Tumors of Cervix

BENIGN MALIGNANT Primary Secondary Adenoma Myoma Papilloma and angioma Carcinoma Sarcoma Mesodermal mixed tumor Secondary From any source

Adenoma (Mucous Polyp) Clinical Features Asymptomatic Vaginal discharge Vaginal bleeding Mass at the introitus Differential Diagnosis Carcinoma of the cervix Cervical ectopy Endometrial polyp Products of conception and blood clot Ectropion Cervical tags

Adenoma (Mucous Polyp) Treatment Asymptomatic must be removed and examined by the histopathologist Adenoma may be avulsed easily without anaesthesia Base of the polyp should be cauterized to avoid recurrence Perform curettage

Myomas of Cervix Arise from body of uterus, rarely from cervix Polypoidal Protrude through cervical canal Types Subserous Intramural submucous Myomas of Cervix

Myomas of Cervix Clinical Features Treatment Prone to trauma Ulceration Infection Vaginal discharge Irregular vaginal bleeding Mass at the introitus Treatment Vagival myomectomy or hysterectomy

Papilloma and Angioma Clinical features Treatment Small papillomas Single or multiple associated with vulva and vaginal papillomas Angioma forms superficial growth Treatment Surgical removal

Pre Malignant Conditions of Cervix

Cervical Intraepithelial Neoplasia (CIN) or Dysplasia Spectrum of disordered growth and abnormal microscopic changes confined to epithelium May be Mild (CIN I) Moderate (CIN II) Severe or carcinoma in situ (CIN III) Spontaneous regression of mild and moderate types possible Severe dysplasia may be irreversible May progress into invasive carcinoma

Cervical Intraepithelial Neoplasia (CIN) or Dysplasia CIN I (mild) Involves deeper 3rd of epithelium CIN II (moderate) Involves more than half thickness of epithelium CIN III (severe) Whole thickness of epithelium shows abnormal changes

Screening Normal cervix, transition zone Screening programme Cervical smear Repeated every 3 y up to 60 y Normal cervix, transition zone

Invasive carcinoma of cervix, Pap smear These cancer cells are very anaplastic and show marked variation in size. Note the enormous size of the tumor cells which can be appreciated in comparison with neutrophils present in the smear. anaplastic cancer cells show marked variation in size, in comparison with neutrophils

Treatment Cryocautry Electrocuatry Surgery Follow up Conization LEEP Hysterectomy Follow up

Malignant Tumours of Cervix

Ca cervix One of the most common cancers in the world Incidence: USA 10/1000000 UK 15/1000000 Peak incidence at 35 and 55

Etiology Number of partners Age of first coitus Grand multi parity Social status Race and religion Circumcision Smoking Viruses herpes simplex type 2 / human papulama virus type 16 & 18 Atypical squamous metaplasia

Pathology SQ cell carcinoma 90 % Adeno 5% Mixed 5% Gross Polypoidal Ulcerative Infiltrative

Squamous cell carcinoma cervix Tumour extends to anterior and posterior lips, appears granular and hemorrhagic, cervix surrounding by narrow vaginal cuff Squamous cell carcinoma of cervix The tumor extends to the anterior and posterior lips and appears somewhat granular and hemorrhagic. The cervix is surrounding by a narrow vaginal cuff.

Squamous cell carcinoma in-situ of cervix                                                              Normal epithelium Squamous cell carcinoma in-situ of cervix To the right is normal squamous epithelium with its basal cell layer and orderly maturation upwards. The left side shows carcinoma in-situ characterized by lack of maturation, altered cell polarity, nuclear pleomorphism and increased nuclear / cytoplasmic ratio. As is characteristic of carcinoma in-situ, the neoplastic cells are confined to the epithelial layer and have not invaded through the epithelial basement membrane, under which, the submucosal stroma contains chronic inflammatory cells. lack of maturation, altered cell polarity, nuclear pleomorphism and increased nuclear / cytoplasmic ratio, confined to the epithelial layer, epithelial basement membrane not invaded, submucosal stroma contains chronic inflammatory cells

Spread Direct Lymphatic Blood born

Diagnosis History Asymtpomatic Irregular vaginal bleeding IMB, PCB, PMB Pain Vaginal discharge Examination Normal cervix Hard cervix Ulcer Growth

Carcinoma Cervix

Diagnosis Cytology Schiller test Colposcopy Biopsy of cervix Punch biopsy Wedge biopsy Ring biopsy Cone biobsy

Treatment Assessment Radiotheraphy Surgery young, pelvic sepsis, UV prolapse, fibroid, ovarian tumor, recurrence, pregnancy Combined

Case History Age 36, mass at endocervical os which thickens the barrel of the cervix and fixes the cervix to the surrounding soft tissue Pap smear shows

Case History biopsy showed invasive nests of abnormal squamous epithelium extending under the surface mucosa, extending all the way through the cervical wall and out into the surrounding paracervical soft tissue

Case History The patient underwent a hysterectomy. The gross specimen shows thickened area representing the cervix. Tumour has extended through the wall. cervix was fixed to the soft tissues of the paracervical area

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