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AND CIN
Cancer of the cervix has long been recognized as the
commonest malignancy of the female genital tract
However, in the last four decades invasive cancers of the
cervix showed a significant decline in their occurrence
being now nearly as common as endometrial carcinomas.
One of the key features of cervical cancer is the slow
progression from normal cervical epithelium to precancerous
changes (CIN) to invasive cancer. This slow progression
through numerous precancerous changes provided the
rationale for the preventive and early treatment strategies that
have caused the decline of cervical cancer over the past
decades.
INCIDENCE:
Cervical intraepithelial neoplasia (CIN), may occur at any
age, however it is commoner in younger age groups 25 – 45
years. It is usually present several years before the occurrence
of preinvasive and invasive disease, and is considered as the
premalignant lesion.
Pre-invasive carcinoma (carcinoma in situ) occurs mostly
between 35-45 years.
Invasive carcinoma of the cervix prevails mostly at ages from
40-60 years, with a peak incidence around 50 years, an age
incidence which is nearly 10 years earlier than that for
endometrial carcinoma.
RISK FACTORS:
PATHOLOGY:
two main histological types
Squamous cell carcinoma: The commonest type; (> 90%)
develops from the flat cells, which cover the outer surface of
the cervix (ectocervical carcinoma of the portio vaginalis).
However it may rarely arise in the endocervix due to previous
squamous metaplasia. It is easily and early detected with the
Pap smear test.
B) Adenocarcinoma: Less common; (<10%) develops from
the glandular epithelium, which lines the cervical canal (endo-
cervical carcinoma), but may rarely arise from the columnar
epithelium covering an erosion on the ectocervix,
Ectocervical carcinomas are almost always
of the squamous type, they usually
present in one of three common varieties
Hypertrophic type (exophytic)
Ulcerative type (endophytic)
Infiltrative type (nodular)
Endocervical carcinomas are mostly
adenocarcinomas arising from the columnar
epithelium lining the endocervix. It forms a
spherical growth distending the cervix and
giving it a barrel-shaped appearance.
SPREAD OF CANCER CERVIX:
Clinical Symptoms:
1. Vaginal Bleeding: is the most common
presenting complaint It may be either;
Contact bleeding i.e. after coitus or douching
(commonest).
Intermenstrual bleeding i.e. metrorrhagia.
Postmenopausal bleeding
Persistent bleeding during pregnancy (rarest)
2. Vaginal Discharge: In addition to bleeding, some
patients will complain of profuse, offensive, often
blood stained vaginal discharge, resistant to
conventional treatment.
3. Other Symptoms, such as pain, are uncommon
until very late disease. Pain may be associated with
infiltration of the parametrium or uterosacral
ligaments, pyometra, or sciatic and obturator nerve
affection.
Clinical Signs:
General examination: In early cases, most patients are in a
good general condition and relatively young in age. In
advanced stages, chronic blood loss, urinary manifestations
and ureteric obstruction may lead to severe anaemia,
uraemia and cachexia.
Inspection via a speculum vaginal examination: Invasive
cancer of the cervix presents as a small nodule or ulcer that
bleeds easily on touch. As it advances, it becomes a friable
warty mass that may break into a large ulcer. Later on, the
mass or ulcer will extend to the vaginal walls obliterating the
vaginal fornices.
Per rectum examination (PR): To evaluate
possible parametrial extension.
DIAGNOSTIC PROCEDURES FOR
CANCER CERVIX: