CERVICAL CANCER (Robbins pp 1048)

Pathogenesis / Risk factors: The pathogenesis of cervical cancer largely relates to the risk factors and the HPV. The cardinal risk factors are: 1) Early age of intercourse, 2) Multiple sexual partners, 3) A male partner who has had multiple sexual partners previously. HPV is also related to the pathogenesis in the following ways (I doubt you need to know this, but makes perfect sense): 1) HPV DNA has been isolated from cervical cancers & precancerous lesions, 2) HPV have oncogenes which can transform keratinocytes into cells found in precancerous lesions, 3) HPV has oncoproteins that bind to p53 tumour suppressor gene. There are various types of HPV, which produce lowhigh risk lesions (remember that 16, 18, 31, 33 are all high risk types). It is important to note that a vast number of women with HPV infection DO NOT develop CIN or CERVICAL CANCER.

Cervical Intraepithelial Neoplasia (Robbins pp 1049, Figs: 24-19 – 24-21)

General: The majority of cervical cancer lesions are preceded by a precancerous lesion. The thing about these precancerous lesions is that: they may regress spontaneously or become invasive carcinomas, and they are associated with HPV. These are classified according to the cervical intraepithelial neoplasia 1-3 (mild, moderate, severe dysplasia) classification. The higher the classification, the more risk of progression to carcinoma. The squamocolumnar junction (transformation zone) is the most common place where CIN arises.

Morphology: CIN I: Very similar to condylomata acuminata. There is very few alterations of the epithelial cells. HPV nucleic acid is prominent under certain stains. CIN II: There is atypical cells in lower layers of squamous epithelium. These cells show changes such as: high nuclear/cytoplasmic ratio, hyperchromasia, loss of polarity, increased mitotic figures, abnormal mitoses. CIN III: This is when there are atypical cells are seen throughout all layers of epithelium.

Category: Pathology Notes