Pathological characteristics of cervical cancer

Cervical cancer is mainly squamous cell carcinoma, accounting for about 90%-95%, and adenocarcinoma accounts for only 5%-10%. However, there is no special difference in appearance between the two types of cancer, and both occur in the vaginal part of the cervix or in the endocervical canal.

1. General manifestations

Before developing into invasive cancer, there is no special abnormality in naked eye observation, or it is similar to general cervical erosion. With the appearance of invasive cancer, the cervix can show the following four types: ① Erosive type: There are rough granular erosion areas around the surface of the external cervical opening, or there are irregular ulceration surfaces, which are easy to bleed when touched. ② Exophytic type: also known as hyperplastic type or cauliflower type, with polyp-like or nipple-like protrusions, and then develop into cauliflower-like growths of varying sizes protruding into the vagina, which are fragile and easy to bleed. Cervical cancer, especially adenocarcinoma, can also grow into the endocervical canal, making the cervix barrel-shaped and enlarged, which is also a kind of endogenous type. ③ Endogenous type: also known as invasive type, cancer tissue infiltrates into the deep tissue of the cervix, the cervix is ​​enlarged and hard, but the surface is still smooth or there are only superficial ulcers. ④ Ulcerative type: Regardless of whether the exogenous type or endogenous type develops further, the cancer tissue necrotizes and falls off, forming ulcers, and even the entire cervix is ​​replaced by a large cavity. Because there is often secondary infection, there is a foul-smelling secretion.

2. Microscopic examination

1. Atypical hyperplasia Atypical hyperplasia is characterized by proliferation of underlying cells, disordered cell arrangement, enlarged and darkly stained nuclei, and uneven chromatin distribution. Atypical hyperplasia can be divided into mild, moderate, and severe.

① Mild atypical hyperplasia (anaplastic grade 1): epithelial cells are slightly disordered, cells are slightly atypia, and atypical epithelium occupies the lower third of the epithelial layer. ② Moderate atypical hyperplasia (anaplastic grade II): epithelial cells are disordered, atypia is obvious, and atypical epithelium occupies the lower two-thirds of the epithelial layer. ③ Severe atypical hyperplasia (anaplastic grade III): almost all epithelial polarity is disordered or disappears, and the cells are significantly atypia and it is difficult to distinguish between carcinoma in situ.

2. Carcinoma in situ Carcinoma in situ (CIS) is also called intraepithelial carcinoma. The polarity of the entire epithelium disappears, the cells are significantly atypical, the nuclei are large and darkly stained, the chromatin is unevenly distributed, and there is a nuclear division phase. However, the lesion is still limited to the epithelium, has not penetrated the basement membrane, and has no interstitial infiltration. Atypical cells can also enter the cervical glands in the transitional zone along the opening of the cervical gland cavity, causing the original columnar cells of the glands to be replaced by multiple layers of atypical squamous cells, but the basement membrane of the glands remains intact. This situation is called cervical carcinoma in situ involving the glands.

3. Microscopic early invasive cancer Microscopic early invasive cancer is based on carcinoma in situ. Occasionally, small clusters of cancer cells may be found to have penetrated the basement membrane and invaded into the stroma near the basement membrane in a teardrop-like shape. The depth of infiltration does not exceed 5 mm and the width does not exceed 7 mm. There is no fusion of cancer foci and no signs of invasion of blood vessels in the stroma. There are no clinical characteristics.

4. Squamous epithelial invasive carcinoma When cancer cells penetrate the epithelial basement membrane and invade the stroma to a depth of more than 5 mm, it is called squamous epithelial invasive carcinoma. Dendritic, cord-like, diffuse or mass-like cancer nests may appear in the stroma.