Cervical carcinoma

Cervical carcinoma 

Updated: 01/10/2023

© Jun Wang, MD, PhD

General features

• Incident declining due to screening (Pap test, HPV test)
• Expected to decline more due to HPV vaccination
• Majority are squamous cell carcinoma, followed by adenocarcinoma
• Screening techniques NOT sensitive enough for adenocarcinoma
• May be HPV independent in both squamous and adenocarcinoma 
• HPV-independent cancers tend to have worse prognosis
  
• Current WHO classification 2020
  

Clinical presentations

• Usually asymptomatic
• Commonly identified after abnormal Pap test
• Most common symptom: vaginal bleeding, usually postcoital
• May have watery, mucoid or purulent discharges with malodor
• Symptoms associated with affected structures if advanced, including pelvic or lower back pain, bowel or urinary symptoms, etc

Key risk factors

• Early age at first intercourse
• Multiple sexual partners
• Male partner with multiple prior sexual partners
• Cigarette smoking
• History of HSIL or adenocarcinoma in situ
• Oral contraceptives, parity, family history, associated genital infections, no circumcision in male partner, etc

Key pathogenesis

• HPV products

E6: Promotes degradation of p53, abnormal activation of telomerase

E7: Inactivates retinoblastoma 1, a tumor suppressor

Key morphological features

• Invasive squamous carcinoma: Irregular nests, cords, or projects dysplastic cells with squamous cell differentiation such as intercellularbridges and/or squamous pearls
• Invasive adenocarcinoma: Irregular glandular spaces lined by atypical cells with large irregular hyperchromic nuclei, high nuclear/cytoplasm ratio, brisk mitosis
• p16 positive if HPV associated
  

Treatment

• Surgery
• Pelvic exenteration
• Radiation

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