CASE 16: NEOPLASTIC LESIONS OF THE CERVIX

CERVIX Remember: It starts from the basement membrane, inwards

Carcinoma of the Cervix going outwards
 #1 in the Philippines  If there is a breakage BM: Invasion as a Frank CA
 Women are not compliant for Paps smear
 Changing sexual pattern of women New terminology for dysplasia:
 Exposure of HPV  Low / High Grade Squamous Intraepithelial Lesion
 10 – 12 years: Time from Premalignant stage to Cancer  LGSIL: CIN 1
 RF: Multiple sexual partners, HPV infection, Multiparity,  HGSIL: CIN 2 - 3
Early coitarche, Smoking
 Smoking: Always a RF in CA due to disruption of cell cycle If paps smear does not coincide with colposcopy:
becoming more prone to dysplasia  Pap’s Smear as CIN 2
 Colposcopy as CIN 3
Complaints:  Do cone biopsy
 Exangenous or foul discharges: Infection
 Post coital bleeding Cone Biopsy
 Get the full thickness of transformation zone done by
Early DX: LEEP procedure
 Paps smear within 3 years from the time of first coitus  To rule out if it is CIS or Microinvasion
annually until 3 consecutive negative results (q 2 - 3 yrs)
as long as the patient has NO RF TX:
 Until 60 - 70 years: not at risk for cervical CA but more on  CIN 1: Resolves spontaneously
ovarian or endometrial later on  Observe/ monitor: repeat Pap’s smear in 4 - 6
 If there are present RF initially, instead of simple Pap months with HPV DNA testing
smear: Do Paps smear + HPV DNA Testing
- Absent: NO NOTES -
PE:
 Speculum Exam: Hyperemia, Leukoplakia, Bleeds easily
to touch
 Normal Cervix : Smooth pink
 Atropic Cervix: Pale pink
 Gross Inspection: Abnormal blood vessel formation

If you can't see anything in the gross inspection:

1. Pap’s Smear
2. Colposcopy
3. Ascetic Acid Wash
Absence of Colposcopy
4. Schiller’s Procedure

Pap’s Smear
 Ayers spatula/ Cytobrush
 Get the specimen at the most common site of early
destruction: Squamocolumnar junction (Transformation
zone: Squamous – Outside to Tall Columnar- Inside)
 2 Ways to Read: Slide or Liquid preparation (uses a
special machine to remove debris in which cells can be
seen clearly)

Colposcopy:
 Observe for: ↑ vascularization, punctuations, mosaicism

Ascetic Acid Wash

 1% Household Vinegar
 Abnormal: White Areas

Schillers procedure
 Lugol’s solution reacting with glycogen
 Normal: mahogany or yellow brown,
 White areas: Abnormal

CASE
 36 G6P6, 2 sexual partners, coitarche of age 19
 Lesion: bleeds easily to touch,
 Positive gross lesions: Skip Pap smear & get already do
biopsy either colposcopy guided or punch biopsy (do not
forget to get the normal lesion)

STAGES:
 CIN 1: Lower 1/3
 CIN 2: Lower 2/3
 CIN 3: Whole
 CANCER