Cervical cancer.

“Koilocyte” diagnostic of HPV infection. The koilocyte has a collapse of its keratins peripherally, leaving an empty space around the nucleus. The nucleus also shows increased amounts of hematoxylin staining, reflecting increased DNA content due to unscheduled DNA synthesis from the HPV . Biopsies of gross lesions are done. Colposcopy with biopsy of abnormal areas may be done as indicated. Endocervical curettage and cold knife conization (CKC) are often performed to determine depth of invasion and presence of lymphovascular space invasion in early stage cervical cancers with a normal appearing cervix by inspection and pelvic examination only. A CKC involves an excision of the transformation zone in a cone-shaped specimen with the apex of the cone pointed toward the endocervical canal beyond the transformation zone. Loop excisional electrocautery (LEEP) is typically used to treat CIN II-III. Compared to a LEEP, the CKC (in which cautery is only used after the excision to stop bleeding), preserves the morphology of the tissue to allow an accurate evaluation of the extent of disease by pathologists. The extent of the primary tumor, evident in a CKC is part of the information defined by the term “stage”, and the stage of a cervical cancer then determines the necessity for additional treatment. Cystoscopy and proctoscopy can be done to evaluate for a higher stage tumor defined by invasion of tumor into the bladder or rectum, respectfully. cervical intraepithelial neoplasia to cervical carcinoma in situ to invasive cervical cancer and human papillomavirus infection is central to the development of cervical cancer. These three facts mean that the appearance of invasive cancer can be prevented with early intervention.