There are two main types of cervical cancer. Squamous carcinoma of the cervix, which makes up around 85% to 90% of cervical cancer, and Adenocarcinoma of the cervix. You can have mixed carcinomas but these are very rare. Squamous carcinoma usually arises in what is called the transformation zone, which is the junction between the nonkeratinizing squamous epithelium of the ectocervix (exocervix) and the columnar epithelium of the endocervix. The squamous carcinoma can manifest itself as an exophytic tumor of the ectocervix or an infiltration of the endocervix or just a simple ulceration. Bottomline they can arise from the entire cervical area. This is true of adenocarcinomas as well. 50% are exophytic, 35% are just ulcerations, and 15% are not visible because they are within the endocervical canal.
Remember that the cervix is just the bottom portion of the uterus at which point it meets with and opens up to the vagina. Within this area, the cervix is divided into an exocervix and an endocervix. Cervical cancers can arise from any part of the cervix. So the primary location of cervical cancers is located within the cervix and not the uterus.
As far as mets are concerned, cervical cancer can spread by direct extension into the uterine wall, vagina, peritoneal cavity, bladder, or rectum. It can also spread via lymphatics or blood. Primary mets are to the lungs, liver, and bone.
HPV is central to the development of cervical cancers and can be detected in nearly all cervical cancers, at lease for step 1 purposes. However, most HPV infections are transient. And not all HPVs cause cancer. HPV types 16, 18, 31, and 33 are the only ones associated with cancer formation. And finally HPV alone is not enough to cause cervical cancer. So all cervical cancers have HPV but the converse is not true. I would know this and review the histology of CIN1 (partial dysplasia), CIN2 (about half thickness dysplasia), and CIN3 (full thickness dysplasia, carcinoma in situ). Also know when to screen for cervical cancer and why we do it and why it's effective.
Hope this helps and good luck....
