Endocervical adenocarcinoma: The Silva system and a new classification proposal.

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Published: 24 Jan 2018
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Dr Simona Stolnicu - University of Medicine and Pharmacy of Târgu Mureș, Romania

Dr Stolnicu speaks with ecancer at the 10th BGICC in Cairo about a new, HPV-led screening and classification protocol for women with endocervical adenocarcinoma. 

She describes the accuracy and uptake of HPV screening for gynaecologic disease, and also its utility in testing for other virus-induced cancers.

Click here to watch Dr Stolnicu discuss pseudo-invasive breast lesions.

My focus in gyn and breast pathology and for the gyn pathology I'm more interested in the cervical pathology. Why is that? Because we have the highest incidence and mortality due to this tumour in Europe, in Romania. So we have a lot of tumours and these tumours occur in young patients. What we thought about a couple of years ago is to change the classification that we currently use, the WHO classification, and instead of using morphological features to use HPV status, the HPV infection, because we realised that the tumours, the invasive and the cervical adenocarcinomas, that are linked to the HPV infection do better than the ones that are not linked to this HPV infection. So we are trying to change the classification; we have published already one paper on this topic and we are going on with several other papers in order to simply modify the previous classification with the new one which we think is very important and we may correlate with the screening in cervical cancer and so on.


What proportion of these cancers were coming from HPV?


In our data, and we have collected cases from all over the world because we realised that we need to have a general view, about 10-15% of them are not related to the HPV infection. So those ones probably are not even going to be detected through the screening which is core testing now, the Pap smear and the HPV test. So for those cases we have more aggressively and for those cases we need not only a different classification but a different management because they are a completely different type of tumours.


Do you think that screening could lead to different classification in other cancers?


I don't know but there are other organs in which the classification is now linked to the HPV like the oral cancer, the larynx, anal canal and so on. Yes, so there are several other organs that are infected by HPV and the classification has been changed already. So we're saying that with cervical classification will go on and will be changed. We hope so. By that we will manage the patients differently and we hope to reduce the mortality, that's the main goal.