Cervical cancer

Squamous cell carcinoma: (60-80% of carcinomas of the cervix) are one of the most common tumour in women (peak incidence 40-45 years old)

Morphology: these cancers arise from precursor lesions; classified according to the degree of epithelial maturation and the distribution of cytologic atypia…

• CIN I: (including condyloma), in which the atypia is predominately in the superficial cell layers (koilocytosis), with preservation of epithelial maturation.

• CIN II: in which the atypia is conspicuous in both the superficial and the basal cell layers, but with decreasing maturation.

• CIN III: in which the atypia is in all cell layers but with minimal or no maturation (carcinoma in situ)

Macroscopically: invasive cervical carcinoma manifests itself in three gross morphologic patterns:

• Exophytic or fungating

• Ulcerating

• Infiltrative

Microscopically: SCC can be classified according to the degree of differentiation:

• Keratinizing (nests), large, well differentiated (25%)

• Non-keratinizing, large cell moderately differentiated (65%)

• Undifferentiated squamous cells (remaining 10%)

Natural History:

Risk of progression to malignancy is proportional to the grade of CIN, but the rates of progression are not uniform. Carcinoma in situ is clearly a precursor of invasive carcinoma, the latter developing in up to 70% of women followed without treatment after a diagnosis of carcinoma in situ.

Stages of cervical cancer are as follows:

Carcinoma in situ (100% cure)…

1. Carcinoma confined to the cervix (80-90% survival)

   • IA: preclinical carcinoma diagnosed only by microscopy

   • IB: Histologically invasive carcinoma greater than 5mm in depth

2. Carcinoma extends beyond the cervix but not into the pelvic wall; into the vagina but not the lower third (75% survival)

3. Carcinoma extends to the pelvic wall or lower third of the vagina (35% survival)

4. Carcinoma has extended beyond the pelvis or metastasized (10-15% survival)

Clinical features and complications:

Clinically tumours may present with:

• Abnormal Pap smear

• Vaginal bleeding or discharge

• Pain or bleeding on coitus

• Hematuria

• Weight loss

Cervical tumours especially squamous carcinomas tend to grow by local spread often involving the urinary system. Death may be due to ureteric obstruction leading to hydronephrosis, pyelonephritis and renal failure.

Category: Gynecology Notes , Pathology Notes