This document discusses premalignant and malignant conditions of the cervix. It defines dysplasia as abnormal growth of cervical epithelium and carcinoma-in-situ as abnormal cell changes that do not invade deeper tissues. Risk factors for these conditions include HPV infection, multiple sexual partners, early sexual activity, and smoking. Screening via Pap smear is important for detection, as abnormal results may require colposcopy and biopsy for diagnosis. Treatment options depend on the stage but can include cryotherapy, LLETZ, or hysterectomy for more advanced cancers. Cervical cancer is largely preventable through education, HPV vaccines, and screening/treatment of precancerous lesions.

1. Dr.Tarig Mahmoud Ahmed
MD SUDAN
HAIL UNIVERSITY KSA
Premalignant and malignant
conditions of the cervix

2.  Dysplasia is abnormal growth and
development of the cervical epithelium
 Carcinoma-in-situ ---abnormal change in
cells but not invading the deeper tissues
 Incidence of CIN – 1.2 – 12%
 Usually discovered by the Pap
smear[cervical screening]
 Peak incidence between 25-35 years age

3. Dysplasia can be grading to:

4. Etiology
Exact cause is unknown
Predisposing factors:
1) Human papilloma virus infection 16 & 18.
2) Multiple partners.
3) High risk sexual partners.
4) Coitus at an early age.
5) Sexually transmitted diseases.
6) Cigarette smoking.
7) immunodeficiency.
8) multiparty.

5. transformation zone
The transformation zone is an important area
on the cervix which is defined as the area
where the original squamocolumnar junction
(SCJ) was to the current SCJ ; and it includes
areas of metaplasia.
The transformation zone (TZ) is the site where
premalignancy and malignancy develop.

6. Transformation zone

7. Normal cervix with transformation
zone.

8. Diagnosis

9. Pelvic examination:
Vagina and adjacent organs are examined
visually and bimanually (using both hands).
Pap smear:
a) Involves using a small spatula to obtain a
sample of the cells from the cervix and any
abnormal areas by scraping gently from the
cervix.
b) The cells are spread onto a glass slide.
c) The sample is sent to a laboratory to be
examined under a microscope.

10. A speculum is inserted into the vagina in order to get a good view of the
cervix
-you will use a thin wooden stick called a spatula and a soft cervical brush
called a cytobrush to remove cells from the cervix.
Papanicolaou test…

11. Technic
11
Spatula and cytobrush

12. Colposcopy:
If the smear test is abnormal, patient may be
referred for a colposcopy in order for a biopsy to
be taken.
A colposcope is like a small microscope with a
light.
Abnormal lesions on the cervix are examined
using a magnifying device.
A small sample of cells (a biopsy) is then taken.

13. Colposcopy
13
Is the examination of the uterine cervix and
lower genital tract epithelium under
magnification

14. Management of CIN
Destructive method:
 Cryotherapy (cervix is frozen with liquid
nitrogen)
 Cold coagulation(placing a hot probe on
the cervix in outpatients under local
anaesthetic.)
 Electro-diathermy

15. cryotherapy

16. cryotherapy

17.  Excisional method :
 Large loop excision of transformation zone
(LLETZ):
Often used to remove the area of the cervix that
contains the abnormal cells.
It uses a thin wire to cut away the affected area.
 Knife cone biopsy:
A larger, cone-shaped sample of cervical tissue
is removed and examined for cancer cells.
 Hysterectomy.

18. large loop excision of transformation
zone (LLETZ)

19. Knife cone biopsy

21.  Cervical cancer is one of the most
common cancers, accounting for 6%
of all malignancies in women.
 Worldwide, cervical cancer is second
to breast cancer in incidence and
mortality.
 80% of the new cases occur in
developing countries.

22.  2% women above the age of 40 yrs will
develop this cancer
 Average age 45yrs range 40 – 60 years
 Etiology same as for CIN
 Pathology: lesion starts at the squamo-
columnar junction as an ulcer or fungating
mass.
 Histology: 70% squamous cell cancer, 30%
adenocarcinomas and mixed cancer.

23. Clinical Presentation

24. Clinical presentation
In all stages
Post-coital bleeding
Intermenstrual bleeding
Post-menopausal bleeding
Blood stained vaginal discharge

25. Clinical presentation
Pelvic and speculum
examination:
 Cervical mass which bleeds on
contact and if advanced disease, a
hardness and fixity of the tissues.
 A biopsy in the outpatient should be
taken.

26. Clinical presentation
In advanced disease (stages 3-4):
 Pain (malignant infiltration of the spinal
cord).
 Incontinence (due to vesicovaginal
fistulae).
 Anemia (from chronic vaginal bleeding) .
 Renal failure (from ureteric blockage)

27. Normal cervix
 Smooth, pink .
 Clear mucoid secretion.
 Central hole-'external
os'
Nulliparours-round
Multiparous-slit or
cruciate.
 Cervix in
postmenopausal
women is atrophic .

28. Ca cervix

29. Cervical Cancer Staging

30. Treatment
Stage 1a
Surgical treatment- cone excision - infertility to be
preserved . Hysterectomy is not necessary
Stage 1b
Radical hysterectomy- and pelvic nodes dissection
should be considered(Wertheim's hysterectomy) .
Stages 2 – 4
Radiotherapy ± chemotherapy

31. Radiotherapy
Tow types:
 External radiotherapy ( Teletherapy)
 Internal radiotherapy
(brachytherapy)

32. Cervical cancer is a preventable
disease
 Primary prevention:
 Education to reduce high risk sexual
behaviour
 Measures to reduce/avoid exposure to
HPV and other STIs
 HPV vaccines
 Secondary prevention:
 Treatment of precancerous lesions
before they progress to cervical
cancer (implies practical screening
test).