Lesiones preinvasivas de cancer de cervix, diagnostico, manejo y tratamiento

1. Lesiones Preinvasivas de C áncer de Cervix Gregorio Urruela Vizcaíno Residente III

6. NIC 1

7. NIC 2

8. NIC 3

13. Cérvix

17. Condylomata acuminata:

20. Consideraciones Clínicas

21. Soluciones

22. Historia Natural de NIC >12 – <56 32 CIN 3 5 22 35 43 CIN 2 1 11 32 57 CIN 1 Progresion a Invasion (%) Progresion a CIS (%) Persistencia (%) Regresion (%)

24. Guías de tamizaje: Age Age >30: see ACS Age >30: every 2 to 3 years after 3 consecutive negative tests At least every 3 years 30: annual 30: annual if conventional smear; every 2 years if LBC test Intervalo de Tamizaje para mujeres con riesgo promedio See ACS See ACS Approximately 3 years after onset of vaginal intercourse; no later than age 21 Inicio de Tamizaje USPSTF ACOG ACS

25. Guías de tamizaje: Continue if high risk, sexually active, history of multiple sexual partners, or history of abnormal cytology Continue if screening history uncertain, history of cervical cancer, DES, recent HPV +, HIV + status, other immunocompromised state Age 65 if not otherwise at high risk for cervical cancer Age 70 in low-risk women Age 70: consider if 3 documented negative (and no abnormal) tests in prior 10 years Discontinuacion de tamizaje History of CIN 2 or 3 or cervical cancer: annual No specific recommendations HIV +: see ACS Other immunocompromised states, DES: may require more frequent screening HIV + or other immunocompromised state: 2 tests during first year after immune disease diagnosis, then annually (per CDC) Intervalo de Tamizaje para mujeres con alto riesgo USPSTF ACOG ACS

26. Guías de Tamizaje See ACS See ACS Positive or uncertain history of CIN 2 or 3: annual screening until 3 negative tests obtained, then may discontinue Continue screening if history of DES or cervical cancer Not recommended if total hysterectomy for benign disease Not indicated if removal confirmed with benign pathology and past negative cytologies Not indicated if removal confirmed for benign indication Subtotal hysterectomy: continue screening per guidelines Tamizaje despues de histerectomia USPSTF ACOG ACS

28. Anormalidades epiteliales celulares: Adenocarcinoma Endocervical adenocarcinoma in situ (AIS) Endocervical or not otherwise specified Atypical glandular cells, favor neoplastic Endocervical, endometrial, or not otherwise specified Atypical glandular cells (AGC) Glandular cell Squamous cell carcinoma High-grade squamous intraepithelial lesion (HSIL) Low-grade squamous intraepithelial lesion (LSIL) Atypical squamous cells (ASC) of undetermined significance (ASC-US) cannot exclude HSIL (ASC-H) Squamous cell

39. LEEP Theoretical risk of vapor plume inhalation Risk of postprocedure bleeding Special training required Thermal damage may obscure specimen margin status Desventajas Tissue specimen for histopathology evaluation Low costs of equipment Outpatient procedure using local anesthesia Ease of procedure Favorable safety profile Ventajas

40. Conización en Frío Increased risk of adverse reproductive outcomes Larger volume of cervical stroma removed High cost Operating room setting General or regional anesthesia required Postoperative discomfort Lengthier procedure Potential for hemorrhage DESVENTAJAS Variety of instruments to individualize conization Enhanced patient support if hemorrhage is encountered Tissue specimen for histopathology without margin compromise Paciente bajo los efectos de anestesia VENTAJAS

41. LEEP o CKC MARGENES POSITIVOS Seguimiento: Citología Colposcopía/Biopsia/Curetaje Endocervical Valorar necesidad de un segundo procedimiento por aversión de paciente a progreso de lesión

42. GRACIAS