Cervical Dysplasia

OVERVIEW

Cervical dysplasia and cervical cancer lie on a continuum of conditions. Cervical dysplasia can take one of three paths:

1. Progress to cancer

2. Remain the same and not progress

3. Regress to normal

RISK FACTORS FOR CERVICAL DYSPLASIA AND CERVICAL CANCER

Human papillomavirus (HPV) infection 80% of cases

Risk highest if infected > 6 months

Types 16, 18, 31, 33, high oncogenic potential

■ High sexual activity (increase risk of viral/bacterial infections) Multiple sexual partners

Intercourse at early age (± 17 years)

■ Low socioeconomic status

■ Genetic predisposition

Cigarette smoking (smokers are deficient in folic acid and deficiency plays role in dysplasia)

■ Alcohol, 2 to 4 drinks/wk, can increase risk of HPV infection.

■ Oral contraceptives, particularly with use > 5 years (condoms decrease risk in these women)

■ Young women whose mothers took DES during pregnancy

Preinvasive lesions (confined to epithelium) ^ Normal epithelium ■ Invasive cancer

Risk factors for cervical dysplasia:

OSHA Ends Dirt, Garbage, and Chemicals:

Oral contraceptives

Alcohol

Education/poverty Diethylstilbestrol (DES) Genetics Cigarettes

LOCATION OF CERVICAL DYSPLASIA: TRANSFORMATION ZONE

The transformation zone is the area between the old and the new squamo-columnar junctions.

The squamo-columnar junction exists between the squamous epithelium of the vagina and ectocervix and the columnar epithelium of the endocervix. With age, metaplasia occurs, transforming columnar cells to squamous cells and thereby advancing the squamo-columnar junction proximally toward the

The adolescent cervix is more susceptible to carcinogenic stimuli.

Cervical dysplasia almost always forms at transformation zone.

Two things to remember about Pap smear:

1. It is a screening tool.

2. It provides cytologic information, not histologic.

Are the results of a Pap enough to diagnose cervical cancer? No-Pap smear only gives cytology. Colposcopy and biopsy are needed for histology, which is necessary for diagnosis, staging, and treatment.

endocervix. The area between the original junction and the new junction is the transformation zone.

PAP SMEAR

A cytologic screening test for cervical neoplasia

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