Cervical cancer paper kau fa

Cervical Cancer Prevalence at King Abdulaziz University

HospitalJ Am Sci 2013;9(5):375-379]. (ISSN: 1545-1003)

Prof. Fadwa J. Altaf.Dr .Ghader A. Mokhtar

De. Faris M. Altaf

This project was funded by The Deanship of

Scientific Research (DSR)King AbdulazizUniversity, Jeddah,

Grant no. (259/140/1431).

The authors acknowledge with thanks DSR technicaland financial support

Scientific Research Grant

• To estimate the prevalence of HPV in carcinoma of cervix and

its subtype by PCR• To identify the most frequent Cervical cancer histological type

in our Population

Cervical Cancer Incidence-In the early sixties cervical cancer (CC) incidence

was the second cancer of the females in Western Societies

-Nowadays its incidence drops down to eighth.

Due to increase our understanding of the pathogenesis of CC as a results

of series of publications in this aspect.

Cervical cancer KAU Experience

It is well documented in the literature that CC has many risk factors top of the list is:

Human Papilloma Virus infection (HPV) The viral infection will cause

series of cytological changes in cervical epithelium that start from mild epithelial changes to carcinoma

of cervix.These changes can be detected by cytological

examination of the cervix by Pap smear.

Major Histological Risk Of CCThe histological risk of CC are squamous intraepithelial

changes (SILs). There are many reports from different provincesof the Kingdom mainly from Western region, and

they are all hospital based studiesThese reports indicate:

There is a definite increase in the prevalence of cervical epithelial changes in PS from

(1.6 %, 2.2% to 7.9% and recently 17.3%).(Altaf, Jamal et al, Abdullah et al, Alhakeim et al,& Altaf et al 2001, 2002,

2003, 2004,2006, 2012 )Which reflect an increase in the incidence of HPV

infection

Cervical cancerAccording to

Saudi cancer registry of 2001(NCR) report that cervical cancer is the 8th most frequent cancer

among women between 15 and 44 years of age.

Its prevalence is 3%Age Specific Rate (ASR) is 2/100,000 female

population.It is preceded by cancer of

Breast, thyroid, leukemia, lymphoma, brain, colon, oral cavity, ovary and Hodgkin lymphoma.

Cervical cancer

The World Health Organization ( WHO) currently estimates that women in

Saudi Arabia population age 15 years& older are of 6.5 million

They are a risk of developing ofCervical cancer

Human Papillomavirus and Related Cancers in Saudi Arabia.WHO Summary Report and Fact Sheet 2010 [cited 2012 May

Cervical cancerSquamous intra epithelial changes are increasing in

the recent years in many reports from different regions of the Kingdom.

However, no information on the frequent histopathological types of CC.

F.J.Altaf etal, J Am Sci 2013;9(5):375-379

Cervical cancer

WHO recognize more than 30 histological types

of cervical carcinoma

TABLE 1: Modified World Health Organization (WHO) histological classification of invasive carcinoma of the uterine cervix

1 – Squamous cell carcinoma – Keratinizing / Non- keratinizingMicroinvasive squamous cell carcinoma Invasive squamous cell carcinoma Verrucous carcinomaPapillary squamous cell (transitional)Papillary squamous cell (transitional) carcinomaLymphoepithelioma-like carcinoma

2 – Adenocarcinoma Mucinous adenocarcinomaEndocervical typeIntestinal typeSignet-ring typeEndometrioid adenocarcinomaEndometrioid adenocarcinoma with squamous metaplasia


2 – Adenocarcinoma continued////

Clear cell adenocarcinomaMinimal deviation adenocarcinomaEndocervical type (adenoma malignum)Endometrioid typeWell-differentiated villoglandular adenocarcinomaSerous adenocarcinomaMesonephric carcinoma

3- Other epithelial tumorsAdenosquamousc arcinoma

Glassy cell carcinomaClear cell adenosquamous carcinomaMucoepidermoid carcinomaAdenoid cystic carcinoma


3- Other epithelial tumors……….continued////

Typical carcinoid tumorAtypical carcinoid tumorLarge cell neuroendocrine carcinomaSmall cell carcinomaUndifferentiated carcinoma

Cervical Cancer in Saudi Arabia

We did not find a single study in Saudi Arabia

that addressed the frequency of the histological types of

cervical cancer and to compare it to literature.

Cervical cancer

In this study we tried to reevaluate all the cases of carcinoma of cervix by

reclassifying thembased on WHO histopathology

classification

ObjectiveIs to identify the most frequent

histopathological types of CC diagnosed at King Abdulaziz

University Hospital (KAUH) &to compare its histological type

with literature.F.J.Altaf etal, J Am Sci 2013;9(5):375-379

MethodsA retrospective study was designed to

reclassify all cases that were diagnosed as CC

World Health Organization (WHO) classification system was used

Department of Pathology of KAUH from January 1990- September 2012.

F.J.Altaf et al, J Am Sci 2013;9(5):375-379

Material and MethodsData base of Phoenix System( 1995-2012)

All the cases with cervical biopsies that hadcervical cancer diagnosis or carcinoma in situ in the

archives of the Department of Pathology KingAbdulaziz University Hospital.

Manual search of the old cases (from 1995-1990).

Material and MethodsInclusion criteria

Invasive cervical cancer carcinoma in situ inExclusion critreia

*Cervical intraepithelial neoplasia ( CIN I& CIN II)*Endometrioid carcinoma of endometrial type that

presented as cervical mass*Adenocarcinoma of cervix (endometrioid ) type that cannot be differentiated histopathologically

from endometrial type based on the material submitted.

Material and MethodsAll selected cases hematoxcilin and eosin stained

(H&E) slides were reviewed

Cases diagnosis were reclassified based on the modified World Health Organization (WHO)

classification system of invasive carcinoma of the uterine cervix

The task was performed by authors (FA &GM).

Results167 cases that was identified and

reclassified.Some cases had single histopathology diagnosis

(n=147)Others had multiple specimen over a period of time

(n=20)

The diagnosis was based on one specimen and all other specimen were disregarded if they carry the

same diagnosis

F.J.Altaf etal, J Am Sci 2013;9(5):375-379

Results167 cases that was identified and

reclassified.The most frequent type was:

Squamous cell carcinoma (83%) Non keratinizing = keratinizing squamous

Adenocarcinoma (7.7%) Adenosquamous (3.6%).

F.J.Altaf et al, J Am Sci 2013;9(5):375-379


We found no much difference in the prevalencebetween the non Keratinizing and keratinizing

squamous cell carcinoma

32% versus 31%.

No big differences in their mean age as well

51 versus 54 years.

Literature major histological type Of CC

1-Squamous cell carcinoma (SCC) 75-80% Non-keratinizing more than keratinizing

mean age 55 years. 2-Adenocarcinoma 20-25%

3-Other epithelial carcinoma including Adenosquamous

small cell carcinoma


The literature review reveal there is differencein the prognosis in the treatment of KSCC &NKSCC

Radiotherapy is a modality of treatment.

Keratinizing SCC is less sensitive to radiotherapy in comparison to non keratinizing SCC and

subsequently to survival

In situ carcinomaThe in situ squamous carcinoma is 20% (32/167)

with mean age of 44 yearsYounger than the invasive SCC

Older than literature.

It could be related to late detection as a result of absence of cervical cancer screening program

OrIt could be related to the disease natural history in

this part of the world.

Adenocarcinoma

Invasive adenocarcinoma represented 7% of ourcases.

It is presenting few years earlier than invasiveSCC (48 years)

No big age difference as reportedin literature

KAU cases Histopathological type identified, mean age & frequency

Histological Types N % Mean Age

Std. Deviation

Squamous cell carcinoma, non-keratinizing 5.4 32.1 50.7037 14.54937Squamous cell carcinoma, keratinizing 51 30.1 54.2353 13.51531

Microinvasive squamous cell carcinoma 1 0.6 30.0000

Invasive squamous cell carcinoma 1 0.6 29.0000

Carcinoma in-situ / CIN III 32 19.6 44.2500 11.98655

Invasive papillary squamous cell carcinoma 1 0.6 40.0000

In-situ adenocarcinoma 1 0.6 58.0000

Invasive adenocarcinoma endocervical type 12 7.1 48.0000 10.35725

Adenosquamous carcinoma 6 3.6 47.8333 11.90658

KAU cases Histopathological type identified, mean age & frequency….continued

Histological Types N % Mean Age Std. Deviation

Papillary serous adenocarcinoma 2 1.2 56.5000 6.36396Mucoepidermoid carcinoma 2 1.2 51.5000 16.26346

Invasive adenosarcoma 2 1.2 70.0000 .00000

Small cell carcinoma 1 0.6 38.0000

Undifferentiated carcinoma 1 0.6 46.000

Total 167 99.4 50.2048 13.73053

Molecular Testing

Few studies had looked at the presence of HPVin cytology by molecular methods in 100cases

They found 6% of the cervical smears have oncogenic HPV.

Gazaz et al Saudi Med. j. 2007;28:1810-1818

Molecular TestingAl-Muammar et al

They looked at HPV DNAin cytology specimen and correlates it with PS in

120 cases. 38 case (31.6%) were found positive by PCR for

HPV-16 or HPV-18 or both.

Al-Muammar Tet al Ann Saudi Med .2007;27(1):1-5.

Molecular TestingAl-Muammar et al.

.When they correlated that finding with the Pap smear cytologythey found 10 cases (8.3%) showed minor cytological changes

-(reactive and reparative changes,-inflammatory cellular changes,

-low-grade squamous epithelial lesions [LGSL]) Of these 10 only 6 were HPV-infected

1 HPV-16, 1 HPV-18,

4 HPV-16/18), making the prevalence of HPV 60% (6/10) in those with cytological changes

5% (6/120) in all subjects.Very much similar result to Gazaz study in the

Western region 6% HPV DNA detected in cervicalcytology

Molecular TestingAl Hebishi et al

looked at the prevalence ofHPV virus DNA in 100 cases that have the diagnosis

of cervical cancer.They concluded that 89% cervical cancers in Saudi

Arabia were associated with HPV infection78.7% (70/89) of HPV-positive tumors were infected

with HPV-16/18

Alsbeih G. et al. Gynecologic Oncology; 121, Issue 3, 1 June 2011, P522–526.

Conclusion

Cervical carcinoma occurs in matching frequency with major histological type and age group in

literature The keratinizing and non keratinizing are almost

similar in prevalence which is different than other reports.

Lack of CC screening program and research in this area obscure a lot of information of the natural history of this health problem in this part of the

world.

This project was funded by The Deanship of

Scientific Research (DSR)King AbdulazizUniversity, Jeddah,

Grant no. (259/140/1431).

The authors acknowledge with thanks DSR technicaland financial support

Modified World Health Organization (WHO) histological classification of invasive carcinomas of the uterine cervix

Squamous cell carcinoma – Keratinizing / Non-keratinizing

Microinvasive squamous cell carcinomaInvasive squamous cell carcinoma

Verrucous carcinomaWarty (condylomatous) carcinoma

Papillary squamous cell (transitional) carcinomaLymphoepithelioma-like carcinoma

2- AdenocarcinomaMucinous adenocarcinoma

Endocervical typeIntestinal type

Signet-ring typeEndometrioid adenocarcinoma

Endometrioid adenocarcinoma with squamous metaplasia

Clear cell adenocarcinomaMinimal deviation adenocarcinoma

Endocervical type (adenoma malignum)

Endometrioid typeWell-differentiated villoglandular

adenocarcinomaSerous adenocarcinomaMesonephric carcinoma

3- Other epithelial tumorsAdenosquamous carcinoma

Glassy cell carcinomaClear cell adenosquamous carcinoma

Mucoepidermoid carcinomaAdenoid cystic carcinomaAdenoid basal carcinomaTypical carcinoid tumor

Atypical carcinoid tumorLarge cell neuroendocrine carcinoma

Small cell carcinomaUndifferentiated carcinoma

Cervical cancer paper kau fa

Education

Transcript of Cervical cancer paper kau fa