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Pathology of Cervical Carcinoma

Pathology of Cervical Carcinoma. Introduction:. Best example of cancer prevention. Potentially curable if detected early Long pre-cancer state. Shed abnormal cells – cytological test - PAP Easy access to biopsy and treatment. WHO statistics. Risk Factors.

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Pathology of Cervical Carcinoma

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  1. Pathology of Cervical Carcinoma

  2. Introduction: • Best example of cancer prevention. • Potentially curable if detected early • Long pre-cancer state. • Shed abnormal cells – cytological test - PAP • Easy access to biopsy and treatment.

  3. WHO statistics

  4. Risk Factors • Early age at sex, Multiple partners. • Oral contraceptives, smoking , etc. • HPV infection – central to cancer (>85%) • High risk types – 16, 18, 31, 33 (Bound-DNA) • Low risk types – 6, 11, 42-44 (Free DNA) • Oncogene E6 (p53) & E7 (Rb) • Other viral/mutations can cause rarely.

  5. Sexual Exposure Pathogenesis: HPV Infection Cervical Transformation Zone Squamous Ep Columnar Ep High Risk Types (16,18) Low Risk-6,11 Smoking, Hormone, Oral contr. parity, Altered immune response etc. Squamous Ca Adeno Ca

  6. Cervical Intraepithelial Neoplasia (CIN) • Dysplasia within Ep. – (no infiltration) • Squamo-Columnar junction – common site • Dysplasia + Koilocytes - Plenty of HPV DNA • May Progress or Regress - Risk of cancer. • Classification: • Mild – Moderate – Severe dyspalasia0 (CIS) • CIN-I, CIN-II & CIN-III (CIS)

  7. Normal Cervix:

  8. Condyloma Cx.

  9. Normal Cervix : SUPER F INTERM BASAL

  10. Cervical Dysplasia:

  11. Cervical HPV infection:

  12. Pap Smear Results:

  13. Morphology: • Raised (acuminatum) or flat (macular). • Koilocytotic atypia • Abundant HPV nucleic acids. • Atypical cells in the basal region (CIN-1) or completely replace normal cells (CIN-3)

  14. Ca Cx - Morphology • 3 gross types ■Exophytic/Fungating, Ulcerating & Infiltrative. • 80% Squamous-Ca, 20% other. ■Adeno-carcinoma, Adenosquamous, Clear-cell carcinoma etc. • 40-50 peak age.

  15. Staging: • Stage 0 – CIN-III • Stage 1 – Ca limited to Cx • 1a – Preclinical – diagnosed by microscopy • 1a1- Minimal invasive • 1a2 – Microscopic invasion <5mm • 1b – more than 5 mm invasion • Stage 2 – Beyond but pelvic wall free • Stage 3 – Pelvic wall/lower vagina involve • Stage 4 – Extension beyond pelvis.

  16. Clinical Features: • Asymptomatic – Abnormal cells in smears • Vaginal Bleeding • Treatments – Cone biopsy, hysterectomy • 5 year survival • Stage1->80%, Stage2–75%, Stage3-35% & 10-15% with Stage 4 disease.

  17. Ulcerating Ca Cx:

  18. Fungating Ca Cx

  19. Stage IV – Ca Cx (Block Dissection)

  20. Spread: • Direct: • Down – Vagina, Labia • Lateral – adnexa, ureter, ovary, Pelvic wall • Anterior – bladder • Posterior – Rectum • Lymphatic: • Paracervical, Parametrial , Obturator, Int & Ext iliac, Common iliac, Presacral. • Para-aortic • Blood: Liver, lungs etc.

  21. Stage IV – Ca Cx (Block Dissection)

  22. Carcinoma Cervix:

  23. Infiltrating Carcinoma Cx:

  24. Squamous Carcinoma:

  25. Summary: • Carcinoma cervix is related to HPV infection with other risk factors. (smoking) • Early diagnosis by cytological PAP test. • Predominantly Squamous type(80%). • Clinically divided into 1- 4 stages. • Spread by direct, lymphatic & blood.

  26. Thank you!

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