Cervical Cancer and Screening
Terms in this set (39)
medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Colposcopy is used to pinpoint which areas to biopsy.
the most common type of abnormal Pap smear result. ASCUS is an acronym for atypical squamous cells of undetermined significance and indicates mild cellular cervical changes with an unknown cause.
Managing an ASUCS result
Adolescent Women (age 20 and younger): For young women with an ASCUS Pap smear result, the test is repeated in 12 months.
Adult Women: Adult women with an ASCUS Pap result will either have the Pap test repeated at 6 and 12 months or have a reflexive HPV DNA test. A reflexive HPV DNA test utilizes the sample used for the Pap smear and eliminates the need for another sampling. ASCCP guidelines favor HPV DNA testing for adult women with ASCUS Pap results.
An HPV DNA test is performed just like a Pap smear. The test detects the presence of a high risk HPV infection that could potentially lead to cervical pre-cancer or cancer if left unmonitored or untreated.
risk factor for cervical cancer
- increased # of pregnancies and births.
- early menarche is NOT a risk factor for cervical cancer (is a risk for endometrial cancer0
- early age of first intercourse ***
- high # of sexual partners during lifetime. ***
- Tobacco smoking
Epidemiology of cervical cancer
- 275,000 women die annually worldwide
- 1st or 2nd most common cause of CA deats among women in developing.
- In the US, a large majority of the cases have been prevented by regular screening (~60% of cases that occur in developed countries have not gotten regular screening)
DDx of vaginal bleeding
vulva/ vagina: endometriosis, atrophy (older pts), adenosis, trauma (chid), malignancy (excl mets)
cervix: polyp, endometriosis, cancer
uterine body:pregnancy related, leiomyoma, endometrial polyp, endometrial hyperplasia, malignancies
Adnexa: endometriosis, hormonally active tumor/cyst, ectopic
systemic: purpura, hemorrhagic diasthesis, iatrogenic (IUD, drugs, OCPs)
Early signs of invasive cervical cancer
Early: thin watery blood tinged dischare, often unrecognized by patient
classic: intermittent painless metrorrhagia (in b/w cycles so there is no physiological reason to see bleed) or spotting. Noticed only after douching or postcoital
Later: heavy bleeding, more frequent, lasts longer
Late signs of invasive cervical cancer
- leg or flank pain (ureter, pelvic wall, sciatic nerve roots)
- dysuria and hematuria (bladder)
- rectal bleeding and constipation
- distant metastases
- leg edema (vein and lymph nodes)
- uremia (involvement of ureter)
- massive vaginal bleeding.
Vaginal exams of invasive cervical cancer shows up in what 3 major types?
exophytic, deep infiltrating, ulcerative
Exophytic presentation of invasive cervical cancer
- most common
- large friable mass that bleeds on contact
- may involve endocervix, causing "barrel shaped" distended canal.
Deep infiltrating presentation of invasive cervical cancer
stony hard cervix, minimal ulceration
ulcerative presentation of invasive cervical cancer
- irregular ulcer that erodes the cervix
- forms a crater that can include the upper vagina
- more liable to be inflamed --> seropurulent discharge
Adenocarcinoma of the cervix
Also associated w/ HPV 16, 18.
How does an adenocarcinoma of the cervix present?
starts at endocervical canal and may be limited tot he canal or protrude from external os.
How do you Dx adenocarcinoma of cervix?
0 - in situ
1 - limited to uterus
2 - beyond uterus but not pelvic wall or lower vagina
3 - To wall, lower vagina, hydronephrosis
4 - metastasis to distant structures
FIGO stage 1
IA1: 3mm depth, 7 mm horizontal
IA2: 3-5 mm deep, 7 mm horizontal
IB1: clinically visible 4 cm diameter or more than IA2
IB2: clinically visible >4cm diameter
FIGO stage 2
IIA: w/o parametrial invasion
IIB: parametrial invasion
FIGO stage 3
IIIA: lower 1/3 vagina only
IIIB: pelvic wall or hydronephrosis or nonfunctioning kidney
FIGO stage 4
IVA: mucosa of bladder or rectum or beyond true pelvis
IVB: distant metastasis
Managing carcinoma at FIGO stage 0
conization check margins
Managing carcinoma at FIGO IA1
Conization if margins clear (preserve fertility), trachelctomy or hysterectomy w/ node dissection
Managing carcinoma at FIGO IB1, 2 & IIA
Radical hysterectomy and node dissection or chemo/ radiation
Managing carcinoma at FIGO IIB - IVA
most prevalent STD worldwide
High risk HPV genotypes are linked to what cancers?
cervix, vulva, vagina, anus, penis, head/ neck
16,18 implicated in 70% of cervical cancer, types 6,11 in 80% of condyloma
What percentage of sexually active adults acquire genital HPV before age of 50?
What percentage of HPV infections get cleared in 1 year?
How long does high risk HPV serotypes take to develop into cervical cancer?
quaravalent (Gardasil): types 6,11, 16, 18
divalent (cervarix): 16,18
3 doses administered at 0-1-6 months
How effective is the HPV vaccination
100% effective in preventing infection for at least 5 years in patients who were 16,18 naive 1 month after first dose
Who and when should the HPV vaccine be administered?
prior to potential exposure to HPV through intercourse; benefit is likely to diminish w/ increasing # of lifetime partners.
Guidelines for cervical cancer screening: below 21 y/o
Guidelines for cervical cancer screening: 21- 29
cytology alone every 3 y
Guidelines for cervical cancer screening: 30-65 y/o
preferred: HPV and cytology co-testing every 5 years
acceptable: cytology alone every 3 years
screening by HPV testing alone is not recommended.
Guidelines for cervical cancer screening: >65 y/o
No screening after adequate negative prior screening
women w/ history of CIN 2/3, AIS or cancer should continue age- based screening for at least 20 years
Guidelines for cervical cancer screening: hysterectomized patient
no screening necessary if no cervix and no history of CIN2/3, AIS or cancer in past 20 years
Guidelines for cervical cancer screening: HPV vaccinated
same age- specific recommendations as unvaccinated women
What are the limits for HPV vaccination?
insufficient data for efficacy of vaccine in women >26 years old. women should get vaccination prior to sexual activity.
males: 11-21. limited data beyond that.