Cervical Cancer .doc

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Anatomy and Cell Biology
Course Code
Anatomy and Cell Biology 4461B
Geordie Shepherd

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TS Lecture 4: Cervical Cancer Statistics • Third most common cancer world-wide • Second most common cancer in women world-wide Leading cause of death due to cancer in developing countries; incidence has declined in • North America Risk Factors • Early age of onset of sexual activity • Multiple pregnancies • Multiple sexual partners • Long-term oral contraceptive use • Smoking and HIV infection (reduces local immune responses/carcinogenic) HPV • DNA virus that infects stratified epithelium of skin and mucous membranes • Only a minority of the variants will cause benign anogenital warts and a select few “high- risk” types can cause malignancy • Most common oncogenic viruses: • HPV16 • HPV18 Etiology • Target cells infected by HPV are the epithelial cells of the transformation zone • Transformation zone: area of cells making the transition between differentiated epithelial cells of the cervix (squamous) and those of the endocervix (columnar) Progression • Most infections are temporary; 90% gone after two years • Those that persist can lead to gradual oncogenic transformation of cervix epithelia • Increased sexual activity puts women at risk for multiple infections; increases risk of cervi- cal cancer • Low grade dysplasias usually occur in 20s - 15% progress to high-grade • High grade dysplasias in 30s - 1/3 progress in 10 years if left untreated • Invasive carcinomas in 40s • Lesions have exophytic growth (outwards) or infiltrative (invading into tissue) • Extension into endocervix, uterine cavity or into vagina • Uterus and cervix have rich networks of lymphatics: dissemination into lymphatics usu- ally occurs in an orderly sequence • Direct invasion into neighboring organs (bladder, rectum) • Most common distant lymphatic sites are the lungs, mediastinal and supraclavicular lymph nodes, bone and liver Diagnosis • Pap Test - recommended that it is performed in the early 20s and then every two consecu- tive years, then every three years following 30. • Detects: • LSIL - low grade squamous intraepithelial lesion • HSIL- high grade squamous intraepithelial lesion • Atypical cells - squamous cells of undetermined significance; since 10-20% have un- derlying moderate to severe dysplasia, this diagnosis cannot exclude HSIL • If PAP test comes back positive for LSIL, HSIL or atypical cells: • Colposcopy • Illuminated, magnified view of the cervix facilitates biopsy for accurate and firm di- agnosis • Cold Cone Biopsy • Excision of a cone of tissue using a cold knife is used if • Colposcopy is inadequate • Invasive lesion • Tumor is suspected in uterus • No gross lesion is observed on colposcopy (ev
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