cervix

• Cervical dysplasia


  Replacement of one mature cell type with a less mature cell type, precancerous
• Age group most at risk for cervical dysplasia and/or cervical cancer

  • 25-35 years old
• Risk factors for high cervical cancer risk

  • Multiple partners and unprotected sex
  • HPV infection with HPV 16/other high risk types
  • Immunocompromised
  • Environmental factors/smoking
  • HSV
  • Chlamydia infection
  • Lower socioeconomic status
• Association of HPV and cervical cancer

  HPV strains 16/18 cause cervical cancer
• How HPV causes cervical cancer

  1. HPV likes immature basal cells of squamous epithelium and cells of squamocolumnar junction

  2. It makes viral proteins E6/E7 and inhibit tumor suppressor proteins (p53) to decrease DNA repair

  3. Increases cell turnover and causes increased mutations
• Cervical cancer


  • Can be SCC or cervical adenocarcinoma
  • Grows very slow with associated hematogenous metastases
• ASCUS


  Atypical Squamous cells of undetermined significance
• ASC-H


  Atypical Squamous cells, cannot rule out high grade
• LSIL


  Low grade squamous intraepithelial lesion; worse and associated with HPV+
• HSIL


  High grade squamous intraepithelial lesion
• CIS


  Carcinoma in situ
• Signs and symptoms of cervical dysplasia/cancer

  • Asymptomatic at first
  • Abnormal vaginal bleeding
  • Vaginal discomfort
  • Vaginal discharge with unpleasant odor
  • Pain with urination
  • If metastasis beyond pelvic wall, symptoms of constipation/bloody urine
• Physical exam findings of cervical dysplasia/cancer

  • Enlarged, irregular, firm cervix
  • Barrel-shaped cervical enlargement
  • Friable
  • Bleed
  • Cauliflower like lesions
  • Ulcerations
• Diagnosis of cervical dysplasia/cancer

  Pap, colposcopy with cervical biopsy
• Screening for cervical dysplasia/cancer should start at age 21
• Pap smear screening schedule for ages 21-29


  Every 3 years
• Pap smear screening schedule for ages 30-65


  Pap cytology and HPV every 5 years; pap cytology every 3 years
• Discontinuation of Pap smear screening

  Discontinue at age 65 with negative consequence screens in last 10 years; screened for 20 years post treatment for CIN2,3
• When to do colposcopy


  If no visible lesion but abnormal cervical cytology, test for above abbreviations and if positive do colposcopy and directed biopsies and endocervical sampling
• If no cervix, no screening unless hysterectomy is performed for cervical cancer/precancer, then continue pap on vaginal cuff
• HPV testing


  1. HPV positive: screen 2x in first year post diagnosis; yearly after

  2. Other immunocompromised conditions: screen yearly

  3. HPV testing on 21yo+ with ASC-US cervical cytology; triage test for LSIL in postmenopausal women; follow-up test on CIN I/neg colposcopy in women with ASC-US, ASC-H, LSIL, AGCs; follow-up after CIN II/III; just done with paps for 30yo+