Cervical Neoplasia and Cervical Cancer Flashcards
How is severity of cervical intraepithelial neoplasia determined?
Portion of epithelium showing disordered growth and development
Starts at the basal layer and expands
CIN I, II, III based on how many 1/3s the epithelium is disordered
When does CIN most commonly occur?
During menarche and after pregnancy
What is the primary causative agent in CIN and cervical cancer?
HPV
What are low-risk HPV strains?
6 and 11, causes condylomas
What are high-risk HPV strains?
16, 18, 31, and 45
What are the current guidelines for cervical cancer screening?
Start at age 21 regardless of risk factors
Pap every 3 years from 21-29
Co testing at age 30+ and every 5 years if negative
Stop at age 65-70
In patients with ACS-US (undertermined), what is the next management?
Reflex HPV testing to determine whether colposcopy is needed
In patients with ACS-H or higher, what should be done next?
Proceed directly to colposcopy because HPV testing will invariably be high risk
What changes can be seen in cervical lesions on colposcopy biopsy?
Acetowhite epithelium, mosaicism, punctuations, atypical vessels
What are the treatment for CIN I, II, and III lesions?
CIN I = repeat pap every 6 mo for 1 year, or repeat HPC testing in 1 year, LEEP if abnormal
CIN II = LEEP or pap/colpo every 6 mo for 2 years
CIN III = LEEP
What is follow-up care after LEEP?
Repeat pap every 6 mo for 1 year, or pap/colpo 1 year after
if normal, then return to routine screening for at least 20 years
What is the most common type of cervical cancer?
Squamous cell carcinoma (80%)
adenocarcinoma (20%)
What is the most common symptom of SCC?
Postcoital bleeding
How to diagnose SCC?
Biopsy
How is cervical cancer staged?
Clinically, based on invasion into adjacent structures
Stage 1 = confined to cervix
Stage II = beyond cervix but not to pelvic side wall (with bulky disease)
Stage III = to pelvic sidewall or lower 1/3 vagina
Stage IV = extension beyond pelvis or invasion into local structures
