4 - Gynae - The Cervix and its disorders - Premalignant disease of the Cervix (CIN) Flashcards
define CIN
Cervical intraepithelial neoplasia
-histo abnormality of cervix in which abnormal epithelial cells occupy varying degrees of squamous epithelium
What does dyskaryosis mean in this context
describes cellular abnormality only from cervical smear - suggests presence of CIN
3 CIN groups?
1 - mild dysplasia - atypical cells in lower third
2 - moderate dysplasia - atypical cells in lower two thirds
3 - severe dysplasia - atypical cells in full thickness (carcinoma in situ)
Aetiology of CIN? what contributes? how to prevent? what incr risk of early mal progression?
HPV - sex trans - causes CIN - smoking, COCP, immunosuppression contributes
give HPV vaccine (types 16/18)
immsuppression
How is it diagnosed?
no clinical features
cervical smear abnormal and colposcopic abnormality suggests presence - Dx confirmed histologically
trt rationale? how are the dif stages trtd? what does trt do?
to prevent progression to invasion
CIN 1 - usually observed
CIN 2 and 3 removed with large loop excision of TZ (LLETZ)
this trt treats and also identifies any unexpected invasion
if left untrted - 1/3 of who will dev CC in next ?? years
CIN 1 - what can it do?
1/3 of CN 2/3 will dev CC in next 10y
can become malignant but least potential - commonly spont regresses
when is peak incidence? becoming more or less common?
25-29y
more common
cervical smear - when done? what about after 65?
all women from 25y if had intercourse, then every 3y until 49 then every 5y until 64
>65 - only women w no smears since 50 or recent abnormal tests
when is colposcopy indicated? what to do if not?
if mild abnormality and high risk for HPV
(not done if not high risk HPV) - continue routine recall
what is it called when abnormal columnar cells are seen? what must be done if found? how to do this? when would hysteroscopy be done?
CGlandularIN
r/o adenoca of cervix/endometrium - use colposcopy and endocervical curettage or w cone biopsy
when cause of abnormal cells is unclear
what are the complx of LLETZ
post op haemorrhage (uncommon)
incr risk slightly of preterm delivery
