Master the board step 3

Gynecology
Invasive Cervical Cancer
The average age of diagnosis is 45 years.
Diagnostic Testing
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Cervical biopsy: The most common diagnosis is squamous cell carcinoma.
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Metastatic workup is the next step in evaluation: Includes pelvic exam, CT
scan (to look for metastatic disease), cystoscopy, and proctoscopy.
Treatment
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Management is simple hysterectomy or modified radical hysterectomy.
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Adjuvant therapy (radiation therapy and chemotherapy) is given when any
of the following conditions is present:
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Metastasis to lymph nodes
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Tumor size > 4 cm
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Poorly differentiated lesions
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Positive margins
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Local recurrence
Cervical Neoplasia in Pregnancy
A 25-year-old woman with a 15-week pregnancy by dates is found to have HGSIL
(high-grade squamous intraepithelial lesion) on a recent Pap smear. On pelvic
examination there is a gravid uterus consistent with 15 weeks’ size, and the cervix
is grossly normal to visual inspection. What is the next step in management?
a. Colposcopy and biopsy
b. Cone biopsy
c. Endocervical curettage
d. Hysterectomy
e. Repeat Pap after pregnancy
Answer: A. A pregnant woman with abnormal Pap smear is managed in the same way as a
nonpregnant woman with the exception of endocervical curettage, which is not performed
because of increased cervical vascularity. An abnormal Pap smear is evaluated
with colposcopy and biopsy. Pregnancy does not predispose to abnormal cytology and
does not accelerate precancerous lesion progression into invasive carcinoma.
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