A modified terminology for cervical intraepithelial neoplasia

Article Abstract:

To bring classification up-to-date with current knowledge, a new way of categorizing and conceptualizing squamous cell carcinoma of the cervix (cervical cancer) is proposed. The systems currently in use rely mainly on morphological criteria to describe the stages of cervical cancer. One system lists the stages as cervical intraepithelial neoplasia (CIN, growth of new, abnormal epithelial cells): CIN 1, CIN 2, CIN 3, and invasive carcinoma (when the malignancy has deeply penetrated the uterine tissue). The other, and older, formulation conceptualizes cervical cancer as a two-stage process, with discrete divisions between the stages: dysplasia (changes in normal cellular architecture), then carcinoma in situ (CIS). This approach resulted in treatment by hysterectomy for many women. Recent research results regarding the association of human papillomavirus (HPV) with genital tract cancers led to a new conceptualization. It is suggested that the term ''low-grade CIN'' be applied to cases in which infection with HPV has produced a lesion that may or may not develop further to malignancy. ''High-grade CIN'' (the former CIN 2 and CIN 3) would then be reserved for intermediate- and high-risk HPV types (different viral strains); this designation would include lesions that are precursors of malignancy. HPV infections progress when the virus, dwelling within cell nuclei, undergoes a change and begins to integrate itself into cellular DNA. The genetic mechanisms of this event are briefly described; a marked change in the appearance of the genital lesion can be noted at this point. Use of a classification system that takes modern knowledge into account would allow the clinician to immediately understand the kind of abnormality thought to be present. Lesions classified as high-grade CIN lesions would be true cancer precursors, and appropriate investigation of the patient would be instituted. The proposed schema adds an operational component to the outdated morphologic descriptive terms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Development and progression, Cervical cancer, Identification and classification

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Case-control study of cancer of the vulva

Article Abstract:

Cancer of the vulva, the external portion of the female genitalia, is uncommon (1.6 per 100,000 US women). It occurs more often in elderly women and in blacks. Women with a history of genital herpes or venereal warts (condyloma, human papillomaviruses) are more likely to develop cancer of the vulva. In addition, cancer of the vulva and cancer of the cervix often coexist. It is postulated that since the cells lining the cervix, vulva and the anal region are derived from similar cell lines during embryonic development, there may be some common factors causing cancers in that region. Risk factors involved in cancer of the vulva were studied among 209 vulvar cancer patients. The risk of vulva cancer increases as the number of sexual partners increases. Women with five or more partners were two to three times more likely to develop cancer of the vulva than women with one or no sex partners. The risk for cancer was increased in women who had intercourse at an early age and in women with low socioeconomic status. Women with a history of genital warts, an abnormal PAP smear, or a history of smoking were more likely to develop cancer of the vulva (15.2, 1.8 and 2.0 times respectively). Women who had a history of both genital warts and smoking were 35 times more likely to develop cancer of the vulva. The age at which menstruation began and ended, history of pregnancy or hygienic factors (bathing and washing habits) were not related to an increased risk for cancer of the vulva. Risk factors such as sexual behavior and history of venereal warts are also found among women with cervical cancer. The relationship between the human papillomaviruses, smoking behavior and cancer seem to be worth investigating further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Cancer, Vulvar cancer

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Cervical effacement: variation in belief among clinicians

Article Abstract:

Cervical effacement (thinning) occurs when the cervix of the uterus is incorporated into the lower segment of this organ and the cervical canal shortens. Effacement occurs prior to or during early labor. It is measured as a percentage of the uneffaced cervix or as the length of the uneffaced cervix in centimeters. This measurement can be useful in evaluating preterm labor, predicting successful labor induction, and assessing the progress of labor. It is uncertain if one method of measuring cervical effacement is better than the other. The percentage method is equivalent to the centimeter method if there is general agreement on the length of the uneffaced cervical canal. Otherwise, the centimeter method is preferable because it does not rely on any such standard. Questionnaires were sent to 126 physicians practicing obstetrics, asking which measurement method they used and what they considered the length of the completely uneffaced cervix to be. Responses were obtained from 84 (65 percent) of the physicians. Fifty-three (65 percent) reported using the percentage method, 11 (13 percent) measured the length of the cervix in centimeters, and 18 (22 percent) used both methods. The average estimated length for the uneffaced cervix was 2.47 centimeters, with a range of 1 to 4 centimeters. Private physicians estimated the length to be significantly shorter than did hospital physicians. These results indicate that the percentage method is less accurate because physicians rely on a wide variation of lengths of the uneffaced cervix. Adopting a measurement based on length in centimeters would bring about a more standardized, and thus useful, method for assessing cervical effacement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Medical examination, Labor (Obstetrics), Cervix uteri

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