Model Answer
0 min readIntroduction
Carcinoma cervix, a malignant neoplasm arising from the cervix, remains a significant global health concern, particularly in low- and middle-income countries. It is largely preventable through effective screening programs and vaccination against Human Papillomavirus (HPV). Understanding the complex interplay of factors leading to its development (etiopathogenesis), employing accurate diagnostic tools, and correctly staging the disease are fundamental to effective management and improved patient outcomes. The incidence of cervical cancer is the fourth most common cancer in women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020 (WHO, 2020 - knowledge cutoff).
Etiopathogenesis of Carcinoma Cervix
The development of cervical cancer is a multi-step process, typically taking 10-20 years. It’s strongly linked to persistent infection with high-risk types of Human Papillomavirus (HPV), particularly HPV 16 and 18, which are responsible for approximately 70% of cases.
- HPV Infection: HPV is a DNA virus that infects the basal layer of the cervical epithelium. High-risk HPV types express oncoproteins E6 and E7, which interfere with tumor suppressor genes p53 and Rb, respectively, leading to uncontrolled cell proliferation.
- Risk Factors: Several factors increase the risk of HPV infection and progression to cervical cancer:
- Early age at first sexual intercourse
- Multiple sexual partners
- Smoking
- Immunosuppression (e.g., HIV infection)
- Long-term oral contraceptive use (minor risk)
- Parity (number of pregnancies)
- Progression Stages:
- CIN 1 (Cervical Intraepithelial Neoplasia 1): Mild dysplasia, often regresses spontaneously.
- CIN 2: Moderate dysplasia, has a higher risk of progression.
- CIN 3: Severe dysplasia/carcinoma in situ, high risk of progression to invasive cancer if untreated.
- Invasive Carcinoma: Cancer cells penetrate the basement membrane and invade the stroma.
Tests Employed for Diagnosis of Carcinoma Cervix
Diagnosis involves a combination of screening tests to detect pre-cancerous lesions and confirmatory tests to establish a definitive diagnosis.
- Screening Tests:
- Pap Smear (Cytology): Detects abnormal cervical cells. Sensitivity varies, but generally good for detecting high-grade lesions.
- HPV DNA Testing: Detects the presence of high-risk HPV types. Higher sensitivity than Pap smear for detecting CIN 2+ lesions.
- Visual Inspection with Acetic Acid (VIA): Abnormal areas appear white after application of acetic acid. Useful in resource-limited settings.
- Confirmatory Tests:
- Colposcopy: Magnified examination of the cervix with application of acetic acid and iodine. Allows for targeted biopsy.
- Biopsy: Histopathological examination of cervical tissue to confirm the presence of cancer and determine its grade.
- Cystoscopy and Proctoscopy: To assess for local spread.
- Imaging Studies: MRI, CT scan, PET scan to assess for regional and distant metastasis.
Stages of Carcinoma Cervix (FIGO Classification)
The International Federation of Gynecology and Obstetrics (FIGO) staging system is used to classify the extent of cervical cancer. The current staging system (2018) is based on clinical examination, imaging, and surgical findings.
| Stage | Description |
|---|---|
| Stage 0 | Carcinoma in situ |
| Stage IA | Invasive carcinoma confined to the cervix |
| Stage IB | Invasive carcinoma extending to the upper 2/3 of the vagina, but not to the parametrium |
| Stage IIA | Invasive carcinoma extending to the lower 1/3 of the vagina, but not to the parametrium |
| Stage IIB | Invasive carcinoma extending to the parametrium |
| Stage IIIA | Invasive carcinoma extending to the lower 1/3 of the vagina and/or involving the parametrium |
| Stage IIIB | Invasive carcinoma extending to the pelvic wall and/or causing hydronephrosis or hydroureter |
| Stage IVA | Invasive carcinoma extending to bladder or rectum |
| Stage IVB | Distant metastasis |
Conclusion
Carcinoma cervix remains a preventable and treatable disease. Understanding its etiopathogenesis, utilizing appropriate diagnostic modalities, and accurate staging are crucial for effective management. Continued efforts towards HPV vaccination, robust screening programs, and improved access to healthcare are essential to reduce the global burden of this disease. Further research into targeted therapies and immunotherapies holds promise for improving outcomes in advanced stages.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.