Background

Pathology literally means the study (logos) of suffering (pathos). It is a science that deals with causes and mechanisms of disease that result in manifestation of illness. Also, it is the bridge between basic science and clinical practice. A cure for malignancy is a major challenge for medicine. Understanding of pathology of malignancy will assist in the clinical understanding of the disease.

A neoplasm is defined as a new growth that is composed of cells that grow abnormally and in an uncoordinated fashion, such that they exceed the growth of the surrounding normal tissues. Neoplasms may be benign or malignant. A malignant neoplasm is characterised by its ability to invade normal tissues and to spread to distant sites (metastasis). While strictly speaking the term cancer or carcinoma refers to a malignancy arising in epithelial tissues, it is often used as a generic term to describe all malignant neoplasms.

Cancer is a result of genetic mutations that are acquired, usually spontaneously. These genetic mutations alter the function of the cells such that the cells acquire self-sufficiency and become unresponsive to normal control mechanisms to evade cell death and gain limitless replicative potential. These cellular changes that result in malignancy can be linked to environmental insults, infections by viruses, inherited genetic mechanisms and a combination of these processes. The malignancies in the female genital tract exemplify many of these different pathways. In the developed world, the most frequent malignancy of the female genital tract is endometrial carcinoma; the most common sub-type is linked to unopposed oestrogen stimulation and a resultant alteration in the cellular micro-environment. Cervical cancer is caused by infection with high-risk human papilloma virus (HPV). The virus infects the cell by entering into the basal cells in the cervical transformation zone. The viral DNA integrates with the DNA of the epithelial cells, particularly when there is a persistent infection with high-risk strains (notably types 16 and 18). This results in inactivation of important regulatory mechanisms and confers immortality on the cell, thus allowing progression to neoplasia. Some ovarian, tubal and endometrial cancers are associated with genetic abnormalities. Mutations in the BRCA-1 and 2 genes are the cause of about 10% of breast, tubal and ovarian cancers. Lynch syndrome, which is associated with defects in DNA repair, is associated with an increased risk of endometrial and ovarian cancers.