Pathologic Staging, Histopathology and Cervical Cancer Screening

In cases treated by surgical procedures, the pathologist’s findings in the removed tissues can be the basis for accurate statements on the extent of disease. The findings should not be allowed to change the clinical staging, but should be recorded in the manner described for the pathologic staging of disease. The TNM nomenclature is appropriate for this purpose.

Pathologic Staging

Unlike FIGO staging criteria, TNM staging accounts for node positivity; however, the FIGO and TNM classifications are otherwise virtually identical in describing the anatomical extent of disease. Clinical staging is essential to select and evaluate therapy, while the pathological stage provides the most precise data from which to estimate prognosis and calculate end results.

Infrequently, hysterectomy may be carried out in the presence of unsuspected invasive cervical carcinoma. Such cases cannot  be clinically staged or included in therapeutic statistics, but it is desirable that they be reported separately. If considered appropriate, some of these patients may be offered repeat laparotomy with full parametrectomy and pelvic lymphadenectomy to allow potentially curative surgery and/or determine the need for adjuvant chemoradiation .

Staging is determined at the time of the primary diagnosis and cannot be altered, even at recurrence. Only if the rules for clinical staging are strictly observed is it possible to compare results among
clinics and by differing modes of therapy.

 

Histopathology

All tumors must be microscopically verified. Cases should be
classified as carcinomas of the cervix if the primary growth is in the
cervix. All histologic types must be included. The histopathologic
types are:
• Squamous cell carcinoma (keratinizing; non-keratinizing; verrucous).
• Endometrioid adenocarcinoma.
• Clear cell adenocarcinoma.
• Adenosquamous carcinoma.
• Adenoid cystic carcinoma.
• Small cell carcinoma.
• Undifferentiated carcinoma.
Grading by any of several methods is encouraged, but is not a
basis for modifying the stage groupings. Histopathologic grades are
as follows:
• GX: Grade cannot be assessed.
• G1: Well differentiated.
• G2: Moderately differentiated.
• G3: Poorly or undifferentiated.
When surgery is the primary treatment, the histologic findings
permit the case to have pathologic staging, as described above. In
this situation, the TNM nomenclature may be used.

Cervical cancer screening

Primary prevention of cervical cancer through vaccination, and secondary prevention through the detection of cervical cancer precursors, are both known to be effective preventive measures. Details on cervical cancer screening can be accessed via the FIGO website (www.figo.org).