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