Cervical Malignancy and Pre-Malignancy. Valerie Capstick, 2010. Malignant Changes in the Female Cervix: Objectives. Describe the risk factors, symptoms, and physical finding characteristic of cervical cancer Describe the spread pattern of cervical cancer
Cervical Malignancy and Pre-Malignancy
Valerie Capstick, 2010
Cancer of the Uterine Cervix
Starting with the end.
Finishing with the prevention.
Don’t need to know the rare types
IIa upper vagina with no parametrial invasion
IIb Parametrial invasion
Most treated with Radiotherapy and chemotherapy
Occasional IIa will get surgery
Treatment: radical radiotherapy and chemotherapy
Premalignant changes of the Uterine Cervix
And how we prevent Cervical Cancer.
Pathophysiology of Premalignant changes on cervix
Two types of epithelium on the cervix interact to create an area that is vulnerable to the oncogenic HPV virus. The penis does not have this type of interaction
Columnar (produces mucous)
What is metaplasia?
NOTE: This cervix has
had acetic acid applied,
the SCJ is not obvious
with the naked eye or
with out acetic acid.
Normal Process !!
Conversion of a normal glandular epithelium to a normal squamous epithelium
Starts at puberty, accelerates at pregnancy
These cells are uniquely vulnerable to HPV infection.
(Human papillomavirus infection)
(80% of ever sexually active females)
(Cervical Intraepithelial Neoplasia)
(1-3% of those infected with HPV)
(?% Of those with dysplasia who do not get diagnosed and treated)
HSIL high grade
LSIL low grade
Human Papilloma Virus
‘Persistent infection with one of the carcinogenic types of HPV is a necessary, but not sufficient, cause of both squamous and glandular malignancy.’
Technique described on one of the documents on HOMER
(Technique for obtaining satisfactory pap smears)
Pap smearsWhat age to start, how often, when to stop, any exceptions?
Guideline for Screening for Cervical Cancer (on Homer)
Abnormal Pap Smear
Pathologist or cytotechnician create the report.
Bad news: Many ways a pap can be abnormal, and type of change and age of woman dictates next step.
Good news: The pathologist will tell you what to do as part of the report.
Pap Smears: A. Normal Pap, B. ASCUS (not normal, not precancerous…atypical squam cells undet. Significance)C. LSIL-low grade C. HSIL – high grade
Redo pap if you get ASCUS
Normal (vast majority)
ASC-H (atyp squam, high grade)
Normal (vast majority)
AGC-(atypical glandular cells)
Areas of mosaic, punctation, white
epithelium suggest areas of dysplasia.
Biopsy suspicous areas (small, representative sample)
Must treat entire transformation zone:
LEEP (loop electrosurgical excision procedure)-most common
Hysterectomy-rare, usually only if other indications
anterior lip of