CERVICAL_CANCER_histopathology_final.pptx

Cervical cancer histopathology

1. CERVICAL CANCER. BY ADEYEMI OYINDAMADE ANGEL.

2. DEDICATION: To my late aunt, Mrs Rose Brown, who died of cervical cancer. And the millions of women who have died from cervical cancer. Dr SHALOM DOGO BALA.

3. OUTLINE. INTRODUCTION BRIEF ANATOMY OF THE CERVIX FUNCTIONS. EPIDEMIOLOGY, RISK FACTORS, SIGNS & SYMPTOMS. PATHOGENESIS. MORPHOLOGY. DIAGNOSIS, TREATMENT, PREVENTION. CONCLUSION & REFERENCE.

4. INTRODUCTION. The cervix, the loyal gatekeeper & unsung hero of the female reproductive system, which is situated between the uterus & vagina. Anatomically, the cervix is composed of two regions; the ectocervix & endocervical canal. The junction between the ecto & endocervix is the transformation zone. The ectocervix is the portion of the cervix that projects into the vagina. It is lined by stratified squamous non-keratinized epithelium. The endocervical canal is the more proximal & inner part of the cervix. It is lined by mucus-secreting simple columnar epithelium.

5. FUNCTIONS. The cervix performs two main functions: It facilitates the passage of sperm into the uterine cavity. This is achieved via the dilation of the external & internal os . Maintains sterility of the upper female reproductive tract. The cervix, & all structures superior to it, are sterile. This environment is maintained by the frequent shedding of the endometrium, thick cervical mucus & a narrow external os .

6. What is cervical cancer? It is a malignant growth that occurs in the cervix. It is primarily caused by the abnormal growth of cells on the cervix that have the potential to invade or spread to other parts of the body. It is primarily caused by HPV, a sexually transmitted infection. Despite significant advancements in the prevention & early detection, cervical cancer remains a significant global health concern, particularly in low & middle-income countries.

7. EPIDEMIOLOGY. Prevalence in Nigeria: 2 nd most common cancer, high mortality rate (due to late diagnosis & limited access to treatment), factors contributing to the high prevalence include: early sexual activity, multiple sexual partners & limited access to cervical cancer screening. Race: latina women, black women & native American women. Age: has a bimodal peak; early-onset cervical cancer & late-onset cervical cancer.

8. RISK FACTORS: HPV infection, early sexual activity, multiple sexual partners, smoking, weakened immune system, oral contraceptive use (long-term). SYMPTOMS: Often asymptomatic in early stages. Later symptoms may include abnormal bleeding, pelvic pain, & unusual vaginal discharge.

9. PATHOGENESIS. Cervical cancer primarily arises from persistent infection with high risk HPV, types 16&18. The pathogenesis of cervical cancer involves several s teps: 1. HPV infection: HPV infects the epithelial cells in the cervix especially the transformation zone where columnar epithelium meets the squamous epithelium. 2. V iral oncogene expression: the high risk HPV types produce oncogenic proteins, mainly E6 & E7. T hese proteins interfere with normal cell cycle regulation.

10. CONT. E6 promotes degradation of p53, a tumor suppressor protein responsible for DNA repair & apoptosis. E7 inactivates Retinoblastoma protein, the loss of pRb function results in unchecked cell growth. 3. Cervical dysplasia: in some cases, the body’s immune system clears the infection. However, if the infection persists, it can cause changes in cervical cells. These changes are known as cervical intraepithelial neoplasia (CIN). These changes can be considered as precancerous.

11. CIN. CLASSIFICATION: CIN 1: mild dysplasia: often resolves on its own without treatment. CIN 2: moderate dysplasia: indicates more pronounced abnormalities. Has higher risk of progressing to cancer compared to CIN 1. CIN 3: severe dysplasia or carcinoma in Situ: abnormal cells are extensive but haven’t yet invaded deeper tissues.

12. 4. Progression to invasive cancer: most common subtypes of cervical cancer are Squamous cell carcinoma (almost 80% of cases) & adenocarcinoma (15% of cases). Advanced tumors often invade through the anterior uterine wall into the bladder blocking the ureters. Hydronephrosis with post renal failure is a common cause of death in advanced cervical carcinoma.

13. LSIL & HSIL. LSIL ( low grade squamous intraepithelial lesion) & HSIL ( high grade squamous intraepithelial lesion). These are cytological terms used to describe abnormal cervical cells detected in a pap smear. In LSIL, the atypia is confined to the basal third of the epithelium . In HSIL, the atypia extends to two thirds (or more) of the epithelial thickness .

14. MORPHOLOGY. Squamous cell carcinoma: it often presents as an exophytic (outward growing) mass or an ulcerative lesion. Microscopically: it shows nests & sheets of malignant squamous cells. Keratinization & intercellular bridges are common features. Adenocarcinoma: it can appear as a bulky, endophytic (inward growing) mass. Microscopically: it is characterized by malignant glandular cells forming irregular glandular structures. Mucin production is often is often observed.

15. DIAGNOSIS. Pap smear: gold standard for screening. A screening test that can detect abnormal cells in the cervix. Colposcopy: a detailed examination of the cervix using a special microscope. Biopsy: taking a small sample of cervical tissue to examine the extent of abnormal cell changes.

16. TREATMENTS. EARLY STAGES: - Cryosurgery [used to treat CIN 1]. – Colonization. – Laser ablation. ADVANCED STAGES: - Radiation therapy. – Concurrent chemoradiation \chemotherapy. – Hysterectomy [ simple\radical]. – Trachelectomy .

17. PREVENTION. EDUCATION & ENLIGHTENMENT. HPV vaccination; For both boys & girls. Regular screening.

18. CONCLUSION. THE STORY OF CERVICAL CANCER IS ONE OF SCIENCE, HOPE, & VIGILANTENESS. EVERY CHAPTER EMPHASISES THE IMPORTANCE OF PREVENTION & EARLY DETECTION, FROM THE SNEAKY HPV INVASION, TO THE WATCHFUL PAP TESTS & VALIANT INTERVENTION OF IMMUNISATIONS. PREVENTION IS OUR ARMOUR & KNOWLEDGE IS OUR SWORD IN THE FIGHT AGAINST CERVICAL CANCER. LETS DESIGN A FUTURE IN WHICH CERVICAL CANCER IS BUT A FAINT MEMORY.

19. REFERENCE. PATHOMA ROBBINS & CONTRAN.