CERVICAL CANCER. Xi Cheng ， M.D. & Ph. D. Department of Gynecologic Oncology Fudan University Shanghai Cancer Center 2012. Risk factors and etiology. Demographic risk factors Lower socioeconomic status Ethnicity Age Behavioral risk factors Early age of intercourse （ <16 years old ）
Xi Cheng， M.D. & Ph. D.
Department of Gynecologic Oncology
Fudan University Shanghai Cancer Center
Demographic risk factors
Behavioral risk factors
Medical risk factors
Human papillomavirus (HPV)-- the main etioloy
proliferation, and accumulation of
Adapted from N Engl J Med 2005; 353: 2101–04.
the area where Nearly all
cervical neoplasia occurs
Variant in SCJ location
Adapted from Lancet 2007; 370: 890–907.
Cervical Intraepithelial Neoplasm , CIN
CIN = cervical intraepithelial neoplasia; CIS = carcinoma in situ.
From Ostor, 1993.
Cervical intraepithelial neoplasia(CIN)
SIL: squamous intraepithelial lesion；CIS: carcinoma in situ
A.Normal； B. LSIL ; C.HSIL(CIN2); D.HSIL(CIN3)
Routine Cytological screening
Repeat Cytology and
HPV Testingat 12 months
ASC-US = atypical squamous cells of undetermined significance
FIGO annual report
Cervical Cancer Incidence
Squamous Cell Carcinoma
comprise 80-85 percent of all cervical cancers
arise from the ectocervix
(a).exogenic cancer:the most common type
(c).ulcer type cancer
(d).cervical canal type cancer
(a).microscopic invasive cancer: tear-drop or serrate cancer cell group growing through basal membrane
(b).invasive cervical cancer: invasiveness of stroma is beyond the microscopic invasive cancer,and according to the cellular differentiation it is divided into 3 degrees:
degree I:cornified large cell type,mitosis<2/HP
degree II:uncornified large cell type,mitosis 2~4/HP
degree III:small cell type,mitosis>4/HP
Cervical Squamous Cell Carcinoma
account for 15% of cervical Cancer
originate from cervical canal, invade canal wall and paracervical tissue,protrude the external OS,focus appearance,cervical appearance
1.Local Tumor Extension
paracervical and parametrial
lymph nodes internal,
external iliac lymph nodes
common iliac lymph nodes
paraaortic lymph nodes
Cytology: Cervical Squamous Cell Carcinoma
Cervical punch biopsies or conization specimens are the most accurate for allowing assessment of cervical cancer invasion
Other malignant tumors of cervix
Carcinoma of the Cervix Uteri – Staging FIGO,2000
Indication: IA-IIA Physically able to tolerate an aggressive surgical procedure
Advantage: ovarian preservation,avoid the long-term effects of radiation therapy
Different surgery approaches:
Advantage: avoids the risks associated with anesthesia and surgery,the main theraputic approach for stage IB2,IIA2,>III patients
Different radiotherapy approaches:
Adapted from Cardiovas Intervent Radio 2003；26(3): 234-241.
Every 3 months for 2 years,then every 6 months for 3-5 years, then annually
Different types of HPV in cervical cancer
Character-istics of two candidate HPV vaccines
One etiology----HPV infection
Two pathological types---- squamous cell carcinoma, adenocarcinoma
Three tumor spread types----local tumor extension, lymphatic Spread, hematogenous dissemination
Four clinic stages---- I, II, III, IV.
Five diagnostic methods----cervical cytology, lugol iodine solution stain, colposcopy, biopsy, cervical conization.