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Cervical Cancer (Postmenopausal :female_sign: (Reproductive age :female…

- - - - No cervical cancer
        
        Cause is HPV, needs to have sex & have time to develop ca :crab:
        
        Age 11 = menarche
        
        HPV strains: 16, 18, 30s = :crab:
        
        6, 11 = warts
        
        Once infected, constant inflammatory condition that places at risk in to postmenopause (rest of life)
- - - - Cancer SCC
        
        spread to endothelium (endocervical ca) invisible
        
        ectocervical ca = visible
    - - Controllable Risk factors
        
        Sex, STDs
        
        Smoking :smoking:
        
        (2-3x risk increase)
    - - S/s of full blown :crab:
        
        postmeno. bleeding
        
        postcoital bleeding
        Dx: biopsy
        
        How to stage?
        
        more involvement of the vagina increases stage.
        
        start at the cervix and moving out
        
        Further out to the side = B
        
        A is either micro/ or just down the middle
        
        Stage 1: only cervix
        
        A = microscopic (cytology)
        
        B = macroscopic (seen w/ naked :eye:)
        
        Stage 2:
        
        A: upper 2/3 of vagina
        
        B: involves cardinal ligament
        
        Stage 3:
        
        A: involves lower 3 of vagina
        
        B: involves pelvic side wall
        
        Stage 4: Distant Mets (outside gyn spread)
        
        A: bowel & bladder
        
        B: distant, not local
        
        1 more item...
- - - - Can't see lesion? Endocervical
        
        take out everything: Cone Biopsy
        
        What to do w/ a positive Pap? How to interpret?
        
        even though adolescents :girl::skin-tone-2: get HPV infections, they will clear the HPV and never have a problem w/ it. (i.e. won't have it as an adult)
        
        most :female_sign:get Asx screen: 21yo repeat q3y
        
        (even if no sex activity)
        
        :warning:q1y if HIV pos.
        
        if > 30yo :woman::skin-tone-2: & getting HPV testing w/ Pap: q5y
        
        :octagonal_sign: @ 65yo :older_woman::skin-tone-2:, unless pos. Paps
        
        Screen: Asx
        
        Pap
        
        :green_cross:Normal Pap
        
        continue q3y (or other regimen if indicated)
        
        :check::red_flag:Grossly Abn Pap
        
        Colposcopy
        
        2 more items...
        
        :shrug::skin-tone-2:Atypical Squamous cells of Undetermined Significance (ASCUS)
        
        1 of 2 options
        
        Reflex HPV DNA
        
        Increase surveillance to q6m Pap
        
        In short: if its still scary :mask:, get the culpo.
        
        else return to q3y screen
        
        2 more items...
- - - - f/u: find ca? Need Staging
        Clinical exam: where ca :crab:is relative to vagina, cardinal ligament, & pelvic sidewall
        
        Tx: Depends
        
        ASCUS= HPV DNA testing
        
        Ecto lesion: local ablation (LEEP/Cryo :snowflake:)
        
        Endo lesion: cone biopsy
        
        "Endo-cone"
        
        IIA or better: Local resection is better (curative)
        
        IIB or worse: debulk & CTX (-platin) & rad :radioactive_sign:
        
        Prophy: Vaccine vs. HPV: sig. reduce amount of Cervical Ca.
        
        Gardisil: girls :girl::skin-tone-2: 11-26yo ; boys :boy::skin-tone-4: 11-21
        
        can extend range to as young as 9, late as 26 :male_sign: (but these are outside CDC rec's)