?
2. How is sexual promiscuity related to the risk for cervical cancer?