Cervical Dysplasia & Cancer Flashcards
This area of the cervix has glandular columnar cells
Endocervix
This area of the cervix has squamous cells
Ectocervix
where the glandular columnar cells meet the squamous cells on cervix is known as
Squamocolumnar Junction (SCJ)
when is squamous metaplasia most active
during adolescence / pregnancy
where do nearly all cervical neoplasia develop?
w/in transition zone of SCJ
what is a increased risk for cervical CA?
early age of 1st sexual intercourse / 1st pregnancy
Dietary deficiencies of what may alter immunity and promote viral persistence leading to cervical dysplasia
Vit A, C, E, beta carotene, folic acid
_____ –> decreased ______ –> allows genetic mutations over time –> _____
Old Age
Immunocompetence
Cancer
68y/o woman has a Hx of taking DES (Diethylstilbestrol) to prevent miscarriage in 1971 what does this put her at risk of
clear cell adenocarcinoma of vagina and cervix
Demographic risk factors for cervical neoplasia
Ethnicity (latin American, U.S. minorities)
Low socioeconomic status
increased age
Behavioral risk factors for cervical neoplasia
Early coitarche multiple sexual partners male partner w/multiple prior sexual partners tobacco smoking dietary deficiencies
Medical risk factors for cervical neoplasia
Cervical high-risk HPV Infx Exogenous hormones (combine hormonal contraceptive) parity immunosuppression inadequate screening
What is considered mild cervical dysplasia
Cervical Intrepithelial Neoplasia 1 (CIN 1)
abnormal cells confined to lower 1/3 of squamous epithelium
manifestation of HPV
(most regress after few years)
What is considered moderate cervical dysplasia
Cervical Intrepithelial Neoplasia 2 (CIN 2)
abnormal cells confined to middle 1/3 of squamous epithelium
mix of low and high grade
(~40% regress spontaneously w/in 2yrs)
What is considered Severe cervical dysplasia
Cervical Intrepithelial Neoplasia 3 (CIN 3)
abnormal cells confined to upper 1/3 of squamous epithelium
(risk of invasive cancer ~30% in 30yrs)
What is considered cervical carcinoma in situ
Full thickness involvement of cervix
What CIN is considered precancerous
moderate-severe (CIN 2 and 3)
what are the Low Risk HPV
6 / 11
visible genital warts, laryngeal papillomas, minority of subclinical HPV infx
(rarely oncogenic)
what are the High Risk HPV
Types: 16 (MC), 18 (2nd MC), 31, 33, 35, 45(3rd MC)
persistent HPV infx required –> cervical cancer
Pt w/ a HPV 16/18 leasion lasting >6months will develop what?
Squamous Intraepithelial Lesion (SIL)
When do you screen for HPV?
women >/= 30
triage / surveillance of certain cytology abnormalities
post-Tx surveillance
how often to complete pap screening in Pt <21
do not screen will likely clear infx
how often to complete pap screening in Pt 21-29
pap q 3 yrs
how often to complete pap screening in Pt 30-65
pap w/HPV (co-test) q 5yrs
pap alone q 3yrs
how often to complete pap screening in Pt >65
no screening needed if no Hx of cervical changes- 3 neg paps in a row; 2 neg co-test in 10 yrs w/most recent in 5yrs
Pap results return as ASC-US w/+HPV
Tx like LGSIL –> colposcopy
Pap results return as ASC-US w/-HPV or w/o co-testing
repeat pap in 1 year
if still abnormal after 1yr –> colpo
How to TX pregnant woman with pap results of ASC-US results
Tx as not pregnant
NO endocervical curette use or EMB
defer colpo until 6wks postpartum
biopsy only If high grade lesion
How to TX pregnant woman with pap results of ASC-H results
Do NOT defer colpo until postpartum
if you are unable to visualize entire transformation zone cant be seen w/colposcopy what should be done
LEEP (Loop electrosurgical excision procedure)
CKC (Cold Knife Cone)
what is considered a poor prognostic indicator of cervical cancer that is not included in clinical staging
Lymphovascular spread
Majority (70%) of all cervical cancers are what type and arise from where
Squamous Cell;
from ectocervix
Adenocarcinomas of the cervix are usually ______ and have a _______ prognosis compared to Squamous cell
mucinous adenocarcinoma;
worse prognosis
how to control abnormal bleeding w/cervical cancer
Monsel paste (ferric subsulfate) & vaginal packing
How may those w/cervical cancer present
watery/purulent/bloody discharge polypoid mass/papillary tissue/ barrel shaped cervix cervical ulceration/glandular mass necrotic tissue enlarged uterus lymphadenopathy (spread) Hydronephrosis (compressing ureters) Constipation
Tx of Cervical Cancer in pregnancy
early stages- may postpone TX until delivery
Advanced stages- Tx may lead to fetal losses
