Squamous Cell Carcinoma of the Cervix

Abstract

Squamous cell carcinomas constitute the vast majority of all cervical cancers. Unlike vulval squamous carcinomas, these are almost invariably human papillomavirus (HPV) mediated, and the incidence worldwide varies widely, largely depending on the presence of a universal screening programme for detecting precancerous changes and/or genitally transmitted high-risk HPV. Although a range of morphologically defined “subtypes” is listed in the WHO classification, these generally have no bearing on management or behavior; similarly there is no universally accepted grading system with direct prognostic relevance. It is far more important to diagnose these tumors accurately, as there are a number of mimics with clinical implications. Most important of all is to assign the correct clinicopathological stage, an exercise directly dependent on pathological assessment; at the earlier stages, generally in screen-detected lesions, the challenge is to measure lesions accurately and reproducibly so the patient is appropriately managed and neither over- nor undertreated. In this regard it is important to clearly delineate those cases of invasive cancer that can be managed conservatively based on current evidence. At the higher stages, the pathologist must determine whether there is microscopic parametrial or vaginal involvement not detected on clinical examination, in addition to the presence and extent of nodal involvement, and the careful assessment of radical surgical specimens including exenterations for the status and clearance of margins. These aspects will be discussed in this chapter.