Cervical Cancer Stage 3

Pathophysiology
PATHOPHYSIOLOGY (NARRATIVE FORM)

• Cancer of the cervix typically originates from a dysplastic or premalignant lesion previously present at the active squamous columnar junction. The
transformation from mild dysplastic to invasive carcinoma generally occurs slowly within several years, although the rate of this process varies widely.
• Carcinoma in situ is particularly known to precede invasive cervical cancer in most cases. In different reported series of patients with untreated
carcinoma in situ who were followed up for many years, invasive carcinoma developed in about 30% of patients at 10 years and in about 80% of
patients at 30 years. However, the carcinoma-in-situ lesion may regress after the initial diagnosis; such an occurrence was reported in 17 (25%) of 67
patients who were followed up for at least 3 years. Progression to invasive carcinoma becomes established and is considered irreversible once the
malignant process extends through the basement membrane and invasion of the cervical stroma occurs.
• Multiple local growth patterns of invasive cervical cancer have been described, with combination growth patterns being common. The patterns
include the following: exophytic, nodular, infiltrative, and ulcerative.
• The exophytic variety is the most common growth pattern. It usually arises from the exocervix and is often polypoid or papillary in form. Exophytic
cervical cancer may result in a large, friable, bulky mass that involves only the superficial aspect of the cervix and has the tendency for excessive
bleeding.
• The nodular variety typically arises in the endocervix and grows through the cervical stroma into confluent, firm masses that cause the cervix and
isthmus to expand. Large, nodular- type tumors that circumferentially involve the endocervical region and large, exophytic-type tumors that originate
from the endocervix and extend into the endocervical canal result in what has been referred to as a barrel-shaped cervix.
• The infiltrative growth pattern leads to a stone-hard cervix that may be predicated to have minimal visible ulcerations or an exophytic mass.
Infiltrative exocervical lesions tend to invade the vaginal fornices and the upper part of the vagina. On the other hand, infiltrative endocervical lesions
tend to extend into the corpus and the lateral parametrium.