Name
CERVICAL DYSPLASIA
DESCRIPTION
DETAIL
CAUSES : Strong linkage with infections by human papilloma viruses types 16, 18, 31, 33, and 35. Other types of the same virus have also been implicated. -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS : β’ Invasive carcinoma of the cervix β’ Condyloma acuminatum* DNA STUDY - DIPLOID OR POLYPOID NUCLEUS IS NORMAL. ANEUPLOIDY IS HALLMARK OF MALIGNANCY SPECIAL TESTS β’ Viral DNA hybridization (Virapap) and others β’ Colposcopy β’ PAPNET system to review negative Pap smears β’ CYTYC 2000 thin prep Pap test (replacement of current Pap preparations) DIAGNOSTIC PROCEDURES : β’ Papanicolaou smear β’ Colposcopy and directed cervical biopsies β’ Cone biopsy (by cold knife, laser, or loop excision) β’ Endocervical curettage β’ Loop electrosurgical excision procedure (LEEP) β’ Cervicography β’ Speculum examination β’ Use of HPV DNA typing to select certain cases with borderline abnormalities, e.g., atypical squamous cells of undetermined significance (ASCUS), for closer followup and colposcopy
TYPENOTES
RISK FACTORS: Multiparity and pregnancy before age 20 years, Multiple sexual partners, Early age in first sexual intercourse, Condyloma acuminatum infection elsewhere in the body, Cigarette smoking, Prostitution, Lower socioeconomic statusDRUG(S) OF CHOICE : β’ Treatment is primarily surgical β’ Fluorouracil (Efudex) once or twice daily as 5% vaginal cream supplemental therapy PATIENT MONITORING : Repeat Pap smears every 4 months during the fi rst year after cone excision for severe dysplasia, every 6 months thereafter. For lesser lesions, repeat Pap smear yearly. Probe endocervical canal to assure patency. PREVENTION/AVOIDANCE: . Monogamy of both sexual partners . Use of condom during coitus if unable to practice monogamy . Abstain from smoking . Emphasize importance of yearly Pap smears for patients . Ability to obtain skilled colposcopy service as needed . Patient education (individually or by community services) to emphasize the need for Pap smear . Educate medical care providers to make patient referrals for the screening service unless they provide it themselves POSSIBLE COMPLICATIONS: . Some severe dysplasia will progress to invasive carcinoma of the cervix . Possible complications following cone biopsy of the cervix: . Hemorrhage . Infection . Cervical stenosis . Cervical incompetence . Infertility . Incomplete excision of dysplastic tissue . Recurrence EXPECTED COURSE/PROGNOSIS : . Generally excellent . Persistence of dysplasia can occur due to incomplete excision . Recurrence of dysplasia can occur due to inability to eradicate the human papilloma virus in the patients body or prevent new infections
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
PAP"S SMEAR, COMPLETE BLOOD COUNT, BIOPSY