00:01
Let’s talk about cervical
cancer and, in verbiage
highlight the things we’ve noted.
00:08
E6 and E7. E6 knocks out p53.
00:12
E7 will knock out Rb.
00:15
These are viral oncogenes found in abnormal cervical tissue
that has been infected by human papillomavirus known as HPV.
00:22
The E6 and E7 gene proteins transform cells
due to their interactions iwth two intracellular proteins
called p53 and Rb, which stands for retinoblastoma but in this instance is related to cervical cancer.
00:37
If you have a --
Now, understand the language.
00:41
If you know your basic
neoplasia, then you understand
that if you have a
hypophosphorylated Rb,
that’s a key importance,
if you have a
hypophosphorylated Rb.
00:54
This means that an Rb has
not been phosphorylated.
00:57
This means that the Rb is
now complexed with E2F.
01:00
And therefore, where is my cell?
The cell is stuck
between G1/S phase.
01:06
However, if you have E7,
the E7 is going to
then remove the break.
01:13
So it promotes proteolysis
of hypophosphorylated Rb.
01:16
Guess what E7 did.
01:19
It got rid of Rb.
01:20
It removed the break.
01:21
If you remove the break,
then E2F allows for a cell
to go from G1 to S phase.
01:27
Understand the normal first
that I just explained.
01:29
And then what happens
here with high grade HPV
that possess E6, E7?
An issue results in cervical
intraepithelial neoplasia.
01:40
In case you missed what CIN
stands for, there it is.
01:43
C – cervical, I –
intraepithelial, N – neoplasia.
01:48
Is this cancer?
No.
01:53
Is this dysplasia?
Yes.
01:57
So CIN, precancerous lesion
detected by Pap smear.
02:03
Next,
the Pap smear has been
done, and screening.
02:08
How important has this
been for the United States
or in the world in general?
Really important, right?
So therefore, because of the
introduction of Pap smear
as a screening method,
and also vaccination,
cervical cancer in
developed countries
starts dropping in terms of
death by gynecologic cancers.
02:33
Worldwide though, cervical cancer
is still very, very common.
02:37
The picture, histologically
that you’re seeing here,
would be an abnormal,
abnormal Pap smear,
in which you would
then expect to find
your HPV infected cells
with atypical nuclei.
02:50
Once again here, we’ll walk through
the major histologic changes.
02:54
Normal on your left, what
kind of cells are these?
Exocervix,
and we have squamous.
03:03
In the middle, I want you to
compare the left to the right.
03:07
I want you to focus upon
the dysplasia in CIN 3.
03:11
What’s dysplasia mean?
Disordered proliferation.
03:16
Lots of proliferation
taking place.
03:19
Thick, thick, thick, thick, thick.
03:21
I want you to take a look
at the bottom of this.
03:24
That's the basement
membrane, that’s the stage.
03:26
Do you see it being ruptured?
No.
03:29
This is CIN 3.
03:31
You’re one step closer to?
Invasive cervical cancer.
03:37
I want you to compare the basement
membrane in CIN 3, which is
the bottom of the
thickened dysplasia.
03:44
And note, on the right that the
membrane has now ruptured
and the cancer cells from
above are then penetrating
and invading into the
cervical mucosa.
03:57
Welcome to, unfortunately,
a patient who’s developed
invasive cervical cancer.
04:05
What then happens
after invasion?
Here’s your cervical
cell cancer.
04:12
You’ll notice here,
let me set up the picture, that
you've done a pelvic exam,
you’re looking at
the cervical os.
04:19
But this time, you see
mass-like structure
sticking out of the cervical os.
04:25
This is not the vagina. The
vagina has been removed.
04:28
We’re looking at
the cervical os.
04:30
Along with this, what’s
behind it is the uterus.
04:34
Okay.
04:35
This mass-like structure that
you’re seeing by the cervix,
you look at this,
no doubt, it’s cancer.
04:40
Upon Pap smear,
you'd find your keratin pearls
and so on and so forth,
then you know it,
squamous cell cancer.
04:47
Now, this is a beautiful
picture to illustrate.
04:50
What if you start having lateral
invasion of your cervical cancer?
You can now close your eyes.
04:57
Think about the cervix and the
surrounding structures that you have
If you start laterally invading, and
your patient starts showing signs of
changes in BUN and creatinine.
05:10
And you find your BUN creatinine
ratio to be elevated.
05:15
Elevated.
05:16
"What does that has to do
with your cervix, Dr. Raj?"
BUN creatinine is a measurement
of your kidney. Yes
But if you have lateral
invasion in the cervix,
what structure are you
then obstructing?
There you go.
05:29
You’re obstructing the kidney.
05:32
Your patient, often cause of
death is post renal failure
because of lateral invasion of
your cancer in cervical cancer.