Cervical Carcinoma
Invasive cervical carcinoma typically arises from pre-existing CIN lesions. Squamous cell carcinoma is the most common histologic subtype, followed by adenocarcinoma.
1. Epidemiology & Risk Factors
- HPV Association: HPV types 16 and 18 are responsible for >70% of cases.
- Other Factors: Early age of sexual debut, multiple sexual partners, immunosuppression (e.g., HIV), and smoking.
2. Clinical Features
| Presentation | Significance |
|---|---|
| Postcoital Bleeding | Classic presenting symptom; must be investigated. |
| Advanced Disease | Pelvic pain, urinary symptoms (ureteral obstruction/hydronephrosis), and leg edema (lymph node spread). |
3. Exam Must-Knows
- Screening: Pap smear (cytology) combined with HPV testing is the cornerstone of early detection.
- Staging: Clinical staging is primarily used (unlike most other cancers which use TNM/surgical staging).
- Spread: Direct extension to the vagina, parametrium, and bladder/rectum is common.
Pathology Board Hint: For board exams, remember that squamous cell carcinoma remains the most common histology. If a vignette mentions a patient presenting with postcoital bleeding, the first step is a pelvic exam and Pap smear. Do not forget the association between adenocarcinoma and endocervical involvement.