Reproductive Aged Cervical cancer is caused by the Human Papilloma Virus. Its carried in asymptomatic males and infects a woman during sex. While not all cervical cancer is HPV related, for our purposes its 11 Menses + Sex 51 Virus stays with her, ok to assume it is. Therefore, it occurs in sexually active females. risk never ends HPV causes an infection of the cervical mucosa, transforming the cells of the cervix through inflammation. The cells with a nucleus are located at the basement membrane; this is where cells will be first transformed (CIN I). As cancerous cells grow and fill the epithelial layer (Carcinoma In-Situ) they eventually penetrate the basement membrane and become full blown cancer. HPV causes cancer (subtypes 16, 18, 30s, 45) and genital warts (subtypes 6, 11). Risk factors are number of sexual partners, HPV, Endocervical smoking, and history of STDs. Carcinoma CIN I CIN III Ectocervical Symptoms and Patient Presentation Dysplasia Carcinoma In situ Carcinoma Asymptomatic screening is the preferred method of diagnosis. Screening is with Pap Smears (start 21, stop 65). In any patient 16,18,45 HPV Dysplasia/CIS Squamous Cell who has post-coital bleeding, consider cervical cancer. Do a pelvic and stage staging is clinical, not by imaging. In a post- h/o sex partners pap smear q1y surgery or menopausal woman, its likely secondary to vaginal atrophy. That other STDs, HPV chemo said, all women who bleed after sex deserve a pelvic (and soon.) smoking (LSIL) (HSIL) (Cancer) Diagnosis and Treatment If a mass is identified on exam the diagnosis is made by biopsy of that mass. The patient must then be staged. Cervical cancer is Stage IV the only cancer that is clinically staged rather than surgically a- Bowel/Bladder b- Distant Mets colpo, rectal, vaginal exams. The further down the vagina the Ia: Microscopic higher the grade. B classification denotes involvement of the Ib: Macroscopic cardinal ligament or the pelvic sidewall. Involvement of the IIa: 2/3 vagina bowel, bladder, or distant mets makes it stage 4. In addition to the Stage I IIb: Parametrial physical a CT scan can be used to stage. Cancers that are IIa or IIIa: 1/3 vagina better are cured surgically. Cancers that are IIb or worse are III b IIb IIIb: Sidewall treated with debulking and chemo. Stage II a IVa: Adj Organs IVb: distant mets Screening
Stage III a The most high-yield topic for cervical cancer is screening. A woman should receive a pap annually starting at 21 years old (regardless of when she began having sex). If theres ever an abnormal pap (other than ASCUS) do a reflexive colposcopy. From the colpo we get a sampling of two things: ectocervical biopsy and endocervical curettage. If Ecto and Endo the Asx Screen problem is on the outside of the cervix and a local destruction can be done: LEEP, Cryo or laser. If the Ecto and the Endo or couldnt be sampled, it must be assumed its in the endocervix; ASCUS Anything but ASCUS or Pap Smear a normal pap a cone biopsy is required. Both local destruction and cone biopsy are curative. If the original pap showed ASCUS, dont do a colpo. Either repeat the pap q3month to watch for resolution or do an HPV DNA to confirm its high risk HPV. If the patient is ASCUS Abnormal pregnant a colpo or cone biopsy may harm the pregnancy - it can be deferred until after delivery (preferred 6 weeks postpartum). Remember, it takes 3-7 years to develop cancer from precancer, Colpo so 9 months of pregnancy wont make a huge difference. Repeat at 6 HPV DNA months Prevention Everyone (including males) should get the HPV vaccine. A hard ASCUS and HPV + Colpo yes is recommended for females 13-26 + males 12-21. Some say ASCUS and HPV - q3y Ectocervix Endocervix as early as 9 (for boys and girls) and as late as 26 (for men). The ASCUS and + repeatColpo Only + Ecto CDC recs starting @ 11; the key is before theyre sexually active. ASCUS and repeat q3y Local Cone Destruction (LEEP, Cryo)
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