preinvasive and early invasive cervical lesions Flashcards
what is the normal cervix anatomy
4cm in length (pinky size)
external cervical os is 1 cm in diameter
origin of pap smear
dr papanikolau did smears of his wife’s cervix every day and compared it to other women with cervical cancer
epidemiology of cervical cancer
incidence has increased d/2 general increase in promiscuity
mortality has reduced d/2 early dg from pap smears
3rd most common cancer in women after ovarian and endometrial
why is the hpv vacc (Gardasil) given in adolescence
optimum response of the vaccine occurs oin adolescent years
when is CIS dg vs when cervical cancer
CIS: 25
cervical cancer: 52
how is a sample from the endo cervix taken
brush through the opening into the canal
how is a sample from the exocervix taken
with a spatula
when is the first pap smear taken
21 years of age is the first pap smear
cytology only
how often should pap smears be taken
every 3 years after the first if the results are normal
until 30
routine pap smear for ages 30 - 65
pap smear every 3 years
if additional hpv testing is done the next pap is in 5 years
routine pap smear for 65y/o
discontinued IF
- never had an abrnormal pap smear
- rx from CIN 2+ was over 20 years ago
routine paps for hysterectomy pts
discontinue paps IF
- hysterectomy was not done d/2 cancer
- no abnormal pap in 2o years
which women are advised to continue paps
Women w/ RF for cervical cancer e.g.
- immunocomp/HIV
- exposure to Diethylstilbestrol in utero
- chronic steroid use
list the abnormal cytology results from pap smears
(intraepithelial lesions)
- ASCUS (atypical sq cells of undetermined sig)
- LSIL (low grade sq intraepi lesion)
- ASCH (atypical sq cells, can’t exclude HSIL)
- HSIL ( high grade sq intraepi lesion)
- AGC (atypical glandular cells)
what does ASCUS MEAN
abnormal cells on cytology but unsure about what they are
- HPV test is done
- colposcopy done ONLY IF high risk hpv found
what is LSIL
CIN 1
- hpv testing
- colposcopy
what is ASC-H
- ominous looking cell but HSIL not confirmed
COLPOSCOPY is mandatory
what does it mean if you get HSIL
CIN2/CIN3 LIKLEY
- colposcopy mandartory
- if fertility isn’t wanted then LEEP
atypical glandular cells
suggests abnormalities in the uterus
how to take biopsy during colposcopy
apply acetic acid and look for abnormal staining in the transitional zone
- area’s that stain white
- cobble stone / mosaic looking areas
- punctated vessels
- abnormal vessel geography
- hair pin loops
- non tree like
how are biopsies taken in during colposcopy
Conization
- Procedure: excision of a cone of cervical tissue that contains parts of both the ectocervix and endocervix
- performed using a cold knife, electrosurgical loop (LEEP), or a laser
- Premenopausal: transformation zone biopsy from ectocervix → shallow cone
- Postmenopausal: transformation zone biosy from endocervix → deep cone
side effects of Conization
- Intraoperative or postoperative bleeding
- Cervical stenosis causing infertility
- Cervical insufficiency during pregnancy
- Infection, uterine perforation
why do we need biopsy
tells the depth of the lesion
determines the therapeutric action
how do dysplastic cells appear
Ovoid, eccentric and larger nuclei
what is CIN 1
bethseda: LSIL
- Epithelial architecture mostly intact
- mitotic figures in lower third of the epithelium
- Koilocytes may be present
what is CIN II
- bethseda
- LSIL: w/o hpv16
- HSIL: w/ HPV 16
- Loss of epithelial architecture into as far as the middle third or 2/3of the epithelium
- Koilocytes may be present.
what is CIN III
Bethseda: HSIL
- Complete loss of organized epithelial architecture
- Irregular nuclei and mitotic figures can be found throughout all epithelial layers.
- Basal membrane is still intact.
Koilocytes may be present.
what is CIS
complete loss of all normal architecture
abnormal cells reach up to basement membrane w/o penetration
therapeutic steps with CIN1
repeat pap + HPV testingin 1 year
(gives body a chance for self resolution)
- normal results: routine pap in 3 years
- abnormal results for either: repeat colposcopy and biopsy
procedures for CINI-III
surgical resection w/
- leep
- cryo
what is LEEP
loop electrical excision provedure
- thins the functional cervix
- different from biopsy as a larger amount of the cervix is removed for rx
- further biopsy may be done to ensure clear margins
natural progression of CIN 1 lesions
CIN I
- 60% Regress spontaneously
- 30% persist
- 10% progress to CIN IIi
- LESS THAN 1% become canceroues
natural progression of CIN II lesions
40% regress
35% persist
20% CIN III
5% cervical cancer
CIN III progression
30% regress
50% stay CIN III
12-22% cervical cancer
