Published: 2020-02-25

Comparison of clinicopathological characteristics of endogenous and exogenous cervical cancer with its clinical significance

Fariha Choudhry, Tahir Muhammad, Xuewu You, Lu Liu, Asrar M. A. Abdulaziz, Yu Sun, Baoxia Cui, Sai Han, Youzhong Zhang


Background: Cervical cancer is the third leading cause of cancer death in women of less developed countries due to poor screening and decreased diagnostic approaches. We aimed to investigate and differentiate the distinct clinicopathological characteristics and prevalence of endogenous and exogenous cervical in hospitalized patients.

Methods: A study was performed contained 663 patients that were enrolled and underwent for screening of endogenous and exogenous cervical cancer in Qilu Hospital of Shandong University, from January 2010 to March 2015.  

Results: Our results indicated that combined examination of thin-prep liquid-based cytology test and human papillomavirus (HPV)-DNA are effective for diagnosis of endogenous and exogenous cervical cancer. The clinicopathological characteristics based on tumor growth pattern, and high risk HPV-DNA incidence had no significant difference (p>0.05) in endogenous and exogenous cervical cancer patients. The higher ratio of lymph node metastasis in endogenous cervical cancer and exogenous cervical cancer during IB1-stage (24.3% vs 12.9%), and in IIA2-stage (36.4% vs 25%) was observed respectively. In addition, our data provide compelling evidence that the level of deep interstitial infiltration, and lymphatic vascular infiltration in endogenous cervical cancer was collectively higher (82.7% and 33%) compared to exogenous cervical cancer (62.4% and 18.3%) respectively during all stages.

Conclusions: The higher percentage of lymph node metastasis, deep interstitial infiltration, and lymphatic vascular infiltration was observed in endogenous cervical cancer which might be the biomarker and differential key points for the diagnosis of endogenous cervical cancer. Taken together, our study provides clinicopathological features to diagnose, and differentiate the endogenous and exogenous type cervical cancer with its prevalence.


Cervical cancer, Endogenous cervical cancer, Exogenous cervical cancer, Lymph node metastasis

Full Text:



Stewart B, Wild CP. World Cancer Report. World Health Organisation, 2014.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68(6):394-424.

Center M, Siegel R, Jemal A. Atlanta, GA: American Cancer Society, 2011.

Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PE, et al. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol. 2015;16(14):1405-38.

Rodin D. The enduring need for cancer treatment. PLoS One. 2016.

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. Cancer J Clin. 2015;65(2):87-108.

Vinh-Hung V, Bourgain C, Vlastos G, Cserni G, De Ridder M, Storme G, et al. Prognostic value of histopathology and trends in cervical cancer: a SEER population study. BMC Cancer. 2007;7(1):164.

Dan S, Wang W, Ren J, Li Y, Hu H, Xu Z, et al. Clinical application of massively parallel sequencing‐based prenatal noninvasive fetal trisomy test for trisomies 21 and 18 in 11 105 pregnancies with mixed risk factors. Prenat Diagn. 2012;32(13):1225-32.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. Cancer J Clin. 2005;55(2):74-108.

Shi JF, Qiao YL, Smith JS, Dondog B, Bao YP, Dai M, et al. Epidemiology and prevention of human papillomavirus and cervical cancer in China and Mongolia. Vaccine. 2008;26:M53-M59.

Clark MA, Naahas W, Markert RJ, Dodson MG. Cervical cancer: women aged 35 and younger compared to women aged 36 and older. AM J CLIN ONCOL. 1991;14(4):352-6.

Elliott P, Tattersall M, Coppleson M, Russell P, Wong F, Coates A, et al. Changing character of cervical cancer in young women. BMJ. 1989;298(6669):288-90.

Bulk S, Visser O, Rozendaal L, Verheijen R, Meijer C. Incidence and survival rate of women with cervical cancer in the Greater Amsterdam area. Br J Cancer. 2003;89(5):834.

Grisaru D, Covens A, Chapman B, Shaw P, Colgan T, Murphy J, et al. Does histology influence prognosis in patients with early‐stage cervical carcinoma? Interdiscip Int J Am Cancer Soc. 2001;92(12):2999-3004.

Lau HY, Juang CM, Chen YJ, Twu NF, Yen MS, Chao KC. Aggressive characteristics of cervical cancer in young women in Taiwan. Int J Gynecol Obstet. 2009;107(3):220-3.

Yang L, Jia X, Li N, Chen C, Liu Y, Wang H. Comprehensive clinic-pathological characteristics of cervical cancer in southwestern China and the clinical significance of histological type and lymph node metastases in young patients. PLoS One. 2013;8(10):e75849.

Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1-17.

Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. The Lancet. 2007;370(9590):890-907.

Basu P, Mittal S, Vale DB, Kharaji YC. Secondary prevention of cervical cancer. Best Pract Res Clin Obstet Gynaecol. 2018;47:73-85.

Sawaya GF, Huchko M J. Cervical cancer screening. Med Clin. 2017;101(4):743-53.

Barnholtz-Sloan J, Patel N, Rollison D, Kortepeter K, MacKinnon J Giuliano A. Incidence trends of invasive cervical cancer in the United States by combined race and ethnicity. Cancer Causes Control. 2009;20(7):1129-38.

Wang SS, Carreon JD, Gomez SL, Devesa SS. Cervical cancer incidence among 6 Asian ethnic groups in the United States, 1996 through 2004. Interdiscip Int J Am Cancer Soc. 2010;116(4):949-56.

Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137-50.

Dai M, Bao Y, Li N, Clifford G, Vaccarella S, Snijders P, et al. Human papillomavirus infection in Shanxi Province, People's Republic of China: a population-based study. Br J Cancer. 2006;95(1):96.

Sun ZR, Ji YH, Zhou WQ, Zhang SL, Jiang WG, Ruan Q. Characteristics of HPV prevalence among women in Liaoning province, China. Int J Gynecol Obstet. 2010;109(2):105-9.

Wu RF, Dai M, Qiao Yl, Clifford GM, Liu ZH, Arslan A, et al. Human papillomavirus infection in women in Shenzhen City, People's Republic of China, a population typical of recent Chinese urbanisation. Int J Cancer. 2007;121(6):1306-11.

Yuan X, Yang Y, Gu D, Liu H, Yang H, Wang M. Prevalence of human papillomavirus infection among women with and without normal cervical histology in Shandong Province, China. Arch Gynecol Obstet. 2011;283(6):1385-9.

Group FIS. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356(19):1915-27.

Han S, Wang Y, Shi X, Zong L, Liu L, Zhang J, et al. Negative roles of B7-H3 and B7-H4 in the microenvironment of cervical cancer. Exp Cell Res. 2018;371(1):222-30.

Liu Z, Hu K, Liu A, Shen J, Hou X, Lian X, et al. Patterns of lymph node metastasis in locally advanced cervical cancer. Medicine. 2016;95(39):1-6.

Du R, Li L, Ma S, Tan X, Zhong S Wu M. Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations. Asia Pac J Clin Oncol. 2018;14(5):380-5.