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Pathophysiology of Cervical Cancer

Dr. Ali Budi Harsono,SpOG K Onk

Divisi Onkologi Ginekologi


RS Hasan Sadikin Bandung
Objectives

• Anatomy and physiology of normal cervix


- SCJ - squamous metaplasia
- T-zone - nabothian cyst

• Pathophysiology of abnormal cervix


- squamous intraepithelial lesions
- cancer
Anatomy and physiology of
normal cervix

• Ectocervix : squamous epithelium (pink)

• Endocervix : glandular columnar epithelium (red)

• Squamocolumnar junction (SCJ): junction


between squamous & columnar epithelium
Stratified squamous epithelium
Crypts of columnar epithelium
Squamocolumnar junction
Squamous metaplasia

• ……….. physiological replacement of the everted columnar


epithelium on to the ectocervix by a newly formed squamous
epithelium from the subcolumnar reserve cells.

• The region of the cervix where squamous metaplasia occurs is


referred to as transformation zone, and almost all manifestations
of cervical carcinogenesis occur in this zone.
Development of squamous metaplastic epithelium
Transformation Zone

• Area between new SCJ and original SCJ

• Age-related changes

• Covered by metaplastic squamous epithelium

• Vulnerable to neoplastic changes


Original
Squamo-
Columnar
junction
ADOLESCENCE
Woman in her 30s
Perimenopausal woman
POSTMENOPAUSAL WOMAN
Pathophysiology of abnormal cervix

• squamous intraepithelial lesions

• acetowhite lesions

• cancer
Natural History of CIN and Cervical Cancer

Normal cervix

HPV infection
About 60% regress
within 2-3 years
HPV - related changes

Low-grade SIL (atypia, CIN I)


Cofactors
About 15% progress within 3-4 years high-risk HPV
(types 16, 18, etc.)
High-grade SIL (CIN II, III/CIS
30%-70% progress within 10 years

Invasive cancer
Bishop A, et al. PATH 1995:5
Maturation of immature squamous epithelium
ACETOWHITE (AW)

• after application of acetic acid

transient white epithelium

• area of acetowhite
S
higher nuclear density
Application of Acetic acid

CIN I ,LSIL
Before After
Nabothian cyst

Grayish red to reddish yellow epith Cuffed gland opening


Acetowhite lesion of
clinical significance

Well-demarcated, dense, opaque,


acetowhite area(s) in the TZ close
to or abutting the SCJ is the
hallmark of diagnosis of CIN
WE, CIN II
Acetowhite lesion of
nonclinical significance

far from SCJ white line


near the os
(endocervical)

pale white pale white


spots inside
the os
(endocervical)
acetowhite
streak
Cancerous Lesions

- contact bleeding
- cauliflower growth
- infiltrative lesion
- enlarged and hard on
pelvic examination
INVASIVE CARCINOMA
Flat
ulcer
SUMMARY

- Squamous Epithelium

- Columnar Epithelium
- Squamo-Columnar Junction
- Squamous Metaplasia
- Transformation Zone
- Acetowhite Lesions
- Cancer
Thank You