Pathology of Pathology of Cervical Cervical
CarcinomaCarcinoma
Cancer of Cervix
Shashi. 04/21/23
Introduction:Introduction:
Best example of cancer prevention.Best example of cancer prevention.
Potentially curable if detected earlyPotentially curable if detected early Long pre-cancer state.Long pre-cancer state. Shed abnormal cells – cytological test - Shed abnormal cells – cytological test -
PAPPAP Easy access to biopsy and treatment.Easy access to biopsy and treatment.
Cancer of Cervix
Shashi. 04/21/23
WHO statisticsWHO statistics
Cancer of Cervix
Shashi. 04/21/23
Risk FactorsRisk Factors Early age at sex, Multiple partners.Early age at sex, Multiple partners. Oral contraceptives, smoking , etc.Oral contraceptives, smoking , etc. HPV infection – central to cancer (>85%)HPV infection – central to cancer (>85%)
High risk types – 16, 18, 31, 33 (Bound-High risk types – 16, 18, 31, 33 (Bound-DNA)DNA)
Low risk types – 6, 11, 42-44 (Free DNA)Low risk types – 6, 11, 42-44 (Free DNA) Oncogene E6 (p53) & E7 (Rb)Oncogene E6 (p53) & E7 (Rb)
Other viral/mutations can cause rarely.Other viral/mutations can cause rarely.
Cancer of Cervix
Shashi. 04/21/23
Cervical Transformation ZoneCervical Transformation Zone
Pathogenesis:Pathogenesis:Sexual ExposureSexual Exposure
HPV InfectionHPV Infection
Squamous EpSquamous Ep Columnar EpColumnar Ep
Squamous CaSquamous Ca Adeno CaAdeno Ca
High Risk Types (16,18)High Risk Types (16,18)
Low Risk-6,11Low Risk-6,11Smoking, Hormone, Oral contr. parity,
Altered immune response etc.
Cancer of Cervix
Shashi. 04/21/23
Cervical Intraepithelial Neoplasia Cervical Intraepithelial Neoplasia (CIN)(CIN)
Dysplasia within Ep. – (no infiltration)Dysplasia within Ep. – (no infiltration) Squamo-Columnar junction – common siteSquamo-Columnar junction – common site Dysplasia + Koilocytes - Plenty of HPV DNADysplasia + Koilocytes - Plenty of HPV DNA May Progress or Regress - Risk of cancer.May Progress or Regress - Risk of cancer. Classification:Classification: Mild – Moderate – Severe dyspalasia0 (CIS)Mild – Moderate – Severe dyspalasia0 (CIS) CIN-I, CIN-II & CIN-III (CIS)CIN-I, CIN-II & CIN-III (CIS)
Cancer of Cervix
Shashi. 04/21/23
Normal Cervix:Normal Cervix:
Cancer of Cervix
Shashi. 04/21/23
Condyloma Cx.Condyloma Cx.
Cancer of Cervix
Shashi. 04/21/23
Normal Cervix :Normal Cervix :
SUPER F INTERM BASAL
Cancer of Cervix
Shashi. 04/21/23
Cervical Dysplasia:Cervical Dysplasia:
Cancer of Cervix
Shashi. 04/21/23
Cervical HPV infection:Cervical HPV infection:
Cancer of Cervix
Shashi. 04/21/23
Pap Smear Results:Pap Smear Results:
Cancer of Cervix
Shashi. 04/21/23
Morphology:Morphology: Raised (acuminatum) or flat Raised (acuminatum) or flat
(macular).(macular). Koilocytotic atypiaKoilocytotic atypia Abundant HPV nucleic acids.Abundant HPV nucleic acids. Atypical cells in the basal region Atypical cells in the basal region
(CIN-1) or completely replace normal (CIN-1) or completely replace normal cells (CIN-3)cells (CIN-3)
Cancer of Cervix
Shashi. 04/21/23
Ca Cx - MorphologyCa Cx - Morphology 3 gross types3 gross types
■■Exophytic/Fungating, Ulcerating & Exophytic/Fungating, Ulcerating & Infiltrative. Infiltrative.
80% Squamous-Ca, 80% Squamous-Ca,
20% other.20% other.
■ ■Adeno-carcinoma, Adeno-carcinoma, Adenosquamous, Clear-cell Adenosquamous, Clear-cell carcinoma etc.carcinoma etc.
40-50 peak age.40-50 peak age.
Cancer of Cervix
Shashi. 04/21/23
Staging:Staging: Stage 0 – CIN-IIIStage 0 – CIN-III Stage 1 – Ca limited to CxStage 1 – Ca limited to Cx
1a – Preclinical – diagnosed by microscopy1a – Preclinical – diagnosed by microscopy 1a1- Minimal invasive1a1- Minimal invasive 1a2 – Microscopic invasion <5mm1a2 – Microscopic invasion <5mm
1b – more than 5 mm invasion1b – more than 5 mm invasion Stage 2 – Beyond but pelvic wall freeStage 2 – Beyond but pelvic wall free Stage 3 – Pelvic wall/lower vagina Stage 3 – Pelvic wall/lower vagina
involveinvolve Stage 4 – Extension beyond pelvis.Stage 4 – Extension beyond pelvis.
Cancer of Cervix
Shashi. 04/21/23
Clinical Features:Clinical Features: Asymptomatic – Abnormal cells in Asymptomatic – Abnormal cells in
smearssmears Vaginal BleedingVaginal Bleeding Treatments – Cone biopsy, Treatments – Cone biopsy,
hysterectomyhysterectomy 5 year survival5 year survival
Stage1->80%, Stage2–75%, Stage3-35% Stage1->80%, Stage2–75%, Stage3-35% & 10-15% with Stage 4 disease.& 10-15% with Stage 4 disease.
Cancer of Cervix
Shashi. 04/21/23
Ulcerating Ca Cx:Ulcerating Ca Cx:
Cancer of Cervix
Shashi. 04/21/23
Fungating Ca CxFungating Ca Cx
Cancer of Cervix
Shashi. 04/21/23
Stage IV – Ca Cx Stage IV – Ca Cx (Block (Block Dissection)Dissection)
Cancer of Cervix
Shashi. 04/21/23
Spread:Spread: Direct:Direct:
Down – Vagina, LabiaDown – Vagina, Labia Lateral – adnexa, ureter, ovary, Pelvic wallLateral – adnexa, ureter, ovary, Pelvic wall Anterior – bladderAnterior – bladder Posterior – RectumPosterior – Rectum
Lymphatic: Lymphatic: Paracervical, Paracervical, ParametrialParametrial , Obturator, Int , Obturator, Int
& Ext iliac, Common iliac, & Ext iliac, Common iliac, PresacralPresacral.. Para-aorticPara-aortic
Blood:Blood: Liver, lungs etc. Liver, lungs etc.
Cancer of Cervix
Shashi. 04/21/23
Stage IV – Ca Cx Stage IV – Ca Cx (Block (Block Dissection)Dissection)
Cancer of Cervix
Shashi. 04/21/23
Carcinoma Cervix:Carcinoma Cervix:
Cancer of Cervix
Shashi. 04/21/23
Infiltrating Carcinoma Cx:Infiltrating Carcinoma Cx:
Cancer of Cervix
Shashi. 04/21/23
Squamous Carcinoma:Squamous Carcinoma:
Cancer of Cervix
Shashi. 04/21/23
Summary:Summary: Carcinoma cervix is related to HPV Carcinoma cervix is related to HPV
infection with other risk factors. infection with other risk factors. (smoking)(smoking)
Early diagnosis by cytological PAP Early diagnosis by cytological PAP test.test.
Predominantly Squamous type(80%).Predominantly Squamous type(80%). Clinically divided into 1- 4 stages. Clinically divided into 1- 4 stages. Spread by direct, lymphatic & blood.Spread by direct, lymphatic & blood.
Cancer of Cervix
Shashi. 04/21/23
Thank you!Thank you!