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
Chiamydia, 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
- Why was mammography contraindicated for this patient?
- How is sexual promiscuity related to the risk for cervical cancer?
Sample Solution