CAUSES

Social and Economic Factors i.e.: –                    

• women living in poor conditions, with a low income and indifferent education.
• Invasive carcinoma of the cervix is 20 times more common amongst the wives of unskilled laborer’s than it is in those of professional men.

The possible operating factors are i.e.: –

• Low standards of cleanliness
• Coitus or marriage at an early age
• Frequency of sexual intercourse
• Promiscuity of both partners 

Coitus i.e.: –

• The sexually active woman is 2–4 times more likely to develop cancer of the cervix than is the sexually inactive woman.
• The earlier the age of first intercourse, the more the partners, and the more promiscuous the partners, the greater the risk.
• To account for the relationship of cervical cancer to sexual activity, it was once postulated that smegma lying beneath the prepuce of the male phallus is carcinogenic, and this concept was linked with the possible protection offered by circumcision and the increased danger due to poor hygiene.
• Yet smegma was never shown to be carcinogenic, and the male phallus exposed to it continually did not develop malignant disease.

Childbearing i.e.: –

• Invasive cancers occur in multipara.
• High parity means frequent coitus during many years, starting at a young age, and is often associated with poor socioeconomic conditions.

Cervical Irritation and Infection i.e.

• Cervical trauma,
• Chronic cervicitis and ectopy

 Oestrogen i.e.

• While excessive and unbalanced oestrogen stimulation favours the development of cancer of the cervix.
• the disease occurs commonly after ovarian activity has ceased — even after surgical removal of both ovaries.

 Predisposing Histological States i.e.

• Certain histological changes in the cervix which have alleged to be “precancerous”, or which sometimes confused with cancer, include basal cell hyperplasia, squamous cell metaplasia and CIN. Of these, only CIN II-III are likely to be significant forerunners of invasive carcinoma.

Squamous Cell Carcinoma i.e.

• Squamous cell carcinoma usually starts in the area of the squamous-columnar junction (transformation zone) as described above. Occasionally, however, it arises in the endocervix, sometimes deep to the lining.
• Even if not all squamous cell growths begin in reserve cells, those developing in the endocervix almost certainly do. Squamous cell carcinoma of the cervix seen in the micro invasive and invasive forms.
• Some invasive cancers of the cervix are hypertrophic or exophytic, producing a cauliflower-like mass; others are mainly eroding and ulcerative or infiltrative an early growth can simulate an erosion. The squamous cell carcinoma has histological features similar to those of an epithelioma in any site except that pearl formation is unusual.

Proportion

• About 20% of the tumours of the well-differentiated type (often known as “large cell keratinising tumours”). Moderately differentiated tumours (large cell nonkeratinizing tumours) constitute about 60% of the total. The remaining 20% are poorly differentiated (small cell non keratinising tumours).
• However, biopsies taken from different areas of the same tumor often show different degrees of differentiation and different predominant cell types. Two distinctive histological variants of cervical squamous cell carcinoma merit mention; some, usually of the well differentiated type, have cells which contain abundant glycogen and thus appear as “clear” cells, whilst occasionally the poorly differentiated tumours assume a spindle-shaped cell form and so resemble a sarcoma.