screening for cervical disease age 21-29
cytology alone q 3 years
no HPV testing
screening for cervical disease age 30-65
HPV & cytology q 5 years
indications for yearly screening for cervical disease (4)
immunocompromised
CIN 2/3
hx cervical CA
HIV +
HIV+ cervical disease screenings
cytology 2x in the year after diagnosis
annually thereafter
what cytology finding is consistent w/ CIN 1
low-grade squamous intraepithelial lesion (LSIL)
LSIL + HPV –>
LSIL w/o HPV –>
colposcopy
repeat cotesting at 1 year
cytology finding consistent w/ CIN 2/3
high-grade squamous intraepithelial lesion (HSIL)
CIN 1
lower 1/3 of epithelium
lesions typically regress in 12 mo
CIN 2
lower 2/3 of epithelium
about 50% regress
22% progress to CIN 3
few increase to invasive cancer
CIN 3
involves > 2/3 of the epithelial thickness
up to 40% progress to invasive cancer
goal of colposcopy
& if not achieved?
complete visualization of the transformation zone
incomplete visualization –> endocervical curettage
high risk & low risk HPV
high: 16,18
low: 6, 11
ablative method goal & indications (3)
destroys TZ, no specimen collection
persistent CIN > 2 years
CIN 2,3 w/ adequate colposcopy
no suspicion for invasive or endocervical disease
ablative methods (2) and healing time
cryothrapy
laser
4-8 weeks
excision treatment goals & indications
removes entire TZ, provides a diagnostic specimen
inadequate colposcopy
high grade lesions/atypical glandular cells
CIN 2+ or recurrent CIN 2,3
excision methods (2) and healing time
cold knife conization
loop (LEEP)- more common
1-2 weeks
which cervical disease treatment method has higher risk of adverse obstetric outcomes
excision
precursor to cervical adenocarcinoma
adenocarcinoma in situ
adenocarcinoma in situ presentation
lesions may be high in endocervical canal, “skip lesions”
may be asymptomatic & not visible on gross exam
adenocarcinoma in situ diagnostics & treatment
cervical biopsy
cold knife conization
cervical cancer types (2) most common
squamous cell
adenocarcinoma
cervical cancer follow up? (4)
q 4 mo. x 2 years
q 6 mo. until year 5
annual PAP
annual CXR until year 5
uterine fibroids characteristics (4)
most common pelvic tumor
most common indication for hysterectomy
reproductive age pts
estrogen responsive
pelvic pressure/pain, increased/irregular menses, infertility, spontaneous abortion
uterine fibroids
which uterine fibroids are assoc. w/ increased menstrual bleeding
submucosal
postmenopausal pts w/ enlarging uterine masses, PMB, pelvic pain, unusual discharge
uterine sarcoma
chronic estrogen dependent disorders during reproductive years (2)
uterine fibroids
endometriosis
most commonly affected site of endometriosis
ovaries
dysmenorrhea (1-2 days before menses, starting several years after menarche), abd/pelvic pain, dyspareunia, menorrhagia, bowel/bladder sx, LBP, fatigue
endometriosis
endometriosis PE findings (3)
tender posterior vaginal fornix
localized tenderness & nodules in posterior cul-de-sac (pouch of Douglas)
adenexal masses or tenderness (chocolate cysts)
definitive endometriosis diagnostic
laparoscopy & biopsy
1st line tx endometriosis
NSAIDs
type 1 endometrial CA (4)
estrogen dependent
majority
caused by excess estrogen unopposed by progesterone
better prognosis
type 2 endometrial cancer (3)
estrogen independent
seen with endometrial atrophy
poor prognosis
most common site & type of uterine CA
endometrial adenocarcinoma
abn bleeding, pelvic discomfort/pressure, back pain, wt loss, dyspareunia
endometrial cancer
