1.0 Introduction
Cervical Cancer
Cervical cancer is a spectrum that ranges from Dysplasia to invasive cancer. Dysplasia describes an abnormal organization of cells i.e. premalignant changes in the squamous epithelium. It is graded as mild, moderate or severe. Cervical intraepithelial neoplasia is a closely related nomenclature that covers the entire spectrum of changes are graded CIN 1, CIN 2, and CIN 3 according to the third of the epithelium (Upper, Middle, Lower) respectively in which changes occur; corresponding to mild, moderate and severe1.
Invasive cancer is characterized by invasion of deeper tissues. It usually takes three forms; fungating (commonest), ulcerating and infilterating. Histologically, 95% of cells are large cell type either keratinized (well differentiated) or non keratinized (moderately differentiated). Adenocarcinoma arises from endocervical glance, situated anywhere from the internal to the external os. The late stage of the disease usually results into distant metastasis but however, local spread can occur either upward to involve all the cervix, downward to extend into the vaginal vault, laterally, it involves the ureters and anteriolly to involve the bladder, posteriolly to involve the rectum. Lymphytic spread occurs early, while haematogenous spread occurs through systemic circulation mainly depositing in the liver, lungs and bones1.
Pathogenesis of Cervical Cancer
Cervical cancer arises in the so-called transformation zone of the uterine cervix. This is the area which undergoes physiological metaplasia from glandular to squamous epithelium at the onset of adolescence. Human Papiloma Virus (HPV) is very common after the onset of sexual activity, and when it persists, the viral oncoprotein produce perturbation of the cell-cycle controls.
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