I.                    Cervical Cancer

a.      Screening = prevention of invasive squamous cell carcinoma via partnership with the gynecologist and the pathologist

                                                              i.      Pap Smear

1.       Originally derived as a hormonal study

2.       Area where pathologists get sued for the most (may not have gotten sufficient cells from the transformation zone)

3.       Samples the transformation zone of the cervix

4.       Good screening

5.       Not a diagnostic test

6.       Interval is important (how frequent it is done)

7.       Issues of false positives/negatives as with any screening test

                                                            ii.      Colposcopy = examination of vagina and cervix by means of an endoscope = focused biopsy that look specifically for abnormal growth or vessel patterns

b.       Risk factors

                                                               i.      Increased number of sexual partners

                                                             ii.      Early intercourse

                                                            iii.      STDs

                                                            iv.      Early 1^st pregnancy

                                                              v.      Parity

                                                            vi.      Socioeconomic status

                                                           vii.      Cigarettes (nicotine) à cessation will help with wart proliferation

                                                         viii.      Immunosuppression

                                                           ix.      OCP’s

                                                             x.      Vitamin deficiencies

                                                           xi.      Interval since last pap smear
 

3. Histology

Similar to any cancer = neoplastic cells have larger nuclei with increased nuclei/cytoplasm (n/c) ratio; low grade have koilocytes with perinuclear halo, darker nuclei due to increased DNA, and normal maturation of cells while high grade cells are smaller, have bigger nuclei, increased n/c ratio, darker nuclei, and maturation abnormalities.

d. Causes – HPV

                                                              i.      HPV is integrated into the host DNA in cancer

                                                             ii.      Only small % of HPV infection progresses to cancer

                                                            iii.      Long latency

                                                            iv.      Cofactors possible although not definitive

e. Outcomes of combined studies on Low Grade Squamous Intraepithelial Lesions (LGSIL)

                                                               i.      Progress to High Grade Squamous Intraepithelial Lesions (HGSIL) in 16%

                                                             ii.      Persists as LGSIL in 37%

                                                            iii.      Reverts to normal in 46%

f.  Characteristics

                                                              i.      Most are squamous cell carcinoma     

                                                            ii.      Adenocarcinoma type is increasing

                                                          iii.      Can be endophytic (growing inward) or exophytic (growing outward)

                                                           iv.      No symptoms or postcoital bleeding

                                                             v.      Spreads by regional lymphatics

Patients usually die from tumors that affect the uterus or from metastasis

Back to the Reproductive System Index