cervical carcinoma

premalignant cervical conditions (dysplasia)
dysplasia:
The process of metaplasia can be disrupted by external influences and can lead to disordered squamous epithelium called dysplastic epithelium.
Aetiology:
1- HPV is implicated in this process, although HPV infection alone does not appear to be sufficient to cause dysplasia.
2- Smoking and
3- immune suppression appear to be additional factors which may act as co-agents.

Dysplastic epithelium lacks the normal maturation of cells as they move from the basal layer to the superficial layer.
The nuclei tend to be larger, more variable in size and shape and more actively dividing than in healthy squamous epithelium.

Dysplasias (cervical intraepithelial neoplasia) (CIN):
They are graded as mild, moderate or severe, depending on the degree of cytological atypia and also the thickness of the epithelium involved.

1- CIN I affects only the deepest third of the epithelium from the basal layer upwards, with maturation seen more superficial to that.
2- CIN II affects two-thirds of the thickness of the epithelium,
3- CIN III shows no maturation throughout the full thickness, it is severe dysplasia/ or called carcinoma in situ.
Carcinoma of the cervix:
Carcinoma of the cervix is the second commonest cancer among women worldwide, with only breast cancer occurring more commonly.
Worldwide, cervical cancer accounts for about 500,000 new cases diagnosed and 250,000 deaths every year. Of the new cases, 80% occur in the less developed countries and in some of these countries, cervical cancer is the commonest cancer in women.
HPV types 16 and 18 are the most commonly associated with cervical cancer, but many other types are also found. The range of types and proportions of each type vary markedly in different parts of the world. The association between HPV infection and cervical cancer has led to the development of vaccines both to prevent and to treat this disorder and its precursors (CIN).
While it is now technically possible to construct a large range of different vaccines, many years of fieldwork will be necessary to evaluate their efficacy, acceptability and effect upon the prevalence of other HPV subtypes.
*(risk factors for cervical carcinoma):
1- HPV infection.
2- early marriage.
3- multiple sexual partners.
4- liberal sex.
5- young age at 1st pregnancy.
6- high parity.
7- lower socioeconomic status.
8- smoking.