Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

More documents

Recommendations

Info

Chapter 3 FIGURE 3.4: Invasive cervical cancer FIGURE 3.1: Histology – early stromal invasion (x 40) FIGURE 3.5: Invasive cervical cancer FIGURE 3.2: Histology – early stromal invasion (x 10) FIGURE 3.3: Early invasive cervical cancer FIGURE 3.6: Advanced invasive cervical cancer with ulceroproliferative growth 22
An introduction to invasive cancer of the uterine cervix mushroom or proliferating, bulging cauliflower-like growth with polypoid or papillary excrescences. Endophytic cancers may extensively infiltrate the stroma, distorting the cervix, without much visible surface growth. These lesions may expand into the endocervix leaving the squamous epithelium of the cervix intact until the lesions exceed 5-6 cm in a diameter. They result in a grossly enlarged, irregular barrel-shaped cervix with a rough, papillary or granular surface. Such cancers may remain silent for a long time. Partly exophytic and endophytic tumours are usually ulcerated with deep infiltration of the underlying stroma. In all types, bleeding on touch and necrosis are predominant clinical features. Foulsmelling discharge is also common due to superadded anaerobic infection of the necrotic tissue. As the invasion continues further, it may directly involve the vagina, parametrium, pelvic sidewall, bladder and rectum. Compression of the ureter due to advanced local disease causes ureteral obstruction with resulting hydronephrosis (enlargement of kidneys) and, ultimately, renal failure. Regional lymph node metastasis occurs along with local invasion. Metastatic cancer in para-aortic nodes may extend through the node capsule and directly invade the vertebrae and nerve roots. Direct invasion of the branches of the sciatic nerve roots causes back pain, and encroachment of the pelvic wall veins and lymphatics causes oedema of the lower limbs. Haematogenous spread to lumbar vertebrae and psoas muscle may occur without nodal disease. Distant metastases occur late in the disease, usually involving para-aortic nodes, lungs, liver, bone and other structures. Microscopic pathology Histologically, approximately 90-95% of invasive cervical cancers arising from the uterine cervix in developing countries are squamous cell cancers (Figures 3.7 and 3.8) and 2 to 8% are adenocarcinomas (Figure 3.9). Microscopically, most squamous cell carcinomas appear as infiltrating networks of bands of neoplastic cells with intervening stroma, with a great deal of variation in growth pattern, cell type and degree of differentiation. The cervical stroma separating the bands of malignant cells is infiltrated by lymphocytes and plasma cells. These malignant cells may be subdivided into keratinizing and non-keratinizing types. The tumours may be well, moderately or poorly differentiated carcinomas. Approximately 50-60% are moderately differentiated cancers and the remainder are evenly distributed between the well and poorly differentiated categories. FIGURE 3.8: Histology – Non-keratinizing invasive squamous cell carcinoma (x 10) FIGURE 3.7: Histology – Keratinizing well differentiated invasive squamous cell carcinoma (x 10) FIGURE 3.9: Histology – Well differentiated invasive adenocarcinoma (x 20) 23
Page 1 and 2: Colposcopy and Treatment of Cervica
Page 3 and 4: INTERNATIONAL AGENCY FOR RESEARCH O
Page 5 and 6: Published by the International Agen
Page 7 and 8: Contents 11 Management that provide
Page 9 and 10: Acknowledgements The authors gratef
Page 11 and 12: Preface Health care providers have
Page 13 and 14: Chapter 1 An introduction to the an
Page 15 and 16: An introduction to the anatomy of t
Page 25 and 26: Chapter 2 An introduction to cervic
Page 27 and 28: An introduction to cervical intraep
Page 33: Chapter 3 An introduction to invasi
Page 37 and 38: An introduction to invasive cancer
Page 39 and 40: An introduction to invasive cancer
Page 41 and 42: Chapter 4 Table 4.1: Indications fo
Page 43 and 44: Chapter 4 FIGURE 4.2: Colposcope wi
Page 45 and 46: Chapter 4 FIGURE 4.6: Endocervical
Page 47 and 48: Chapter 4 Table 4.2: Preneoplastic
Page 49 and 50: Chapter 5 between the two ocular le
Page 51 and 52: Chapter 5 Obtain specimens for labo
Page 53 and 54: Chapter 5 FIGURE 5.2: Biopsy techni
Page 55 and 56: Chapter 5 tissue tends to mimic inv
Page 57 and 58: Chapter 6 invasive carcinoma. Even
Page 59 and 60: Chapter 6 ages (Figures 1.7d, 1.7e,
Page 61 and 62: Chapter 6 FIGURE 6.7: The colour ch
Page 63 and 64: Chapter 6 Crypt openings Immature s
Page 65 and 66: Chapter 6 a FIGURE 6.17: An area of
Page 67 and 68: Chapter 7 The colposcopic diagnosis
Page 69 and 70: Chapter 7 appears as individual sma
Page 71 and 72: Chapter 7 acid stain is correlated
Page 73 and 74: Chapter 7 FIGURE 7.15: Moderately d
Page 75 and 76: Chapter 7 FIGURE 7.23: A dense acet
Page 77 and 78: Chapter 7 FIGURE 7.30: Mustard yell
Page 79 and 80: Chapter 7 We recommend that the stu
Page 81 and 82: Chapter 8 highlights this responsib
Page 83 and 84: Chapter 8 Appearance before applica
Page 85 and 86:
Chapter 8 diagnosis of AIS and aden
Page 87 and 88:
Chapter 8 a ↑ FIGURE 8.10: Adenoc
Page 89 and 90:
Chapter 9 Inflammatory lesions of t
Page 91 and 92:
Inflammatory lesions of the uterine
Page 93 and 94:
Inflammatory lesions of the uterine
Page 95 and 96:
Chapter 10 Table 10.1: Common sourc
Page 97 and 98:
Chapter 10 Table 10.2 (cont.): A su
Page 99 and 100:
Chapter 11 FIGURE 11.1: Flow chart
Page 101 and 102:
Chapter 11 treatment policies for p
Page 103 and 104:
Chapter 11 Vaginal delivery can be
Page 105 and 106:
Chapter 12 involvement increases wi
Page 107 and 108:
Chapter 12 Table 12.1: Eligibility
Page 109 and 110:
Chapter 12 a b c d e f FIGURE 12.6:
Page 111 and 112:
Chapter 12 during the follow-up in
Page 113 and 114:
Chapter 13 (2) (1) FIGURE 13.2: Ele
Page 115 and 116:
Chapter 13 (1) (2) (3) (4) (5) (8)
Page 117 and 118:
Chapter 13 Once the specimen has be
Page 119 and 120:
Chapter 13 in the endocervical cana
Page 121 and 122:
Chapter 14 Decontamination, cleanin
Page 123 and 124:
Decontamination, cleaning, high-lev
Page 125 and 126:
References Herrero, R. (1997) Preva
Page 127 and 128:
Further reading Suggestions on furt
Page 129 and 130:
Appendix Leukoplakia Condylom
Page 131 and 132:
Appendix regardless of your pregnan
Page 133 and 134:
Appendix Monsel’s paste Ingredien
Page 135 and 136:
Appendix 5 The modified Reid colpos
Page 137 and 138:
Index Acetowhitening . . . . . . .
show all

Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

Create successful ePaper yourself

Delete template?

Save as template?