Tumors of Cervix
• BENIGN
– Adenoma
– Myoma
– Papilloma and angioma
• MALIGNANT
Primary
– Carcinoma
– Sarcoma
– Mesodermal mixed tumor
Secondary
– From any source
Adenoma (Mucous Polyp)
Clinical Features
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Asymptomatic
Vaginal discharge
Vaginal bleeding
Mass at the introitus
Differential Diagnosis
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Carcinoma of the cervix
Cervical ectopy
Endometrial polyp
Products of conception
and blood clot
– Ectropion
– Cervical tags
Adenoma (Mucous Polyp)
Treatment
– Asymptomatic must be removed and
examined by the histopathologist
– Adenoma may be avulsed easily without
anaesthesia
– Base of the polyp should be cauterized to
avoid recurrence
– Perform curettage
Arise from body of
uterus, rarely
from cervix
Polypoidal
Protrude through
cervical canal
Types
Subserous
Intramural
submucous
Myomas of
Cervix
Myomas of Cervix
Clinical Features
– Prone to trauma
– Ulceration
– Infection
– Vaginal discharge
– Irregular vaginal bleeding
– Mass at the introitus
Treatment
Vagival myomectomy or hysterectomy
Papilloma and Angioma
Clinical features
– Small papillomas
– Single or multiple associated with
vulva and vaginal papillomas
– Angioma forms superficial growth
Treatment
– Surgical removal
Pre Malignant
Conditions of Cervix
Cervical Intraepithelial Neoplasia (CIN)
or Dysplasia
• Spectrum of disordered growth and abnormal
microscopic changes confined to epithelium
• May be
– Mild (CIN I)
– Moderate (CIN II)
– Severe or carcinoma in situ (CIN III)
• Spontaneous regression of mild and moderate
types possible
• Severe dysplasia may be irreversible
• May progress into invasive carcinoma
Cervical Intraepithelial Neoplasia (CIN)
or Dysplasia
• CIN I (mild)
Involves deeper 3rd of
epithelium
• CIN II (moderate)
Involves more than
half thickness of
epithelium
• CIN III (severe)
Whole thickness of
epithelium shows
abnormal changes
Screening
• Screening programme
• Cervical smear
• Repeated every 3 y up to 60 y
Normal cervix,
transition zone
Invasive carcinoma of cervix, Pap smear
anaplastic cancer cells show marked variation in size,
in comparison with neutrophils
Treatment
• Cryocautry
• Electrocuatry
• Surgery
– Conization
– LEEP
– Hysterectomy
• Follow up
Malignant Tumours
of Cervix
Ca cervix
One of the most common cancers in the
world
Incidence:
USA 10/1000000
UK 15/1000000
Peak incidence at 35 and 55
Etiology
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Number of partners
Age of first coitus
Grand multi parity
Social status
Race and religion
Circumcision
Smoking
Viruses herpes simplex type 2 / human papulama
virus type 16 & 18
• Atypical squamous metaplasia
Pathology
• SQ cell carcinoma 90 %
• Adeno
5%
• Mixed
5%
Gross
• Polypoidal
• Ulcerative
• Infiltrative
Squamous cell carcinoma cervix
Tumour extends
to anterior and
posterior lips,
appears granular
and hemorrhagic,
cervix
surrounding by
narrow vaginal
cuff
Squamous cell carcinoma in-situ of cervix
Normal
epithelium
lack of maturation, altered cell polarity, nuclear pleomorphism
and increased nuclear / cytoplasmic ratio, confined to the
epithelial layer, epithelial basement membrane not invaded,
submucosal stroma contains chronic inflammatory cells
Spread
• Direct
• Lymphatic
• Blood born
Diagnosis
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History
Asymtpomatic
Irregular vaginal bleeding IMB, PCB, PMB
Pain
Vaginal discharge
Examination
Normal cervix
Hard cervix
Ulcer
Growth
Carcinoma
Cervix
Diagnosis
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Cytology
Schiller test
Colposcopy
Biopsy of cervix
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Punch biopsy
Wedge biopsy
Ring biopsy
Cone biobsy
Treatment
• Assessment
• Radiotheraphy
• Surgery
young, pelvic sepsis, UV
prolapse, fibroid, ovarian tumor, recurrence,
pregnancy
• Combined
Case History
Age 36, mass at
endocervical os
which thickens
the barrel of the
cervix and fixes
the cervix to the
surrounding soft
tissue Pap
smear shows
Case History
biopsy showed
invasive nests of
abnormal squamous
epithelium extending
under the surface
mucosa, extending all
the way through the
cervical wall and out
into the surrounding
paracervical soft
tissue
Case History
The patient
underwent a
hysterectomy. The
gross specimen
shows thickened area
representing the
cervix. Tumour has
extended through the
wall. cervix was fixed
to the soft tissues of
the paracervical area
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