Cervical Cancer Screening And Management In Pregnancy
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
According to the 2017 Cytopathology Checklist, the median reporting rate of atypical squamous cells– undetermined significance (ASC-US) among laboratories in the United States was 5.0% [4]. The incidence of biopsy-confirmed cervical intraepithelial neoplasia (CIN) 1 was 1.6%, CIN 2 4.4%, and CIN 3+ 2.2% [4, 5]. In the United States, the incidence of cervical cancer cases has dropped to 7.4 per 100,000, while deaths from invasive cervical cancer have dropped to 2.8 per 100,000 women [6, 7]. The peak age of incidence of cervical cancer is in the mid-40s [6]. In low- and middle-income countries, cervical cancer is the second most common cancer among people with a cervix, the third most common cause of cancer-related death, and the most common cause of mortality from gynecologic malignancy. In contrast, in high-income countries, the success of Pap smear screening has greatly reduced the incidence of disease by accurately detecting preinvasive and early-invasive cervical disease. In the United States, the incidence of cervical cancer ranges from 1.5 to 12 cases in 100,000 pregnancies [8]. About 1% of people who have cervical cancer are pregnant at the time of diagnosis. The likelihood that a pregnant person with ASC pathology has a detectable high-risk human papillomavirus (HR HPV) is 84% [9].
Gynaecology
Andrew Stevens, James Raftery in Gynaecology Health Care Needs Assessment, 2018
Squamous cell carcinoma, which accounts for 95% of cervical tumours, occurs most commonly at the squamo-columnar junction of the cervix and is characterized by a disordered morphology of the squamous epithelium which, by virtue of its site, is accessible for exfoliate cytology. Premalignant changes in cervical cytology are usually present and detectable for several years before an invasive lesion becomes clinically evident (the lead time). The dilemma is that the natural history of an abnormal smear is still not fully established with many minor abnormalities regressing over time and not requiring treatment.56 Dyskariotic cells are derived from the surface epithelium of the cervix with cervical intraepithelial neoplasia (CIN) or invasive disease. Cervical intraepithelial neoplasia ranges from I (mild), II (moderate) to III (severe/carcinoma in situ).
Cases
Ira Bedzow in Giving Voice to Values as a Professional Physician, 2018
Ms. P., an otherwise healthy 28-year-old woman, sees a naturopath for her primary care.8 However, Ms. P. is planning to have a child with her husband, who asked if they could make an appointment with a gynecologist since he is worried that she might be getting bad “family-planning” advice. As part of her appointment, the gynecologist performed a Pap smear, in accordance with U.S. Preventive Services Task Force guidelines. The Pap smear revealed low grade squamous intraepithelial neoplasia.9 Given the Pap smear findings the gynecologist recommended a colposcopy, to which Ms. P. reluctantly agreed. The colposcopy revealed cervical intraepithelial neoplasia 2,10 a premalignant condition that could progress to invasive adenocarcinoma. The gynecologist then recommended a cervical conization for treatment.11 Ms. P. told the physician that she plans to follow-up with her naturopath and to pursue meditation, colonics, and yoga, and to work with her Reiki master, trained to perform a type of energy healing that is said to involve moving energy through the body in order to balance it rather than have surgery. She further states that she heard that the conization can make it harder for her to carry a pregnancy to term, and that is a priority for her. She also says that her husband does not support her decision.
An insight into clinical and laboratory detections for screening and diagnosis of cervical cancer
Published in Expert Review of Molecular Diagnostics, 2023
Shruthi Padavu, Pooja Aichpure, Ballamoole Krishna Kumar, Anoop Kumar, RadhaKanta Ratho, Shipra Sonkusare, Indrani Karunasagar, Iddya Karunasagar, Praveen Rai
Human papillomavirus (HPV), a member of the Papillomaviridae family, is a non-enveloped, small (~55-60 nm), circular double-stranded DNA (dsDNA) virus having a genome of nearly 8000 bp. Over 200 HPV genotypes have been identified, with high- and low-risk classifications based on biological characteristics and carcinogenic potential. These viruses have been associated with several cancers of the anogenital tract, including anal, vulvar, vaginal, and cervical cancers in women and penile and anal cancers in men [1]. Unprotected sexual activity is the main mode of HPV transmission. It also spreads through close skin-to-skin or skin-to-mucosa contact [2]. In 2009, International Agency for Research on Cancer (IARC) classified mucosal HPV types 16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, 66, and 68 as having oncogenic potential for humans, hereafter referred to as high-risk (HR) HPV types [3]. HR-HPV genotypes are crucial in chronic cervical dysplasia and cervical cancer progression. Cervical intraepithelial neoplasia (CIN) is the diagnostic category for cervical tissue abnormalities linked with a higher risk of developing invasive cancer. There are three levels of abnormality: low-grade or mild dysplasia, classified as CIN 1; high-grade or moderate dysplasia, as CIN 2; and high-grade or severe dysplasia leading to cancer, classified as CIN 3 [4].
Clinical treatment of intra-epithelia cervical neoplasia with photodynamic therapy
Published in International Journal of Hyperthermia, 2020
Antonio Carlos Figueiredo Vendette, Henrique Luis Piva, Luis Alexandre Muehlmann, Delfrank Ananias de Souza, Antonio Claudio Tedesco, Ricardo Bentes Azevedo
Most cervical neoplasms originate from the junction of the simple columnar epithelium (endocervix) with squamous epithelium (ectocervix). This cervical region is a site of intense alteration, especially in intrauterine periods, puberty, and during the first pregnancy, declining after the menopause. The term Cervical Intraepithelial Neoplasia (CIN), as proposed by Richard [11], designates invasive carcinoma as the precursor of cervical cancer. Microscopic analysis findings corroborate the CIN diagnosis: cellular immaturity, cellular disorganization, nuclear abnormalities, and high mitotic activity. If mitoses and immature cells are present only in the lower third of the cervical epithelium, the lesion is usually designated as CIN1. When lesions compromise lower and middle thirds, they are classified as CIN2, and those that compromise up to the upper region are classified as CIN3 [12].
Clearance of HR-HPV within one year after focused ultrasound or loop electrosurgical excision procedure in patients with HSIL under 30
Published in International Journal of Hyperthermia, 2022
Yi Qin, Qing Li, Xunyu Ke, Yan Zhang, Xiaoling Shen, Wenping Wang, Qiuling Shi, Chengzhi Li
Cervical cancer ranks second among malignant tumors as a lethal disease among women and poses a great threat to women’s health and life, with the morbidity increasing in younger populations [1]. A large number of studies have confirmed that persistent high-risk human papillomavirus (HR-HPV) infection is closely related to high-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia grades 2–3 (CIN 2–3) and that HR-HPV is an important factor for the progression of CIN 2–3 to invasive cervical cancer [2]. Human papillomavirus (HPV) is a common sexually transmitted infection in life with the peak incidence observed among sexually active women [3]. The major peak of HPV infection occurs in women aged 26–30 years [4], who are more likely to be infected with the high carcinogenic types [5].
Related Knowledge Centers
- Cervical Cancer
- Epithelium
- Genital Wart
- Precancerous Condition
- Tumor Suppressor Gene
- Immune System
- Cervix
- Cervical Canal
- Papillomavirus Infection
- Intraepithelial Neoplasia