CERVICAL CANCER

FARHANA I. PABER ADZU-SOM II

CERVIX
Allows the passage of menstrual fluid; Promotes fertility; Protects the uterus, upper reproductive tract, and a developing fetus from pathogens; and May play a role in womens sexual pleasure.

ANATOMY
A. Shape and Dimension lower, narrow portion of the uterus, connected to the uterine fundus by the uterine isthmus. cylindrical or conical in shape

ANATOMY
UPPER LIMIT INTERNAL OS
ill-defined junction of the uterine fundus and cervical stroma

Half of its length is visible. Portio Vaginalis- 3 cm long, 2.5 cm wide.

ANATOMY
The portion of the cervix exterior to the external os is called the ectocervix. The passageway between the external os and the endometrial cavity is referred to as the endocervical canal.

ANATOMY
endocervical canal measures 7 to 8 mm at its widest in reproductive-aged women.

ANATOMY
B. BLOOD SUPPLY Internal Iliac Arteries Uterine Arterie-s Cervical Branches.

ANATOMY
VENOUS DRAINAGE Lesser Pelvis Plexus Internal iliac veins + External Iliac Veins Common Iliac Veins IVC

ANATOMY
C. LYMPHATIC DRAINAGE

ANATOMY
D. SUPPORT AND INNERVATION Main support: Cardinal and Uterosacral ligaments.

ANATOMY

PHYSIOLOGY
estrogen levels rise causing the cervix to swell and soften and the external os to dilate. fertile mucus pregnant, the hormone progestin will create more of the thick mucus which acts as a plug. nerve endings surrounding the cervix can result in a cervical orgasm.

HISTOLOGY
STROMA mass and shape collagenous connective tissue (smooth muscle and elastic tissue) and ground substance (mucopolysaccharide). stroma course the vascular, lymphatic, and nervous supplies EPITHELIUM gives rise to cervical neoplasia.

The cervix is covered by both columnar and stratified nonkeratinising squamous epithelia

SQUAMOUS EPITHELIUM
similar to that of the vagina, except that it is generally smooth and lacks rete pegs

GLANDULAR EPITHELIUM
columnar epithelium of the cervix located cephalad to the squamocolumnar junction endocervical glands

MUCOSAL IMMUNITY
Both the secretory (IgA mediated) and cellular immune systems are active macrophages, including some Langerhans cells, lymphocytes are present

The squamocolumnar junction (SCJ)

HUMAN PAPPILOMAVIRUS
Infection with HPV is the primary cause of cervical cancer Malignant transformation requires the expression of E6 and E7 oncoproteins produced by HPV E7 binds and inactivates the Rb protein while E6 binds p53 and directs its degradation-
RESISTANCE TO APOPTOSIS.

 HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, 56, and -58 Type 16 and 18 are the most common.

 In most women, the infection will clear in 9 to 15 months Factors that may have a role in this progression include smoking, contraceptive use, infection with other sexually transmitted diseases, or nutrition

CERVICAL CANCER
RISK FACTORS:
Young age at first intercourse (<16) Multiple sexual partners Cigarette smoking Race High Parity Lower Socioeconomic Status. Infection with Herpes Virus and Chlamydia trachomatis. Use of OC drugs.

EPIDEMIOLOGY
27.55 millions women ages 15 years and older are at risk. every year 4544 women are diagnosed with cervical cancer and 1856 die from the disease . Cervical cancer ranks as the 2nd most frequent cancer among women in Philippines,

SQUAMOUS CELL CARCINOMA

most common. Large cell keratinizing tumors, Large cell nonkeratinizing carcinomas, small cell carcinoma , small cell anaplastic carcinoma.

ADENOCARCINOMA
Adenocarcinoma in situ (AIS)-precursor of invasive adenocarcinoma. made up predominantly of cells of the endocervical type with mucin production. adenoma malignum villoglandular papillary adenocarcinoma

Adenosquamous Carcinoma
Carcinomas with a mixture of malignant glandular and squamous components have a poorer prognosis Glassy cell carcinoma adenoid basal carcinoma adenoid cystic carcinoma

Sarcoma
embryonal rhabdomyosarcomachildren and young adults
grapelike polypoid nodules, known as botryoid sarcoma. diagnosis depends on the recognition of rhabdomyoblasts

Leiomyosarcomas and mixed mesodermal tumors

Malignant Melanoma
Rare it simulates melanoma elsewhere depends on the depth of invasion into the cervical stroma

Neuroendocrine Carcinoma
Neuroendocrine tumors of the cervix are rare (i) small cell, (ii) large cell, (iii) classical carcinoid, and (iv) atypical carcinoid aggressive malignant behavior with the propensity to metastasize. At the time of diagnosis, it is usually disseminated, with bone, brain, liver, and bone marrow

Patterns of Spread
(i) direct invasion into the cervical stroma, corpus, vagina, and parametrium; (ii) lymphatic metastasis; (iii) blood-borne metastasis; and (iv) intraperitoneal implantation