-DR.AKIF A.

B
TYPES Progression to cancer
1) Simple hyperplasia without 1%
atypia

2)Complex hyperplasia without 3%

atypia

3) Simple hyperplasia with atypia 8%

4) Complex hyperplasia with atypia 25-30%

SIMPLE COMPLEX

- It results from increased Less associated with estrogen

Estrogen conditions

- May be associated with glucose May be associated with glocose

intolerance intolerance

Glands are large : Increases Glands number is increased

gland/stroma ratio

Scanty mitosis Numerous mitoses

Glands lined by columnar Lined by stratified squamous

epithelium epithelium
Stroma is sparsely cellular Densely cellular
Characteristics of Atypical cells
1) Large in size

2) Loss of polarity

3) Hyperchromatic nuclei and prominent nucleolus

4) Irregular shape

5) Altered nucleus/cytoplasmic ratio

 Without Atypia With Atypia

Pre Post Ideal :

menopausal menopausal Hysterectomy

Medroxyproge simple complex

sterone for
21days a Progeste Premenopausal women
No
month for one willing fertility : High
therapy
3months therapy dose progesterone with
risk of cancer explained
- Progesterone
containing
IUCD
Most common Gynaecological cancer in Developed
countries : Endometrial Cancer

MC Gynaecological cancer in Developing countries :

Cervical Cancer
-MC age group : >60years

-Risk factor:

Family Family history

Has Hypertension

O Obesity
L Late menopause and early menarche
D Diabetes

A Atypical endometrial hyperplasia

U Unopposed estrogen or increases estrogen
N Nulliparity
T Tamoxifen therapy
I h/o Infertility
1) Smoking : It decreases estrogen levels

2) OCPs : Progesterone containing OCPs are protective

-MC variety of Endometrial Carcinoma = Adenocarcinoma

-MC malignant variety of endometrial Ca. = Clear cell Ca. (Hobnail cells)
CLEAR CELL CA.
(HOBNAIL CELLS)
 Clinical Features
1) Abnormal vaginal bleeding

2) Postmenopausal bleeding (MC)

3) Discharge per vagina

4) Pelvic discomfort

5) Referred pain in Hypogastrium and Iliac fossa : Simpson’s Pain

 Trans Vaginal
USG

If Endometrial
Thickness is

<4mm >4mm

No further
Biopsy
Investigation

-Best test for diagnosing Endometrial Cancer = Hysteroscopy & Biopsy

-Staging is Surgical. It includes

1) Hysterectomy

2) Bilateral Salpingo-oopherectomy

3) Pelvic LN dissection

4) Para aortic LN dissection

STAGE DESCRIPTION TREATMENT
IA Cancer confined to uterus and Grade I & II :Staging
<50% myometrium invoved Grade III : Staging +
Radiotherapy
IB Cancer confined to uterus and Staging + Radiotherapy
>50% myometrium involved
II Endocervical Stroma involved Modified Radical
Hysterectomy +
Radiotherapy
IIIA Tumor Invades Serosa or
adnexa
IIIB Vaginal and/or parametrial
Involvement Debulking surgery
+ Radiotherapy
IIIC Metastasis to pelvic LN
IIID Metastases to Para-aortic LN
IV Distant metastases
 STAGE IA AND STAGE IB
ENDOMETRIAL CANCER.
In stage IA, cancer is in
the endometrium only
or less than halfway
through the
myometrium (the
muscle layer of the
uterus).

In stage IB, cancer has

spread halfway or
more into the
myometrium.
Stage II endometrial cancer

Cancer has
spread into
connective
tissue of the
cervix, but has
not spread
outside the
uterus.
 Stage IIIA
Cancer has spread to the
outer layer of
the uterus and/or to the
fallopian tubes, ovaries, and
ligaments
of the uterus.
 Stage IIIB
Cancer has
spread to the
vagina and/or to
the parametrium
(connective tissue
and fat around the
uterus and cervix).
Cancer has spread
to lymphnodes in
the pelvis and/or around
the aorta
 STAGE IVA
ENDOMETRIAL CANCER.
Cancer has spread into
the bladder and/or
bowel.
 Stage IVB

Cancer has spread to

other parts of the
body beyond
the pelvis, including
the abdomen and/or
lymph nodes in
the groin.
-MC time of Recurrenece = within 2years

-MC Symptom of local recurrence = Vaginal bleeding

-MC symptom of Pelvic Recurrence = Pelvic Pain

Embronal Rhabdomyosarcoma
-MC Malignant tumor of genital tract in girls

-Arises from submucosa of vagina and cervix

-Also k/a Inclusion Cyst

-Retention cysts of cervical glands

-Seen on external os

- No treatment is required

-If large : Ablation

- Treatment : Polypectomy
WHO CIN Description Betheseda
classification
Mild dysplasia CIN I Dysplastic cells LSIL
seen on lower 1/3rd
of epithelial lining
of cervix
Moderate dysplasia CIN II Dysplastic cells HSIL
seen on lower 2/3rd
of epithelial lining
of cervix
Severe dysplasia CIN III Dysplastic cells HSIL
seen on >2/3rd of
epithelial lining of
cervix
Carcinoma in situ Dysplastic cells HSIL
seen full thickness
but basement
membrane is intact
LSIL : Low Squamous Intraepithelial Lesion

HSIL : High Squamous Intraepithelial Lesion

CIN occurs at : Squamocolumnar Junction/

Transformation Zone
-HPV

-Sexually Transmitted Infections

-Coitus before 18yrs
-Multiple sex partner
-Multiparity
-Poor hygiene
-Poor socioeconomic status

-Smoking

-Immunosuppressed

-Women on OCP, Progesterone therapy

-In utero exposure to DES

-MC etiology factor for associated with Cancer Cervix.

Low risk HPV 6,11 Genital warts

High Risk HPV 16, 18 Cancer cervix

STAGE IA1 AND IA2 CERVICAL CANCER

A very small amount of cancer that can

only be seen with a microscope is found in
the tissues of the cervix.

In stage IA1, the cancer is not more than 3

millimeters deep and not more than 7
millimeters wide.

In stage IA2, the cancer is more than 3 but

not more than 5 millimeters deep, and not
more than 7 millimeters wide.
STAGE IB1 AND IB2 CERVICAL CANCER

In stage IB1, the cancer can only

be seen with a microscope and is
more than 5 mm deep and more
than 7 mm wide OR the cancer
can be seen without a
microscope and is 4 cm or
smaller.

In stage IB2, the cancer is larger

than 4 cm.
 STAGE II CERVICAL CANCER
Cancer has spread beyond the
cervix but not to the pelvic wall or
to the lower third of the vagina.

In stages IIA1 and IIA2, cancer

has spread beyond the cervix to
the vagina.
In stage IIA1, the tumor can be
seen without a microscope and is
4 centimeters or smaller.

In stage IIA2, the tumor can be

seen without a microscope and is
larger than 4 centimeters.

In stage IIB, cancer has spread

beyond the cervix to the tissues
around the uterus.
STAGE IIIA CERVICAL CANCER

Cancer has spread to

the lower third of the
vagina but not to the
pelvic wall.
STAGE IIIB CERVICAL CANCER

Cancer has spread to

the pelvic wall;
and/or the tumor
has become large
enough to block the
ureters
STAGE IVA CERVICAL CANCER.
Cancer has
spread to
nearby organs,
such as the
bladder or
rectum.
STAGE IVB CERVICAL CANCER

The cancer has

spread to other parts
of the body, such as
the lymph nodes,
lung, liver, intestine,
or bone.