Cervix

Dr. Raid Jastania

Cervical Cancer Screening

HPV infection

Pre-Cancerous Dysplasia

Cancer

10-20 years

Cervical Intraepithelial Lesions CIN

• Cervical cancer screening (Pap smear)• CIN1, CIN2, CIN3• LSIL, HSIL• HPV

– Low risk: type 6, 8, 11, 42, 44

– High risk: type 16,18, 31, 33, 35

• Host response • Genes involved: P53, RB (retinoblastoma gene)

Cervical Intraepithelial Lesions CIN

• CIN1: – 50-60% regress– 30% persist– 20% progress to CIN3– 1-5% progress to cancer

• CIN3:– 33% regress– 6-74% progress

Cervical Intraepithelial Lesions CIN

• Risk factors– Early age at first intercourse– Multiple sexual partners– Partner with multiple previous partners– HPV– Low socio economic class– Smoking– Immunodeficiency

Cervical Intraepithelial Lesions CIN

• CIN1:– Flat or chondyloma– Superficial layer– Koilocytosis (raison nuclei, perinuclear halo)

• CIN2:– More prominent changes– Squamous maturation is present

• CIN3:– Severe changes, Full thickness– Loss of maturation– Abnormal mitosis

Cervical Intraepithelial Lesions CIN

• Cytology and HPV testing– 70% of CIN on cytoloyg are HPV positive

(high-risk)– 50% of Abnormal cytology (ASCUS) are HPV

positive– 10-15% of normal cytology are HPV positive

Cervical Cancer

• Most are squamous cell carcinoma

• Some are adenocarcinoma, adenosquamous or small cell carcinoma

• Peak of cancer at 45 years

• Peak of CIN at 30 years

Cervical Cancer

• Findings:– Lesion at the transformation zone

– Small, or large, or invasive (Barrel cervix)

– Extend to parametrial soft tissue and lymph nodes

• Symptoms:– Small: asymptomatic, seen on exam as white lesion

– Large: vaginal bleedin, leukorrhea, pain

Cervical Cancer

• Survival 5-year:– Stage 0 pre cancer 100%– Stage1 90%– Stage 2 82%– Stage 3 35%– Stage 4 10%

Cervicitis

• Very common

• Infectious, non-infectious

• Acute, chronic

• Vaginal discharge, leukorrhea

• Chlamydia, Trichomonas, Candida, N. gonorrhea, Herpes

Endocervical Polyp

• Polypoid lesion in the cervical canal

• ? Inflammatory

• Mucus gland, cystic change

• Edematous stroma

• Inflammation

• Can result in vaginal bleeding