Cancer of the uterine cervix (cervical cancer) is the second most common malignancy in women worldwide. The widespread use of the Papanicolau test (Pap smear) for screening purposes is responsible for the dramatic decrease in the number of new cases of cervical cancer in the United States. Approximately 10,000 new cases of invasive cervical cancer are diagnosed every year in the United States and 1/3 (approximately 3,500) will die from their disease. More than 50,000 cases of early cervical cancer (carcinoma in situ) are also diagnosed each year in the United States. Even a larger number of woman will have abnormalities detected in their screening Pap smear (see below)
Advanced cervical cancer is essentially a preventable disease. It’s presentation as a precancerous lesion with a long-lead time gradually progressing through predictable stages into invasive cancer makes this cancer amenable to early detection and cure. In most cases, a premalignant lesion (dysplastic cells) is identified in a Pap smear preparation that requires further evaluation and diagnosis. Pap smears are classified according to the Bethesda System and include:
o Satisfactory for evaluation o Unsatisfactory for evaluation o Specimen rejected/not processed o Specimen processed but unsatisfactory for evaluation
o Negative for intraepithelial lesion or malignancy o Epithelial squamous cell abnormalities o Atypical squamous cells (ASC)
Atypical squamous cells of undetermined origin (ASCUS)
o Low-grade squamous intraepithelial lesion (LSIL)
Human Papilomavirus/ mild dysplasia/cervical intraepithelial neoplasia (CIN) 1
o High-grade squamous intraepithelial lesion (HSIL)
Moderate and severe dysplasia, carcinoma in situ, CIN 2 and CIN 3
o Squamous cell carcinoma o Glandular cell
Atypical glandular cells (AGC)
Atypical glandular cells, favor neoplastic
o Endometrial cells in a woman aged 40 years or older
Squamous cell carcinoma accounts for approximately 80% to 85% of cervical cancers. The degree of differentiation of the cancerous cells correlates with the prognosis of the disease. A well-differentiated large cell squamous cell carcinoma has a better prognosis than a small cell undifferentiated squamous cell carcinoma which is associated with a poor prognosis. Pure adenocarcinomas of the cervix account for less than 20% of all cervical cancers. Similar to squamous cell carcinoma, the less differentiated the adenocarcinoma, the poorer the prognosis.
The degree of abnormalities detected on a Pap smear will determine the intensity of required evaluation. Strong evidence implicates human papillomaviruses (HPV) as a contributing factor in the malignant transformation into cervical cancer. Workup of a woman with an abnormal Pap smear includes:
Repeat Pap smear with colposcopy at regular intervals if untreated
Carcinoma in situ of the uterine cervix is known to precede the development of invasive cervical cancer. Patients diagnosed with carcinoma in situ of the uterine cervix that receive no treatment are known to progress to invasive cancer in approximately 30% of cases over a 10 year period. Although carcinoma in situ of the cervix can regress spontaneously, failure to provide adequate evaluation and treatment to a patient with a carcinoma in situ of the cervix is considered to be a clear departure from the acceptable standard of care (negligence).
Treatment of cervical cancer varies according with the staging of the disease at the time of diagnosis. For early invasive cervical cancer, surgery has remained the treatment of choice (conization, total hysterectomy, radical hysterectomy are accepted procedures). When the cervical cancer has disseminated, radiation therapy (with chemotherapy) represents the current standard of care. Treatment of advanced cervical cancer requires a multidisciplinary approach that includes gynecologic, radiation and medical oncologists.
If you believe that you or your loved have been misdiagnosed or wrongly treated for cervical cancer and suspect the injury may be the result of an obstetrical or gynecologic error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your gynecologic condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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