Chap. 17: Screening in gynecological oncology Flashcards
Par. I: General part of ginecological sreening
prevention, five phases
Par. I: General
Prevention
First, as a preliminary observation, it should be remembered as the evolution of a tumor
can stand out in five phases:
• Debut biological
• Initial phase or not invasive
• Phase invasive localized
• Phase invasive locoregional
• Phase invasive remote
Prevention is the set of measures to:
Prevention is the set of measures to:
• Avoid the onset of the disease: primary prevention
or Target (T): elimination of the causes
or conditions for the application (CA): known causes and avoidable
• Recognize in asymptomatic phase: secondary prevention
or T: discovery of the disease in asymptomatic phase through the administration of test
laboratory and / or instrumental (PAP-test, mammography):
Pre-clinical diagnosis: do before the onset of clinical disease and identifies the disease in its early onset of biological Early diagnosis (see later) is to recognize the disease in phase initial (or phase noninvasive)
or CA: This must be a stage when the disease is asymptomatic, and alterations functional and / or structural detectable with common diagnostic tests
• Treat with the aim to reduce complications (in gynecology the concept of complication goes
extended to recurrence and metachronous tumors): Tertiary prevention or T: prevention of complications
or CA: must be available therapy can reduce the number and extent of complications
Any prevention policy rests on two pillars:
Any prevention policy rests on two pillars:
• About habits (lifestyle, eating habits), risk factors and screening methods or
early diagnosis
• Systematic Application of these methods in the population (screening) or individuals
(Early diagnosis):
or Screening: procedure organized in the territory, enabling identification of a disease or a specific condition in apparently healthy individuals or Early diagnosis: procedure performed on asymptomatic individuals who go at health centers for medical checks
Par. II: Prevention of cervical cancer
Main Features
pap test, risk factors
Main Features
The introduction of the PAP test has led to a significant decrease in the incidence and mortality of
invasive carcinoma.
Risk factors for its occurrence are:
• Early Sexual Activity
• High number of sexual partners
• multiparity
• Before pregnancy and childbirth at an early age
• Tobacco smoke
• Infection with HPV aggressive (16, 18, 31, 33)
• Failure to control: the screening is to not make a major risk factor,
Whereas in the early stages the symptoms are absent
Screening methods
pap test
execution
who runs it
Pap test: is the examination of the first level, to be made to coincide with the onset of sexual intercourse or but no later than 25 years. The test involves taking skin cells exfoliated and is based on the principle that cancer cells lose the cohesion between them for the destruction of desmosomes and exfoliate more abundantly:
Execution
Place the patient in gynecological position
It introduces a speculum into the vagina, highlighting the cervix
We carry two samples
• In correspondence dell’esocervice (as close as possible to the junction
squamocolumnar) with a wooden spatula (Ayre spatula)
• At endocervix by citobrush with cottono fiock
They crawl exfoliated epithelial cells on a slide, in which are fixed with
alcohol or with a mixture of alcohol-ether (in the absence of fixation would be altered and
could no longer be read)
Is colored smear staining with Papanicolaou
It is observed the prepared optical microscope
or Who runs it: being very simple, can be performed not only by the specialist, but also by a midwife or a GP competent
pap test. features, classifications.
or Features:
Rapidity
Easiness
Absence of pain
Low cost
or classifications
Papanicolaou (easier, but almost completely outdated)
• I: smear clearly benign (normal)
• II: smear with minimal cellular abnormalities (inflammatory)
• III: smear with cellular abnormalities, but not neoplastic (atypical)
• IV: smear probably neoplastic
• V: smear frankly malignant (positive for cancer)
pap test. bethesda. classification.
Bethesda
• Normal
• Normal with reactive changes (inflammatory)
• SIL (squamous intraepithelial lesion) Low grade: CIN (neoplasia cervical intraepithelial) 1 or mild dysplasia (affects the lower 1/3 epithelium)
• high-grade SIL
or CIN 2 or moderate dysplasia: affects less than 2/3
or CIN 3 or severe dysplasia: affects the epithelium full thickness, but without exceeding the basement membrane (carcinoma in situ)
• Squamous cell carcinoma: the cells are of squamous simple
• Adenocarcinoma: the cells of glandular type (cylindrical)
• ASCUS: atypical squamous cells of undetermined significance
• AGCUS: atypical glandular cells of undetermined significance: in about 2/3 cases, the repeat testing after 2-3 months ASCUS and not AGCUS are no longer present; in the remaining third of the cases evolve to SIL or
carcinomas
woman general screening. colposcopy. definition and 1/3 execution of it
Colposcopy is the examination of the cervix and vagina with a speculum particular (Colposcope), which provides excellent lighting, a three-dimensional view and a magnification up to 40 times. For carcinoma of the cervix is an examination of the second level or Execution It puts the woman in gynecological position
It introduces the speculum
First time of investigation: examination of the cervix to “panoramic magnification”
(Ie 6-12 times). Also, remove any excess mucus and cleansed the cervix with saline, we study the epithelial angioarchitettura. It is good
notice how the speculum might be introduced until the initial part endocervix:
Therefore, a major limitation of colposcopy is given precisely by the impossibility of
explore the cervical canal and to explore lesions partially or totally
endocervical.
woman general screening. colposcopy. 2/3 execution of it
Second Half survey: observation of the cervix after application of a
solution of acetic acid at 3-5%: this determines the swelling of the tissues, and
particularly the papillae of the glandular mucosa endocervix (which
take on a papillary villous “in grape”), allowing you to
highlight the squamous columnar junction. The acetic acid, in fact, acts on epithelia,
making them swollen and changing its color (pink in the case of normal mucosa,
pearly-white for thickened mucosa) and is more active on abnormal epithelia and thickened.
The effect of acetic acid depends on the amount of nuclear proteins present:
Therefore, the abnormal epithelium, for its higher nuclear density and for the
greatest concentration of nuclear proteins, meets at most
clumping, assuming a more or less colorful background. If atypia involves
crypts pseudoghiandolari cervical canal, you will notice whitish circles
around the orifices of the pseudoghiandole
woman general screening. colposcopy. 3/3 execution of it
Third time survey: observation cervica after application of solution Lugol’s iodine (Schiller test): while the normal squamous epithelium is rich glycogen that binds to the iodine solution, coloring itself in dark brown, the endocervical columnar epithelium and the abnormal, lacking glycogen,
remain unstained
general prevention. purpose of colposcopy.
Purpose: is to evaluate the location and extent of cervical lesions and allow
a biopsy accurate, that may be associated with:
Curettage (scraping endocervical)
Cone biopsy (removal of an entire cone of tissue from the cervix) is
performs in the event of:
• Whole area of transformation is not clearly visible to the colposcope
• Ascent of the colposcopic atypical in the cervical canal beyond the limits of
vision
• Area colposcopic atypical widespread
• Evidence of microinvasion
• Evidence of malignant characteristics in endocervical curettage but not
colposcopic observation
general prevention. probes DNA of biopses
• Probes DNA of biopsies for the diagnosis of cervical infection with HPV types are defined
Virus
Par. III: Screening of endometrial cancer
Main Features
risk factors
Main Features
Predominantly affects postmenopausal women, with a peak incidence around 65 years of age.
Presents:
Risk factors
- or Obesity
- or Hypertension
- or DM
- or nulliparity
Par. III: Screening of endometrial cancer
classification
Main Features
pathology
Pathology: develops cylindrical epithelium lining the lumen of the uterine body and is,
in 90% of cases, represented dall’adenocarcinoma. Is classified according to the degree of
differentiation and proliferation of glandular:
- or G1: well-differentiated
- or G2: moderately differentiated areas with partially solid
- or G3: undifferentiated with predominance of solid areas
Par. III: Screening of endometrial cancer
Main Features
Hormonal considerations
Hormonal considerations
- or The pill is considered a protective factor, as it prevents the endometrial proliferation
- or Hormone replacement therapy in menopause does not increase the risk: in fact, the progestin
- induces the collapse of the endometrium and hinders growth
- or the use of tamoxifen in breast cancer increases the risk of cancer
- endometrium: in fact, these antiestrogenic has a role in the antiproliferative level
- breast, but a role in stimulating the proliferation in the endometrium
