A STUDY OF HISTOPATHOLOGIC PATTERN OF CERVICAL CANCER AND THEIR EXPRESSION OF SURROGATE MARKERS FOR HUMAN PAPILLOMAVIRUS

Abstract

Introduction: Cancer of the cervix is the second most common cancer in women worldwide accounting for 470,000 cases and 230,000 deaths annually, more than 85% of which occur in developing countries. The main aetiological factor is persistent infection with high risk human papillomavirus while early sexual debut, multiple sexual partners, high parity, immune suppression, cigarette smoking and low socioeconomic stats are well recognized risk factors. Cancer of the cervix can be prevented using vaccine, cervical cytology screening, HPV DNA typing and visual inspection using Lugol’s iodine or acetic acid. The gold standard in diagnosis is tissue biopsy. The aim of this study is to determine the distribution and immunohistochemical patterns of expression of p53, p21, p16, MDM2 and c-Myc in cancer of the cervix in ABUTH, Zaria.
Materials and method: The archived haematoxylin and eosin stained slides of cancer of the cervix diagnosed in the Department of Pathology, ABUTH Zaria over ten year period (2004 - 2013) were retrieved. Out of the 748 cases analysed 180 had immunohistochemistry done on them for the markers p53, p21, p16, MDM2 and c-Myc. The selected samples were from 2011-2013 cases been the most recent and expected to have high yield of preserved antigens. The request cards, Bench books, records from Zaria Cancer Registry, patients’ folder and clinicians’ records were used as sources of data and information for the study.
Results: A total of 748 cases were analysed. The peak age of the disease is in the fifth decade with mean age being 44.8 years and age range 23 - 90 years. The commonest histological variant is squamous cell carcinoma, accounting for 87.0% of the cases followed by adenocarcinoma with 9.1% and the least common is choriocarcinoma with 0.1%. A total of 94.7% of the patients presented with late stage disease (stage IIIb accounting for 53.5%) while only 5.3% presented with early stage disease. The positivity for p16 and MDM2 were 91.1% and 70.6% respectively while p53, p21 and c-Myc exhibited 95.0%, 96.1% and 90.0% negativity respectively