Most common cervical carcinoma: March 2007
Ans. C: Squamous Cell Carcinoma Cervical cancer is typically composed of squamous cells. The most impoant risk factor in the development of cervical cancer is infection with a high-risk strain of Human papilloma virus. Women who have many sexual paners (or who have sex with men or women who had many paners) have a greater risk Risk factors for cervical cancer: HPV infection (16,18,31,33), HIV infection Smoking Chlamydia infection, Multiple pregnancies Exposure to the hormonal drug (DES) and a Family history of cervical cancer. Biopsy Procedures While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy. Fuher diagnostic procedures are loop electrical excision procedure (LEEP) and conization. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. Pathologic Types Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examiniation of cervical biopsies. Histologic subtypes of invasive cervical carcinoma include the following: Squamous cell carcinoma (about 80-85%) Adenocarcinoma (nearly 5%) Adenosquamous carcinoma Small cell carcinoma Neuroendocrine carcinoma Staging Cervical cancer is staged by the FIGO staging system Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ) Stage I - limited to the cervix - IA - diagnosed only by microscopy; no visible lesions IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread IA2 stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less - IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm IB1 - visible lesion 4 cm or less in greatest dimension IB2 - visible lesion more than 4 cm Stage II - invades beyond cervix - IIA - without parametrial invasion, but involve upper 2/3 of vagina - IIB - with parametrial invasion Stage III - extends to pelvic wall or lower third of the vagina - IIIA - involves lower third of vagina - IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis IVB - distant metastasis Treatment Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including pa of the vagina). For stage IA2, the lymph nodes are removed as well. Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin/ Paclitaxel+Ifosamide+Mesna based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin/ Paclitaxel+Ifosamide+Mesna chemotherapy followed by hysterectomy. Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. The use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment is recommended. Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.
Adenocarcinoma
Sarcoma
Squamous cell carcinoma
Small cell carcinoma