Precancerous Disease in Gynecology PDF

Precancerous disease in gynecology  Vulvar Precancerous Disease Vulvar intraepithelial neoplasia (VIN) The grade of VIN means how deep the abnormal cells go into the top layer of the skin that covers the vulva. VIN 1 means that the depth of ab...

Precancerous disease in gynecology  Vulvar Precancerous Disease Vulvar intraepithelial neoplasia (VIN) The grade of VIN means how deep the abnormal cells go into the top layer of the skin that covers the vulva. VIN 1 means that the depth of abnormal cells is less than one-third of the top layer of vulvar skin. VIN 2 means that the depth of abnormal cells is less than two-thirds of the top layer of vulvar skin. VIN 3 means that the depth of abnormal cells is more than two-thirds of the top layer of vulvar skin VIN often does not cause symptoms. These may be signs of VIN: Mild to severe itching or burning on the vulva that doesn't go away Changes in the skin color on the vulva. It may be white, pink to red, gray, or dark brown. Thickening of the skin on the vulva A lump or bump on the vulva A sore or cracked skin on the vulva Diagnosis exam of the vulva, vagina, cervix and anus colposcopy biopsy Treatment options for VIN include: no treatment with close follow-up topical therapy laser surgery surgical removal with a wide local excision or a simple vulvectomy  vaginal intraepithelial neoplasia (VAIN) VAIN is categorized based on how abnormal the cells in the epithelium are: VAIN 1 refers to mild dysplasia. The epithelium is mildly abnormal. VAIN 2 refers to moderate dysplasia. The epithelium is moderately abnormal. VAIN 3 refers to severe dysplasia or carcinoma in situ. Diagnosing VAIN VAIN can be found with a colposcopy and biopsy. Treatment options for VAIN Laser therapy. This uses a narrow beam of high-energy light to destroy or remove abnormal cells. This procedure is usually done in a hospital with anesthesia. Bleeding may occur and then go away over several weeks. Topical chemotherapy. This medicine is not absorbed into body system. The medicine kills cancer cells in the lining of the vagina. The medicine most often used is fluorouracil, also called 5-FU. Treatments are usually done once a week for about 10 weeks. Or they may be done every night for 1 week. Other types of treatment. other types of treatment based on the grade of VAIN and your own needs. Partial vaginectomy is surgery to remove part of vagina. Radiation therapy to shrink tumors before surgery or to kill any remaining cancer cells after other procedures. Cervical Dysplasia -- also called Cervical intraepithelial neoplasia (CIN) is the term for abnormal -- and possibly precancerous -- changes in cells on the surface of the cervix. Abnormal squamous cells Bethesda reporting system, which refers to squamous intraepithelial lesion (SIL). Other reporting systems ref SILs are divided into low grade and high grade. CIN is graded as 1, 2 or 3. Low-grade SIL (LSIL) compares to CIN 1. LSIL only affects cells on the surface of the cervical lining or close High-grade SIL (HSIL) compares to CIN 2 and CIN 3. Changes to cells are deeper in the cervical lining. The With HSIL, there are distinct changes to the size and shape of the cells so they look different from normal cel Abnormal glandular cells Atypical glandular cells (AGC) and adenocarcinoma in situ (AIS) are changes to glandular cells in the cervix. Glandular cell abnormalities are not graded and are described using the Bethesda reporting system. AGC means the cells don’t look normal. Changes to cells are linked with a higher risk of becoming cancer or may mean that there is an underlying cancer. AIS means pre-invasive cancer cells are found. This means they haven’t spread into the deeper tissues of the cervix or surrounding tissue Diagnosis If a Pap test result is abnormal, you will have more tests to rule out or diagnose a precancerous condition or cervical cancer. Tests may include: another Pap test after a few months (usually 6 months) if there are mild changes an HPV test, which can sometimes be done on a sample of cervical cells taken during a Pap test a colposcopy exam and biopsy of any abnormal-looking areas an endocervical curettage, which removes cells from the endocervical canal and is usually done at the same time as a colposcopy Treatment options for precancerous changes in the cervix may include: loop electrosurgical excision procedure (LEEP) or other cone biopsy procedure cryosurgery laser surgery hysterectomy Precancerous conditions of the uterus. 1 Simple hyperplasia - Increased number of glands but regular glandular architecture 2 Complex hyperplasia - Crowded irregular glands 3 Simple hyperplasia with atypia - Simple hyperplasia with presence of cytologic atypia (promine 4 Complex hyperplasia with atypia - Complex hyperplasia with cytologic atypia Diagnosis Endometrial biopsy removes small pieces of the lining of the uterus (called the endometrium) so they can be looked at under a microscope. It is usually done in the doctor’s office. Dilation and curettage (D&C) is a procedure in which the cervix (the lower, narrow part of the uterus, or womb) is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium (the inner lining of the uterus). Treatment options for atypical endometrial hyperplasia may include: hysterectomy for post-menopausal women progesterone therapy for women who might want to have children in the future