1. Tumors of Cervix

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

3. 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

4. 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

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

6. 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

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

8. Pre Malignant Conditions of Cervix

9. 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

11. 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

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

17. 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

18. Treatment Cryocautry Electrocuatry Surgery Follow up Conization LEEP
Hysterectomy
Follow up

22. Malignant Tumours of Cervix

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

24. 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

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

28. 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.

29. 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

30. Spread
Direct
Lymphatic
Blood born

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

33. Carcinoma Cervix

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

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

37. 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

38. 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

39. 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

40. Thank You