PRE-INVASIVE DISEASE PRE-INVASIVE DISEASE OF THE CERVIXOF THE CERVIX

CERVICAL CERVICAL INTRAEPHELIAL INTRAEPHELIAL

NEOPLASIANEOPLASIA

DR. AMEL AL-SAYEDDR. AMEL AL-SAYED

Asst. Prof. & ConsultantAsst. Prof. & Consultant

Ob/Gyne Dept.Ob/Gyne Dept.

The Unique accessibility of the cx to cell and The Unique accessibility of the cx to cell and tissue study and to direct physical tissue study and to direct physical examination has permitted intensive examination has permitted intensive investigations of the nature of malignant investigations of the nature of malignant lesions of the cervixlesions of the cervix

A pre-invasive lesion may be present years A pre-invasive lesion may be present years before malignant transformationbefore malignant transformation

Pre-invasive lesions are reversiblePre-invasive lesions are reversible It is theoretically possible to eradicate most It is theoretically possible to eradicate most

deaths resulting from cervlcal ca by using deaths resulting from cervlcal ca by using diagnostic and therapeutic techniques now diagnostic and therapeutic techniques now availableavailable

Recommendations of screening of ACOG together with Recommendations of screening of ACOG together with the American Cancer Societythe American Cancer Society

All women who are or who have been sexually active All women who are or who have been sexually active and reached the age of 18 should undergo an annual and reached the age of 18 should undergo an annual Pap Test and Pelvic exam.Pap Test and Pelvic exam.

After a woman has had three or more consecutive After a woman has had three or more consecutive satisfactory annual examinations with normal satisfactory annual examinations with normal findings, the Pap Smear may be performed less findings, the Pap Smear may be performed less frequently according to her physician.frequently according to her physician.

It should be stressed that the aim of performing a Pap It should be stressed that the aim of performing a Pap Test is to screen for intra epithelium lesions and not Test is to screen for intra epithelium lesions and not to diagnose cervical Ca.to diagnose cervical Ca.

How to perform a Pap TestHow to perform a Pap TestEpidemiology:Epidemiology:1.1. Younger patientsYounger patients2.2. Early intercourseEarly intercourse3.3. MultiparityMultiparity4.4. Multiple sexual partnersMultiple sexual partners5.5. HPV virus infectionHPV virus infection6.6. Lack of use of Barrier Lack of use of Barrier ContraceptionContraception7.7. SmokingSmoking8.8. JewsJews

HPV VirusHPV Virus

-- Many types 6, 11, 16, 18, 30, 31, Many types 6, 11, 16, 18, 30, 31, 33, 33, etc.etc.

-- Causes condylomata acuminataCauses condylomata acuminata

-- Type 16, 18, commonly associated Type 16, 18, commonly associated with Cx. Ca.with Cx. Ca.

Interpretation of Pap SmearInterpretation of Pap Smear

CIN ICIN I Mild dysplasiaMild dysplasia

CIN IICIN II Moderate dysplasiaModerate dysplasia

CIN IIICIN III Severe dysplasia or Severe dysplasia or carcinoma in carcinoma in situsitu

Bethesda SystemBethesda System

Adequacy of cellsAdequacy of cells

InfectionsInfections

Epitheliam cell abnormalityEpitheliam cell abnormality

a.a. Atypias (AUDS) Atypia of Atypias (AUDS) Atypia of undetermined significanceundetermined significance

b.b. Squamous intra ipethial lesions Squamous intra ipethial lesions (SIL)(SIL)

1.1. Low grade SILLow grade SIL == CIN ICIN I

2.2. High grade SILHigh grade SIL -- CIN II + CIN II + IIIIII

If you encounter an abnormal Pap Smear If you encounter an abnormal Pap Smear colposcopy must be performedcolposcopy must be performed

Abnormal colposcopic findings:Abnormal colposcopic findings:A.A. Atypical transformation zoneAtypical transformation zone

1.1. KeratosisKeratosis2.2. Acetowhire epitheliumAcetowhire epithelium3.3. PunctationPunctation4.4. MosavismMosavism5.5. Atypical vesselsAtypical vessels

B.B. Suspect frank invasive CaSuspect frank invasive CaC.C. Unsatisfactory colposcopic findingsUnsatisfactory colposcopic findings

Rx of Abnormal Pap SmearRx of Abnormal Pap Smear

♦ ♦ ObservationObservation

♦♦ LaserLaser

♦ ♦ CautaryCautary

♦ ♦ CryoCryo

♦ ♦ Loop excisionLoop excision

♦ ♦ Podophyllin or TCAPodophyllin or TCA

♦ ♦ ConizationConization

♦ ♦ TAHTAH