Management tactics for patients depending on the degree of dysplasia
The choice of the extent of surgical intervention, in particular cervical conization, strictly depends on the woman's age, the severity of detected dysplasia, and the need to preserve reproductive function.
Management algorithm for young patients:
- Mild dysplasia: preference is given to active surveillance for one year. If there is no regression of the pathological process or if deterioration is noted, surgical treatment is prescribed.
- Moderate and severe dysplasia: a more aggressive approach is indicated. Curettage of the cervical canal is performed in combination with conization (radiosurgical, laser, or electrosurgical techniques are acceptable). The removed fragment is mandatory sent for histological examination.
In postmenopausal women with mild and moderate lesions, conization with curettage is also acceptable. However, in this age group, the indications for a more radical operation—hysterectomy—should be significantly expanded.
Squamous cell carcinoma: morphological pattern
Histological examination of cervical tissues aims to exclude malignant neoplasms. Cervical cancer ranks third among female genital malignancies (about 500 thousand new cases annually worldwide). At the same time, a negative trend is noted: the incidence rate among young women increases by 2% annually.
The most common histological variant is squamous cell carcinoma (keratinizing or non-keratinizing), originating from the stratified squamous epithelium.
Microscopic features of squamous cell carcinoma:
- Strands of anaplastic epithelium are determined below the basement membrane level.
- Cells acquire a polygonal or oval shape, their cytoplasm stains eosinophilic.
- Pronounced cellular polymorphism of nuclei is observed.
- The presence of multiple mitosis figures, including atypical ones, is characteristic.
Features of cervical canal adenocarcinoma
The second most frequent variant is adenocarcinoma, accounting for 5% to 15% of all malignant cervical lesions. Unlike squamous cell carcinoma, it develops from columnar epithelium. The peak incidence of this form shifts to an older age (60–62 years).
Morphological characteristics of adenocarcinoma:
- Glandular structures are visualized on the micropreparation.
- The glands are lined by several layers of atypical cells with extremely high mitotic activity.
- The cytoplasm of tumor cells is pale, has a granular structure, and contains mucin inclusions.
- Cell nuclei are hyperchromatic, pathologically enlarged in size, with coarse chromatin, located predominantly basally.
Tumor growth types and clinical significance
Depending on the direction of neoplasm spread, two macroscopic growth types are distinguished, which correlate with localization and the overall prognosis for the patient:
- Exophytic growth: predominantly occurs when the pathological focus is located on the exocervix (vaginal portion).
- Endophytic growth: characteristic of endocervical lesions (mucous membrane of the cervical canal). It is important to consider that in endophytic forms, the clinical prognosis is always evaluated as more unfavorable.
Screening, prevention, and treatment principles
The basis of screening is preventive examinations at least once every 5 years, cytological examination (PAP test), and HPV testing. If abnormalities are present, colposcopy and biopsy are performed. If morphological results are doubtful, surgical intervention with histological and immunohistochemical (IHC) typing is indicated.
Preventive measures include primary HPV vaccination at the age of 9–13 years (before the onset of sexual activity) and secondary prevention—early detection and treatment of dysplasia (CIN). The performed precancer therapy does not protect against the risk of reinfection with the virus.
Treatment tactics for confirmed cervical cancer depend on the stage. Radical surgery (tumor removal, hysterectomy) combined with radiation therapy is possible only in stages I and II. In stages IB1, IB2, and IIA1 (tumor size up to 4 cm), adjuvant treatment taking into account risk factors is strictly mandatory. More advanced processes require conservative chemoradiation methods. Ultrasound, MRI, CT, cystoscopy, and rectovaginal examination are used to assess parametrial infiltration.
To remember the connection between cancer type and peak age: Squamous — First peak (34–36 years). Adenocarcinoma — Relevant later (60–62 years).
Class and exam questions
What tactics are used for mild dysplasia in young nulliparous women?
Active surveillance is indicated for one year. Cervical conization is performed only in the absence of disease regression or deterioration of the clinical picture.
What is the difference between exophytic and endophytic growth of a cervical tumor?
Exophytic growth is more frequently observed on the vaginal portion (exocervix). Endophytic growth is typical for cervical canal lesions and always has a worse prognosis.
What are the main morphological features of cervical adenocarcinoma?
The tumor forms glands lined by stratified atypical columnar epithelium with pale mucous cytoplasm and hyperchromatic, basally located nuclei.
What else to study on this topic
- Principles of immunohistochemical (IHC) typing of cervical neoplasms
- Assessment of parametrial infiltrates using diagnostic imaging methods (MRI, CT)
- Mechanisms of oncogenesis associated with human papillomavirus (HPV)
- Radical hysterectomy and indications for adjuvant therapy in early stages
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