5 - Specialist Gynaecology Flashcards
% of cases of cervical cancer in developing world
80%
Risk factors for HPV
Increased number of sexual partners Immunocompromise Cigarette smoking Low socio economic status Prolonged use of COCP Higher number of pregnancies Less than 25 years old Early age your first intercourse
Prevention of HPV infection
Avoid sexual intercourse / fewer sexual partners Use condoms Gardasil vaccination
Referral criteria for colposcopy
3 consecutive inadequate smears Borderline nuclear abnormality (squamous /glandular) + HR HPV 1 x mild dyskaryosis +HR HPV 1 x moderate dyskaryosis 1 x severe dyskaryosis 1 x smear with possibility of invasion 1 x smear with possibility of glandular neoplasia. after treatment (by loop or thermocoagulation) if HR HPV positive (irrespective of cervical smear result).
what does colposcopy involve?
Magnified stereoscopic visualization of the cervix. +/- directed tissue sampling. The entire transformation zone must be visualized.
How does application of aceto-white effect the cervix
Application of acetic acid to atypical epithelium results in temporary coagulation of cytokeratins within the surface epithelium. Causing whitening. Dysplastic cells have a higher nuclear:cytoplasmic ratio and acetic acid causes cellular dehydration. Dysplastic cells have less cytoplasm and dehydrate more easily and become more white
What can aceto-white staining in colposcopy indicate
CIN HPV infection Healing tissue Invasive disease.
What does iodine staining in colposcopy indicate?
Iodine stains normal tissue brown due to its glycogen content. It fails to stain abnormal squamous epithelium as a consequence of poor glycogenation
What does punctation in colposcopy indicate?
CIN (stippled appearance of capillary vessels at an abnormal squamocolumnar junction)
What does mosaicism in colposcopy indicate?
CIN = an abnormal vascular feature
In colposcopy the severity of the lesion corrolates with what features
the intensity of acetowhite change sharp margins atypical blood vessels.
Treatment of CIN1
low malignant potential usually resolves spontaneously encourage smoking cessation if persistent may be treated (excision/ablation)
Treatment of CIN2 / 3
higher malignant potential standard treatment is excisional biopsy offer ‘see-and-treat’ treatment
What is Large loop excision of the transformational zone (LLETZ)
Removal of the transformational zone using an electrodiathermy loop under local anaesthetic
What is Laser cone colposcopy treatment
Removal of the transformational zone using the laser as a ‘knife’ under local anaesthesia
What is Knife cone biopsy colposcopy treatment
Requires GA and allows a deep specimen to be taken – can be necessary in cases of glandular CIN (CGIN)
When is hysterectomy indicated for cervical changes / cancer
If other gynaecological problems co-exist or if local excision has failed
What is Radical electrodiathermy colposcopy treatment
Burning the transformational zone under general anaesthesia
What is Cold coagulation colposcopy treatment
Tissue is boiled by applying a probe heated to 100–120°C – performed under local anaesthesia
What is Cryocautery colposcopy treatment
Freezing the tissue – performed under local anaesthesia
What is laser colposcopy treatment
Vaporising the tissue – local anaesthesia
Follow up after LLETZ
6month test of cure. If HR HPV -ve for return to routine recall. If HR HPV +ve for repeat colposcopy
management of moderate and severe dyskaryosis when colposcopy appears normal / low grade
punch biopsy If CIN 2 / 3 for LLETz If CIN 1 discuss at cytopathology meeting and repeat smear + colposcopy in 6m
management of borderline / mild dyskaryosis with +ve HR HPV
refer to colposcopy. If normal appearance repeat smear and colp at 12m If low grade changes for punch biopsy
