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squamous epithelium of the cervix that have been recognized as precursors of invasive squamous cell
carcinoma. CIN is graded on a scale from I to III, which can also be expressed descriptively as mild,
moderate, or severe dysplasia, or carcinoma in situ. On Pap smear, these lesions are classified by
cytologists as squamous intraepithelial lesions of low or high grade
Precancerous stage
Non invasive
May remain so for up to 20days before becoming invasive [cancerous]
May regress spontaneously
Increase risk of cancer occur with the more severe CIN grade
Associated with HPV(16,18,31,33 serotypes
Also called carcinoma in situ if in CIN 3
Easily treated
CIN classification
Grade 1 mild dysplasia
Grade 2 moderate dysplasia
Grade 3 severe dysplasia [carcinoma in situ]
Another classification
1. Low grade
2. High grade
CIN morphology
Early lesions resemble condylomata acuminata
Maybe raised {acuminatum} or macular {flat condyloma}
Nuclear enlargement { in cells}
Hyperchromasia in superficial epithelial cells { this shows active viral replication in
maturing cells that is viral cytopathic effect}
May have koilocytic atypia {nuclear atypia plus perinuclear vacuolation that is
cytoplasmic halos}
Raised lesions [acuminatum] contain usually low risk HPV
Flat CIN usually has high risk HPV
Detection
Papanicolau smear
Squamous cell carcinoma
Age ranges from second decade to old age
Peak incidence increasing in younger age
Increasing incidence due to improving screening technique [ papanicolau smear ] and
increased and early sexual activity.
Morphology
Three patterns
1. Fungating [exophytic]
2. Ulcerating
3. Infiltrative
Spread
Contiguity: to peritoneum, urinary bladder, ureter, rectum, and vagina.
Also metastasizes to liver, lung, bone marrow
Types of squamous cell carcinoma: large cell makes up 95% of squamous cell carcinoma.
Staging
Stage 2: extend beyond cervix but not onto pelvic wall. Involves vagina but not lower third.
Stage 3: extend to pelvic wall. On rectal examination, no cancer free space between tumour and pelvic
wall. Involves lower one-third of vagina.
Stage 4: extend beyond true pelvis or has involved muxosa of bladder or rectum. There is metastasis.
1. Adenocarcinomas
2. Adenosquamous carcinomas, undifferentiated carcinoma or other rare types.
Cervical Adenocarcinomas
Adenosquamous Carcinomas
Management
Treatment