1. Cervix Dr. Raid Jastania

2. Cervical Cancer Screening HPV infection Pre- Cancerous Dysplasia Cancer 10-20 years

3. Cervical Intraepithelial Lesions CIN Cervical cancer screening (Pap smear) CIN1, CIN2, CIN3 LSIL, HSIL HPV –Low risk: type 6, 8, 11, 42, 44 –High risk: type 16,18, 31, 33, 35 Host response Genes involved: P53, RB (retinoblastoma gene)

18. Cervical Intraepithelial Lesions CIN CIN1: –50-60%regress –30%persist –20%progress to CIN3 –1-5%progress to cancer CIN3: –33%regress –6-74%progress

19. Cervical Intraepithelial Lesions CIN Risk factors –Early age at first intercourse –Multiple sexual partners –Partner with multiple previous partners –HPV –Low socio economic class –Smoking –Immunodeficiency

20. Cervical Intraepithelial Lesions CIN CIN1: –Flat or chondyloma –Superficial layer –Koilocytosis (raison nuclei, perinuclear halo) CIN2: –More prominent changes –Squamous maturation is present CIN3: –Severe changes, Full thickness –Loss of maturation –Abnormal mitosis

23. Cervical Intraepithelial Lesions CIN Cytology and HPV testing –70% of CIN on cytoloyg are HPV positive (high-risk) –50% of Abnormal cytology (ASCUS) are HPV positive –10-15% of normal cytology are HPV positive

24. Cervical Cancer Most are squamous cell carcinoma Some are adenocarcinoma, adenosquamous or small cell carcinoma Peak of cancer at 45 years Peak of CIN at 30 years

25. Cervical Cancer Findings: –Lesion at the transformation zone –Small, or large, or invasive (Barrel cervix) –Extend to parametrial soft tissue and lymph nodes Symptoms: –Small: asymptomatic, seen on exam as white lesion –Large: vaginal bleedin, leukorrhea, pain

26. Cervical Cancer Survival 5-year: –Stage 0 pre cancer100% –Stage190% –Stage 282% –Stage 335% –Stage 410%

27. Cervicitis Very common Infectious, non-infectious Acute, chronic Vaginal discharge, leukorrhea Chlamydia, Trichomonas, Candida, N. gonorrhea, Herpes

33. Endocervical Polyp Polypoid lesion in the cervical canal ? Inflammatory Mucus gland, cystic change Edematous stroma Inflammation Can result in vaginal bleeding