Reference Manual - IARC Screening Group

Pathophysiology of Cervical Cancerpossible. In the cervix seen here, in order to get a complete view of theSCJ, the lower lip of the cervix needs to be manipulated downward. This isperhaps best accomplished by using a swab either on the cervix itself or byplacing a swab in the cull de sac and pushing upward, thus bringing thecervix downward and into view. In large and patulous (spread apart)cervices, it may be necessary to open the bivalve speculum wider to betterexpose the SCJ. There is also an area of squamous metaplasia (see below)occurring in a patulous portion of the cervix. This patulous area is probablythe result of obstetrical trauma with subsequent scarring and healing.SquamousMetaplasiaSquamous metaplasia is aphysiologic process throughwhich the glandular cellslining the cervical canalnear the SCJ are graduallyreplaced with squamouscells. This process is aresult of the cervix’sexposure to noxiousagents in the environment, such as bacteria, viruses and unclean foreignbodies. In the cervix shown here, there is a visible area of squamousmetaplasia on the lower lip of the cervix, close to the SCJ. It has a faintwhite, translucent appearance, almost as if a thin white veil were laidonto the cervix. Unlike mucus, it will not wipe away.Ectopy/Ectropion Exposure to hormonessuch as estrogen andprogesterone may affectthe appearance of thecervix. This effect istypified by the increasedpresence of glandulartissue on the outer surfaceof the cervix. This finding,often called ectropion orectopy, is not a pathological condition, but rather a variant of cervicalappearance. The cause of ectopy is unclear, but may relate to exposure tointernal hormonal sources (such as may occur during periods ofanovulation, normal menstruation or pregnancy). It may also result fromexposure to synthetic hormones, when patients use hormonal methods ofcontraception such as combined estrogen/progestin pills and progestin-onlymethods. In this photo, there are neither areas of obvious acetowhitechange (see below), nor is this cervix particularly likely to bleed easilywhen touched (friable), both of which indicate a normal cervix.Cervical Cancer Prevention Guidelines for Low-Resource Settings 3-5