EXAM #1: CERVICAL DYSPLASIA Flashcards
What is the goal of screening for cervical carcinoma?
Catch dysplasia (CIN) before it develops into carcinoma
What screening for cervical dysplasia is recommended?
- Pap smear is gold standard
* Must include the transformation zone
When should screening for cervical dysplasia begin?
21 y/o (regardless of sexual history)
How often should screening with pap smear be performed for a woman that is 21-29 y/o?
Every 3 years
What is the screening recommendation for woman that are 30-65 y/o?
- Pap smear (cytology) + HPV testing Q5 years
- Pap smear alone Q3 years
When should you start screening a woman that is HIV positive?
At time of diagnosis even if less than 21 y/o
When should you start screening a woman that is immunocompromised e.g. s/p solid organ transplant?
21 y/o
How long should a woman that has CIN 2, 3 or cervical carcinoma continue screening?
Annually for 20 years even if older than 65
When should screening stop?
- Woman older than 65 with negative CIN 2+
- S/p hysterectomy
What should an abnormal pap smear be followed by?
1) Confirmatory colposcopy (visualization of the cervix with magnifying glass)
2) Biopsy
What can be added to colposcopy to improved visualization?
Acetic acid
How are more advanced changes confirmed with colposcopy and biopsy treated?
1) Cryotherapy
2) Excisional via “LEEP” i.e. loop electrocautery*
3) Cone biopsy
*Can cause long-term cervical complications
What is the most common subtype of cervical carcinoma?
Squamous cell carcinoma
What subtype of cervical carcinoma accounts for the minority of cases?
Adenocarcinoma
How does SCC compare to adenocarcinoma clinically?
1) Adenocarcinoma is more aggressive
2) Associated with “skip lesions”
What are the clinical manifestations of cervical carcinoma?
Early stages are asymptomatic but symptoms of more advanced cases include:
- Vaginal bleeding
- Postcoital bleeding
- Cervical discharge
- Malodrous
How does cervical carcinoma spread?
1) Local invasion/ direct extension
2) Lymphatic
What are the advanced complications of cervical carcinoma?
1) Extension through the anterior uterine wall to the bladder –blocking the ureters
2) Hydronephorosis
3) Postrenal failure
*Can also cause venous blockage and resulting unilateral edema
What is the first lymph node that will be affected by cervical carcinoma?
Paracervical
How is cervical carcinoma staged?
Clinically
What is indicated for the pre-treatment evaluation of cervical carcinoma?
1) Physical examine
2) Routine blood work
3) CXR
4) IVP i.e. intravenous pyelogram (evaluation of ureter flow)
What is the treatment for Stage 1A1 carcinoma?
Cold-knife biopsy or hysterectomy
*Low risk of pelvic node involvement
What is the treatment for Stage 1A2 carcinoma?
Radical hysterectomy
*15% risk of pelvic node involvement
What is the treatment for Stage 2, 3, and 4 carcinoma?
Radiation and chemotherapy
What is a radical hysterectomy?
- Resection of the uterus and cervix
- Resection of the upper 2/3 of the vagina
- Resection of the pelvic side wall
- Pelvic node dissection
- Sampling of aortic nodes
What is Brachytherapy?
Intracavity radiation
How is HPV prevented?
Vaccination– 9 valent recent approved
*Must be given before sexually active AND pap-smears still indicated
