Cervical dysplasia


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Cervical dysplasia

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Cervical dysplasia

  1. 1. Cervical dysplasia …………………………………
  2. 2. Definition O Cervical dysplasia refers to the presence of precancerous changes of the cells that make up the inner lining of the cervix, the opening to the womb (uterus). O The term dysplasia refers to the abnormal appearance of the cells when viewed under the microscope. The degree and extent of abnormality seen on a tissue sample (such as a Pap smear) was formerly referred to as mild, moderate, or severe dysplasia.
  3. 3. The 2 new systems for studying the cervical dysplasia :. O (cytological system ): Squamous intraepithelial lesion is the pathology terminology for cervical dysplasia observed in smears of cells taken from the cervix. Squamous refers to the type of cell that lines the cervix. intraepithelial refers to the fact that these cells are present in the lining tissue of the cervix. O (histological system ): Cervical intraepithelial neoplasia is cervical dysplasia that is observed on a cervical biopsy or surgically removed cervix.
  4. 4. Cervical intraepithelial neoplasia
  5. 5. The causes : O Cervical dysplasia is caused by infection of the cervix with the human papillomavirus (HPV). Although there are over 100 HPV types, a subgroup of HPVs have been found to infect the lining cells of the genital and reproductive tract in women. HPV is a very common infection and is transmitted through sexual contact; , it is possible to become re-infected with a different HPV type. O Factors that may influence persistence of the infection include: O advancing age, O duration of the infection, being infected with a "high- risk" HPV type).
  6. 6. O Among the HPVs that infect the genital tract, certain types typically cause warts or mild dysplasia ("low-risk" types; HPV-6, HPV-11), while other types (known as "high-risk" HPV types) are more strongly associated with severe dysplasia and cervical cancer (HPV- 16, HPV-18). Cigarette smoking and suppression of the immune system (such as with concurrent HIV infection) have been shown to increase the risk for HPV-induced dysplasia and cancer of the cervix. O The HPV types that cause cervical cancer also have been linked with both anal and penile cancer in men as well as a subgroup of head and neck cancers in both women and men.
  7. 7. Risk factor : O In women, an increased risk of a persistent HPV infection is associated with: O Early initiation of sexual activity. O Having multiple sex partners. O Having a partner who has had multiple sex partners. O Having sex with an uncircumcised man.
  8. 8. Signs or symptoms : O Typically, cervical dysplasia does not produce any signs or symptoms. So regular screening is important for early diagnosis and treatmen
  9. 9. Diagnosis O Because a pelvic exam is usually normal in women with cervical dysplasia, a Pap test is necessary to diagnose the condition. O Although a Pap test alone can identify mild, moderate, or severe cervical dysplasia, further tests are often required to determine appropriate follow-up and treatment. These include: O Repeat Pap tests. O Colposcopy, a magnified exam of the cervix to detect abnormal cells so that biopsies can be taken. O Endocervical curettage, a procedure to check for abnormal cells in the cervical canal. O Cone biopsy or loop electrosurgical excision procedure (LEEP), which are performed to rule out invasive cancer. During a cone biopsy, the doctor removes a cone-shaped piece of tissue for lab examination. During LEEP, the doctor cuts out abnormal tissue with a thin, low-voltage electrified wire loop. O HPV DNA test, which can identify the HPV strains which are known to cause cervical cancer.
  10. 10. Classification / cytologic O Cytological analysis : by pap smear O ASC-US: This abbreviation stands for atypical squamous cells of undetermined significance. The word "squamous" describes the thin, flat cells that lie on the surface of the cervix. One of two choices are added at the end of ASC: ASC-US, which means undetermined significance, or ASC-H, which means cannot exclude HSIL . O LSIL: This abbreviation stands for low-grade squamous intraepithelial lesion. This means changes characteristic of mild dysplasia are observed in the cervical cells. O HSIL: This abbreviation stands for high-grade squamous intraepithelial lesion. And refers to the fact that cells with a severe degree of dysplasia are seen.
  11. 11. Classification / histological O Histologic analysis (cervical biopsies): O CIN 1 refers to the presence of dysplasia confined to the basal third of the cervical lining, or epithelium (formerly called mild dysplasia). This is considered to be a low-grade lesion. O CIN 2 is considered to be a high-grade lesion. It refers to dysplastic cellular changes confined to the basal two-thirds of the lining tissue (formerly called moderate dysplasia). O CIN 3 is also a high grade lesion. It refers to precancerous changes in the cells encompassing greater than two-thirds of the cervical lining thickness, including full- thickness lesions that were formerly referred to as severe dysplasia and carcinoma in situ. O CIN (cervical intraepithelial neoplasia )
  12. 12. Mild dysplasia
  13. 13. Moderate dyplasia
  14. 14. Cervical CA.
  15. 15. Colposcopy
  16. 16. Cervical CA
  17. 17. Cervical lesion
  18. 18. Treatment O Most women with low grade (mild) dysplasia (LGSIL, CIN1) (when the diagnosis is confirmed and all abnormal areas have been visualized), will undergo spontaneous regression of the mild dysplasia without treatment. Therefore, monitoring without specific treatment is often indicated in this group. Treatment is appropriate for women with high-grade cervical dysplasia. O Treatments for cervical dysplasia fall into two general categories: destruction (ablation) of the abnormal area and removal (resection). Both types of treatment are equally effective. Generally, destruction (ablation) procedures are used for milder dysplasia and removal (resection) is recommended for more severe dysplasia or cancer. O The destruction (ablation) procedures are carbon dioxide laser photoablation and cryocautery. The removal (resection) procedures are loop electrosurgical excision procedure (LEEP), cold knife conization, and hysterectomy. Treatment for dysplasia or cancer is not usually done at the time of the initial colposcopy, since the treatment depends on the analysis of the biopsies done during colposcopy.
  19. 19. Carbon dioxide laser photoablation O This procedure, which is also known as CO2 laser, uses an invisible beam of infrared light to essentially vaporize the abnormal area. A local anesthetic is given to numb the area prior to the laser treatment. A substantial amount of clear vaginal discharge and spotting of blood can occur for a few weeks after the procedure. The complication rate of this procedure is very low, about 1%. The most common complications are narrowing (stenosis) of the cervical opening and delayed bleeding. Disadvantages of this treatment include that this procedure does not allow sampling of the abnormal area and is not satisfactory for treating cervical cancer. It is useful, however, for milder dysplasia
  20. 20. Cryocautery O Like the laser treatment, cryocautery is an ablation therapy. It uses nitrous oxide to freeze the abnormal area. This technique, however, is not optimal for large areas or areas where abnormalities are already advanced or severe. After the procedure, women may experience a significant watery vaginal discharge for several weeks. As with laser ablation, significant complications of this procedure are rare and occur in about 1% of patients. They include narrowing (stenosis) of the cervix and delayed bleeding. Cryocautery also does not allow sampling of the abnormal area and is generally felt to be inappropriate for women with advanced cervical disease. Thus, this procedure is not satisfactory for treating cervical cancer, but is useful for milder dysplasia.
  21. 21. Cryocautery
  22. 22. Loop electrosurgical excision procedure O Loop electrosurgical excision procedure, also known as LEEP, is an inexpensive, simple technique that uses a radio-frequency current to remove abnormal areas. It has an advantage over the destructive techniques in that an intact tissue sample for analysis can be obtained. Vaginal discharge and spotting commonly occur after this procedure. Complications occur in about 1% to 2% of women undergoing LEEP, and include cervical narrowing (stenosis) and bleeding. This procedure is used most commonly for treating dysplasia, including severe dysplasia.
  23. 23. LEEP
  24. 24. Cold knife cone biopsy (conization) O Cone biopsy (conization) was once the primary procedure used to treat cervical dysplasia, but the other methods have now replaced it for this purpose. However, when a physician cannot view the entire area that needs to be seen during colposcopy, a cone biopsy is typically recommended. It is also recommended if additional tissue sampling is needed to obtain more information regarding the diagnosis. This technique allows the size and shape of the sampling to be tailored. Cone biopsy has a slightly higher risk of cervical complications than the other treatments, and these can include postoperative bleeding in 5% of women and narrowing of the cervix.
  25. 25. Cold knife cone biopsy (conization)
  26. 26. Hysterectomy O Hysterectomy is the surgical removal of the uterus. This operation is used to treat virtually all cases of invasive cervical cancer. Sometimes, a hysterectomy is done to treat severe dysplasia. It may also be used if dysplasia recurs after any of the other treatment procedures
  27. 27. Hysterectomy
  28. 28. Prognosis O Low-grade cervical dysplasia (LGSIL and/or CIN1) often spontaneously resolves without treatment, but careful monitoring and follow-up testing is required. Both ablation and resection of areas of cervical dysplasia cure approximately 90% of women with dysplasia, meaning that 10% of women will have a recurrence of their abnormality after treatment, requiring additional treatment. When untreated, high grade cervical dysplasia may progress to cervical cancer over time. Resection and ablation therapies have been shown to reduce the risk of developing cervical cancer by 95% in the first eight years after treatment in women with high grade dysplasia.
  29. 29. prevention O A vaccine is available against four common HPV types associated with the development of dysplasia and cervical cancer. This vaccine (Gardasil) has received FDA approval for use in women between 9 and 26 years of age and confers immunity against HPV types 6, 11, 16 and 18. O Abstinence from sexual activity can prevent the spread of HPVs that are transmitted via sexual contact. However, some researchers believe that HPV infection might be transmitted from the mother to infant in the birth canal, since some studies have identified genital HPV infection in populations of young children and cloistered nuns. Hand-genital and oral-genital transmission of HPV has also been documented and is another means of transmission. O HPV is transmitted by direct genital contact. The virus is not found in or spread by bodily fluids, and HPV is not found in blood or organs harvested for transplantation. Condom use seems to decrease the risk of transmission of HPV during sexual activity but does not completely prevent HPV infection. Spermicides and hormonal birth control methods do not prevent the spread of HPV infection.
  30. 30. CASE : The patient said that she had abnormal Pap tests, dysplasia and cancer .she was 24 years when she received a post card in the mail saying she needed to call the office, They did a repeat PAP test that came back as Class 3 dysplasia, then she had a D&C. They decided to follow it for a few months. Then she married and have 2 babies What is the possible treatment for her now ? Hysterectomy