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Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer
Rev Assoc Med B ras 2017; 63(4):379-385 379
REVIEW ARTICLE
Cytopathologic evaluation of patients submitted to radiotherapy
for uterine cervix cancer
Cátia Martins L eite P adilha1*, Mário Lúcio Cordeiro Araújo Junior2, Sergio Augusto L opes de Souza3
1MSc in Pathology from Universidade Federal Fluminense (UFF). Staff (Cytopathology), Instituto Nacional de Câncer (Inca), Rio de Janeiro, RJ, Brazil
2PhD in Medical Sciences from Universidade do Estado do Rio de Janeiro (Uerj). MD, Anatomic Pathologist, and Vice-director (HC2) of INCA, Rio de Janeiro, RJ, Brazil
3Postdoctoral Fellowship from Universidade Federal do Rio de Janeiro (UFRJ). Adjunct Professor, Faculdade de Medicina da Universidade Federal do Rio de Janeiro (FM-UFRJ), Rio de Janeiro, RJ, Brazil
Summary
Study conducted at the Department
of Radiology, School of Medicine,
Universidade Federal do Rio de Janeiro,
Rio de Janeiro, RJ, Brazil
Article received: 8/23/2016
Accepted for publication: 10/19/2016
*Correspondence:
HUCFF, UFRJ
Address: Rua Prof. Rodolpho
Paulo Rocco, 255
Rio de Janeiro, RJ – Brazil
Postal code: 21941-913
Cervical cancer is an important public health problem. Pap smear is the leading
strategy of screening programs for cervical cancer worldwide. However, delayed
diagnosis leads to more aggressive and less effective treatments. Patients with
uterine cervix malignancies who are referred for radiotherapy have advanced-stage
disease, which results in high rates of locoregional recurrence. The use of radio-
therapy as a treatment for cervical cancer causes morphological changes in neo-
plastic and non-neoplastic epithelial cells, as well as in stromal cells, which make
it difficult to diagnose the residual lesion, resulting in a dilemma in cytopatho-
logical routine. Based on the difficulties of cytopathologic evaluation for the
follow-up of patients treated with radiotherapy for cervical cancer, our objective
was to describe the actinic cytopathic effects. Our paper was based on a structured
review including the period from June 2015 to April 2016, aiming at an explor-
atory-descriptive study. Bibliographic investigations were carried out through
selection and analysis of articles, list of authors and keywords, selection of new
articles focused on the analysis of bibliographic references to previously selected
documents, as well as textbooks of recognized merit. The most incident actinic
cytopathological alterations as described in the literature are: cellular gigantism,
nuclear and cytoplasmic vacuolization, dyskeratosis, bi- and multinucleated (B/M)
cells, macro and multiple nucleoli, anisokaryosis, anisonucleolosis and nuclear
pyknosis. To date, a protocol has not been established that can precisely differ-
entiate the morphological characteristics between benign cells with actinic effects
from recurrent malignant cells on post-radiotherapy smears.
Keywords: radiotherapy, uterine cervix neoplasms, actinic effects, cytopathology.
Introduction
Cervical cancer is an important public health problem
worldwide. Its incidence is higher in less developed coun-
tries, compared to the more developed ones.1 The disease
usually begins after the age of 30 years, and its risk in-
creases quickly until it reaches a peak between the ages
of 50 and 60 years. According to Instituto Nacional de
Câncer (Inca, in the Portuguese acronym), 16,340 new
cases of cervical cancer were expected in Brazil in 2016,
with an estimated risk of 15.85 cases per 100,000 women.
In the Northern Region, for example, this malignant tu-
mor is the most incident among the female population.1
Pap smear (Papanicolaou) is the leading strategy of
screening programs for cervical cancer worldwide. In Brazil,
the strategy recommended by the Ministry of Health is
cytopathological examination in women aged 25 to 64 years.
For an effective cervical cancer control program, the orga-
nization, integrity and quality of services and actions in the
care chainmust be guaranteed, as much as patient treatment
and follow-up. 2,3 Pap smears are considered highly effective,
low-cost, and are well accepted by the population.4
Delays in diagnosis, on the contrary, lead to more
aggressive and less effective treatments, in addition to
raising hospitalization costs and mortality rates. As an
example, a large proportion of Brazilian women do not
regularly undergo cervical cancer screening due to shyness,
fear, or lack of awareness, and are thus excluded from
prevention and detection measures.4