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What Is Carcinoma In Situ Of Cervix

Treatment Options For Women Who Dont Want To Maintain Fertility

What is CARCINOMA IN SITU? CARCINOMA IN SITU meaning – CARCINOMA IN SITU definition
  • A simple hysterectomy may be an option if the cancer shows no lymphovascular invasion and the edges of the biopsy have no cancer cells. If the edges of the biopsy have cancer cells present, a repeat cone biopsy or a radical hysterectomy with removal of the pelvic lymph nodes might be an option.
  • If the cancer has grown into blood or lymph vessels, you might need a radical hysterectomy along with removal of the pelvic lymph nodes. Sometimes, surgery is not done and external beam radiation to the pelvis followed by brachytherapy is used.

If none of the lymph nodes are found to have cancer, radiation may still be discussed as an option if the tumor is large, if the tumor has grown into blood or lymph vessels, or if the tumor is invading the surrounding connective tissue that supports organs such as the uterus, bladder, vagina .

If the cancer has spread to the tissues next to the uterus or to any lymph nodes, or if the tissue removed has positive margins, radiation with chemotherapy is usually recommended. The doctor may also advise brachytherapy after the combined chemo and radiation are done.

How Is Adenocarcinoma Of Cervix Diagnosed

In order to make a diagnosis, a physician will take a detailed history followed by a physical and pelvic exam. A Pap smear, if not performed already, may be ordered as a screening procedure. An abnormal Pap smear warrants further testing. Some of the definitive tests that help in diagnosing Cervical Cancer include:

Colposcopy:

  • The cervix is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
  • In order for this procedure to be performed, the female individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside
  • To make the abnormal areas more visible, a weak acetic acid solution is applied to the cervical surface. The abnormal areas appear whiter than the surrounding regions. A solution of Lugolâs iodine may also be used for this purpose
  • The procedure is usually not performed, when a woman has menstrual bleeds
  • It is generally not painful, but in some women it may cause discomfort or cramping

Cervical biopsy: Biopsy is the process of removing tissue for examination. A pathologist looks at the tissue sample under a microscope, to detect any evidence of cancer. Types of cervical biopsies include:

Two methods can be used to obtain a cone biopsy specimen:

Lowgrade Squamous Intraepithelial Lesion

LSIL encompasses HPV, mild dysplasia, and CIN 1. HPVassociated squamous cell changes or cytopathic effects were initially considered to represent a process separate from true dysplasia. However, mounting evidence over the past 20 years has established HPV as the main causal factor in the pathogenesis of virtually all cervical cancer precursors and cancers.

Several studies have demonstrated that the morphologic criteria for distinguishing koilocytosis from mild dysplasia or CIN 1 vary among investigators and lack clinical significance. In addition, both lesions share similar HPV types, and their biologic behavior and clinical management are similar, thus supporting a common designation of LSIL. Most CIN 1, especially in young women, represents a selflimited HPV infection.

Criteria for LSIL are listed in Box 184.

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How Is Adenocarcinoma Of Cervix Treated

Once a diagnosis of Cervical Cancer has been made, the extent to which the tumor has spread is assessed. This is called staging.

  • The FIGO and the AJCC TNM staging systems – are two similar, commonly used staging systems
  • A tumor that remains confined only to the superficial layers of the cervix is said to be carcinoma in situ
  • Depending on how far the tumor has spread beyond the cervix, stages I through IV are defined
  • Stage I cancer is confined wholly to the cervix
  • Stage IV cancer involves the nearby organs, such as the bladder, rectum, or even other distant organs

The treatment modality is chosen, depending on the type and stage of the tumor, age of the individual, and the need to preserve the ability to bear children. Sometimes, more than one type of treatment modalities may be necessary. Treatment options for Adenocarcinoma of Cervix include:

Surgery:

Chemotherapy:

Radiation therapy:

  • This procedure uses high-energy beams to kill the cancer cells
  • These beams may be delivered from outside the body or the radioactive material maybe placed inside the vagina or the uterus
  • Possible side effects may include:
  • Fatigue, nausea, vomiting, and diarrhea
  • Bladder irritation, leading to inflammation
  • Ovaries may be affected resulting in menstrual changes, or premature menopause
  • The vulva and vagina may be affected, causing soreness, or even scar tissue formation

How Is Adenocarcinoma In Situ Of Cervix Treated

Cervix: Carcinoma in situ
  • The treatment of Adenocarcinoma In Situ of Cervix includes undertaking an excisional surgery, which is followed by a close follow-up and regular monitoring
  • If really necessary, a surgical removal of the uterus may be undertaken, if the woman has completed her family and does not wish to bear a child
  • In case no surgery is performed to remove Cervical AIS; then, regular colposcopic studies, testing for HPV infection, and cell analysis studies are important considerations

The following removal techniques may be considered:

  • Laser therapy: The abnormal cells are destroyed using lasers
  • Loop electrosurgical excision procedure, which is used to remove abnormal tissue with a thin wire loop
  • Cryocauterization can help destroy the abnormal cells by freezing them
  • Cone biopsy, which is a surgical procedure performed to remove the abnormal segment of the cervix

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Treatment Option Overview For Cervical Cancer

Patterns-of-care studies clearly demonstrate the negative prognostic effect ofincreasing tumor volume and spread pattern. Treatment, therefore, may vary within each stage as the individual stages are currently defined by Fédération Internationale de Gynécologie et dObstétrique .

Table 5. Standard Treatment Options for Cervical Cancer

Pelvic exenteration

Ductal Carcinoma In Situ Treatment

Most women with ductal carcinoma in-situ are cured with proper treatment. Treatment may include:

  • Lumpectomy. This is a type of breast-conserving surgery . This may be followed by radiation therapy.
  • Mastectomy. This is surgery to remove the breast or as much of the breast tissue as possible.
  • Tamoxifen. This drug may also be taken to lower the chance that ductal carcinoma in-situ will come back after treatment or to prevent invasive breast cancer.

Surgery

If youre diagnosed with ductal carcinoma in-situ , one of the first decisions youll have to make is whether to treat the condition with lumpectomy or mastectomy.

Lumpectomy

Lumpectomy is surgery to remove the area of ductal carcinoma in-situ and a margin of healthy tissue that surrounds it. This is also known as a surgical biopsy or wide local incision. The procedure allows you to keep as much of your breast as possible, and depending on the amount of tissue removed, usually eliminates the need for breast reconstruction.

Research suggests that women treated with lumpectomy have a slightly higher risk of recurrence than women who undergo mastectomy; however, survival rates between the two groups are very similar.

If you have other serious health conditions, you might consider other options, such as lumpectomy plus hormone therapy, lumpectomy alone or no treatment.

Mastectomy

Most women with ductal carcinoma in-situ are candidates for lumpectomy. However, mastectomy may be recommended if:

Radiation therapy

Hormone therapy

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Standard Treatment Options For Stage Ia1 Cervical Cancer

  • Age younger than 40 years.
  • Presumed stage IA2 to IB1 disease and a lesion size no greater than 2 cm.
  • Preoperative magnetic resonance imaging that shows a margin from the most distal edge of the tumor to the lower uterine segment.
  • Squamous, adenosquamous, or adenocarcinoma cell types.

Intraoperatively, the patient is assessed in a manner similar to a radical hysterectomy; the procedure is aborted if more advanced disease than expected is encountered. The margins of the specimen are also assessed at the time of surgery, and a radical hysterectomy is performed if inadequate margins are obtained.

Intracavitary radiation therapy

Intracavitary radiation therapy is a treatment option when palliative treatment is appropriate because of other medical conditions and for women who are not surgical candidates.

If the depth of invasion is less than 3mm and no capillary lymphatic space invasion is noted, and the frequencyof lymph-node involvement is sufficiently low, external-beam radiation therapy isnot required. One or two insertions with tandem and ovoids for 6,500 mg to 8,000mg hours are recommended.

Treatment For Stage I Disease

Histopathology Cervix –Squamous metaplasia & carcinoma-in-s

Pregnancy does not alter the course of cervical cancer. As a result, in certain cases, patients may elect to postpone treatment until its effects on the pregnancy are minimized. This may be considered for patients with the more common, and less aggressive histologic subtypes: squamous, adenocarcinoma, and adenosquamous. Patients with high-risk subtypes, such as small cell or neuroendocrine tumors, should be counseled toward immediate treatment despite the effects on the fetus, given their risk of progression.

Patients with early stage disease may safely undergo fertility-sparing treatments including cervical conization or radical trachelectomy, as indicated. The optimal timing for this procedure is in the second trimester, before viability. Some authors have suggested waiting until the completion of a pregnancy to initiate treatment. For patients with IA2 and IB disease such a delay may also be safe, but because of a risk of lymphatic spread, assessment of lymph-node status should first be ascertained. The status is best determined surgically via a laparoscopic or open lymph-node dissection, which can be safely performed up to approximately 20 weeks of pregnancy. In patients without lymphatic spread, waiting for fetal viability to initiate treatment is an option. Patients with positive lymph nodes should be counseled toward immediate treatment.

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What Are The Risk Factors For Adenocarcinoma In Situ Of Cervix

The risk factors for Adenocarcinoma In Situ of Cervix may include:

  • Contracting human papillomavirus infection: HPV is a virus that is often transmitted through sexual contact. High-risk HPV association is seen in most cases
  • Having multiple sexual partners
  • Using birth control pills for extended periods of time
  • Taking medication that suppresses the immune system
  • Other factors causing a poor immune system including HIV infection and organ transplant
  • Giving birth at a young age; being sexually active at a young age
  • A diet lacking fruits and vegetables
  • Smoking

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

Standard Treatment Options For Stages Ib And Iia Cervical Cancer

  • Age younger than 40 years.
  • Presumed stage IA2 to IB1 disease and a lesion size no greater than 2 cm.
  • Preoperative magnetic resonance imaging that shows a margin from the most distal edge of the tumor to the lower uterine segment.
  • Squamous, adenosquamous, or adenocarcinoma cell types.

Intraoperatively, the patient is assessed in a manner similar to a radical hysterectomy; the procedure is aborted if more advanced disease than expected is encountered. The margins of the specimen are also assessed at the time of surgery, and a radical hysterectomy is performed if inadequate margins are obtained.

Neoadjuvant chemotherapy

Several groups have investigated the role of neoadjuvant chemotherapy to convert patients who are conventional candidates for chemoradiation into candidates for radical surgery. Multiple regimens have been used; however, almost all utilize a platinum backbone. The largest randomized trial to date was reported in 2001, and its accrual was completed before the standard of care included the addition of cisplatin to radiation therapy. As a result, the control arm utilized radiation therapy alone. Although there was an improvement in OS for the experimental arm, the results are not reflective of current practice. This study accrued patients with stages IB through IVA disease, but improvement in the experimental arm was only noted for participants with early stage disease .

Radiation therapy alone

IMRT

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What Is Adenocarcinoma In Situ

Adenocarcinoma is a type of cancer that starts in the glands that produce mucus. Your body has mucus-producing glands in several organs, including:

  • uterus
  • colon
  • pancreas

Adenocarcinoma in situ means that there are abnormal cells in these mucus-producing glands, but they arent cancerous and have not spread. If left untreated, these abnormal cells could become cancer.

AIS is sometimes referred to as cancer stage 0.

You can develop AIS in any organ that has mucus-producing glands. However, it is most commonly found in the cervix, lungs, pancreas, and colon.

Find out more about the common types of AIS in the sections below.

Surgery And Radiation Therapy

Clinical approaches to treating papillary squamous cell ...

Surgery and radiation therapy are equallyeffective for early stage, small-volume disease. Younger patients maybenefit from surgery to preserve the ovaries and avoidvaginal atrophy and stenosis.

Therapy for patients with cancer of the cervical stump is effective and yields results that are comparable with those seen in patients with an intact uterus.

References
  • Lanciano RM, Won M, Hanks GE: A reappraisal of the International Federation of Gynecology and Obstetrics staging system for cervical cancer. A study of patterns of care. Cancer 69 : 482-7, 1992.;
  • Whitney CW, Sause W, Bundy BN, et al.: Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 17 : 1339-48, 1999.;
  • Morris M, Eifel PJ, Lu J, et al.: Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 340 : 1137-43, 1999.;
  • Rose PG, Bundy BN, Watkins EB, et al.: Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340 : 1144-53, 1999.;
  • Keys HM, Bundy BN, Stehman FB, et al.: Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340 : 1154-61, 1999.;
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    Who Gets Adenocarcinoma In Situ Of Cervix

    • Adenocarcinoma In Situ of Cervix is exclusively observed in women; more often in the 30-40 year age category
    • AIS of Cervix occurs in women on an average 10-15 years before invasive adenocarcinoma of cervix is diagnosed
    • The condition may occur in all races and ethnic groups and no specific predilection is observed;

    Stages Of Cervical Cancer

    Once cancer has been diagnosed, additional tests may be performed to determine whether or not the cancer has spread to other parts of the body. This is called staging. Learning the stage of the cancer helps plan treatment options.

    Tests that may be performed to determine whether cancer has spread include:

    • Cystoscopy or proctoscopy;to check to see if cancer has spread to the urethra or bladder
    • Computed tomography scan , which combines multiple X-rays to provide three-dimensional clarity and show various types of tissue, including blood vessels.
    • Magnetic resonance imaging , using magnets and radio waves provide three-dimensional body images. It may also be used to determine if a tumor is benign or malignant.
    • Positron emission tomography scan , called a PET scan. A PET scan is an imaging test that can help reveal how your tissues and organs are functioning. A small amount of radioactive material is necessary to show this activity.

    The International Federation of Gynecology and Obstetrics believes that any staging system should be universally feasible and applicable, as well as provide a worldwide standardized classification that allows various medical centers to compare results.;The major categories of the FIGO classification are as follows:

    The FIGO stages are further categorized as follows:

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    How Is Ais Diagnosed

    Most people who have any type of AIS have no symptoms. AIS is often found during screenings or unrelated imaging tests. For example, cervical AIS might be found during a routine pap smear and cervical cancer screening.

    When AIS is found, a doctor will likely order a biopsy. During the biopsy, a medical professional will remove a small piece of tissue from the affected organ. They will study the sample to see if the abnormal cells are AIS or another stage of cancer.

    Youll be diagnosed with AIS if the doctor finds that the cells arent cancerous and arent growing.

    Squamous Cell Carcinoma And Variants

    Cervical Sunday and AIS or Adenocarcinoma In Situ

    Editorial Board Member:;Carlos Parra-Herran, M.D.Editor-in-Chief:;Topic Completed:Minor changes:CopyrightPage views in 2020:Page views in 2021 to date:Cite this page:

    • An invasive epithelial tumor composed of neoplastic cells with varying degrees of squamous differentiation
    • Most common type of cervical carcinoma
    • Nearly all cases are associated with high risk human papillomavirus and arise from a precursor lesion, high grade squamous intraepithelial lesion
    • Predominantly associated with HPV 16 and HPV 18
    • More common in low resource countries and women without adequate cytologic screening
    • Variable morphology with several histologic variants described
    • ICD-O: 8070/3 – squamous cell carcinoma, NOS
    • ICD-10: C53.1 – malignant neoplasm of exocervix
    • ICD-11: 2C77.Z – malignant neoplasms of cervix uteri, unspecified
    • Fourth most common type of cancer and cause of cancer mortality among women worldwide in 2018
    • Most common type of cervical carcinoma
    • Most patients are 40 – 54 years old
    • Significant disparities in incidence and mortality between low resource countries versus high resource countries
    • Incidence varies from 100 per 100,000 in unscreened women to 1 – 5 per 100,000 in highly screened women
    • Approximately 75% decrease over the past 50 years in countries with cervical cancer screening programs
    • Approximately 76&#37 of recent cases occur in countries without screening programs
    • In high resource countries, more common in women who failed to receive screening or follow up

    Stage I

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