Carcinoma Cervix | Medical Science Optional Notes for UPSC PDF Download

Carcinoma Cervix - Etiopathogenes

• Infection with Human Papillomavirus (HPV)
• Sexually transmitted infections (STIs)
• Sexual activity before the age of 18
• Having multiple sexual partners
• Multiple childbirths (multiparity)
• Inadequate personal hygiene
• Low socioeconomic status
• Smoking
• Individuals with compromised immune systems
• Women using oral contraceptive pills (OCP) or undergoing prolonged progesterone therapy have an increased predisposition to adenocarcinoma of the endocervix.
• Exposure to diethylstilbestrol (DES) in utero

"HPV plays a central role in the development of cervical neoplasia. HPV DNA is detected in 95% of all squamous cell carcinomas and 90% of all adenocarcinomas."

"There are 13 high-risk HPV subtypes; among them, subtypes 16 (most common) and 18 are present in up to 62% of cervical carcinomas. The HPV subtypes associated with cervical cancer include 16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, and 68."

Features of CIN (Carcinoma In Situ)

• Various levels of Dysplasia
• Changes in the Nucleus-to-Cytoplasm ratio
• Hyperchromatic nuclei
• Presence of Mitotic figures
• Preservation of the basement membrane

The lesions progress with time and ultimately end up as frank invasive cancers.

Grading of Dysplasia (Carcinoma In Situ)

Diagnosis

• Pap smear

To minimize the risk of false-negative results in Pap smear:

• Cytology from endocervical scraping
• HPV testing
• Liquid-based cytology

In the absence of Pap smear facilities:

• Visual Inspection of Acetowhite Areas (VIA)

Other Tests

• Examination with colposcope
• Cone biopsy, serving both diagnostic and therapeutic purposes
• Computed Tomography (CT)
• Chest X-ray
• Positron Emission Tomography CT (PET-CT)
• Essential laboratory tests

PAP Smear

Commencement age for Pap smear: 21 years, irrespective of the age of initial sexual activity. Instruments utilized: Ayres spatula and endocervical brush.

First slide: Constructed from the portio vaginalis of the cervix.
Second slide: Formulated from the endocervix.

Fixative employed: 95% ethyl alcohol.
It is crucial not to let the slide undergo air drying.

Schedule of Pap smear:

• For women aged 21-29 years: Pap test every 3 years (previously conducted annually).
• Women aged 30-65 years: Combined Pap test and HPV testing every 5 years.
• Cervical cancer screening is recommended to cease after the age of 65 years.
• For HIV-positive women, annual check-ups are advised until the age of 65.
• If a Pap test raises suspicions, screening should continue until the age of 75.

Histopathology

• Epidermoid carcinoma - Predominant type, accounting for 80%, originates from the stratified squamous epithelium of the cervix, characterized by tadpole cells, hemorrhage, and necrosis.
• Endocervical carcinoma - Comprising 20%, arises from the mucous membrane of the endocervical canal.

The most prevalent histological variant is squamous carcinoma, primarily attributed to squamous metaplasia wherein the columnar epithelium of the cervix transforms into squamous. Another variant is adenocarcinoma.

Carcinoma Cervix - Repeats 

What is intraepithelial neoplasia (carcinoma in situ)? Give the pathology of carcinoma cervix. How can you make an early diagnosis of carcinoma cervix? (2011)