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Transcript of Case study
Lifestyle-smoker, exercise, reduce stress
Diet-antioxidants, fruits, vegetables
Follow-up - q 3-4 months for first 2 yrs, then q 6-12 months in years 3-5, then return to yearly annuals with pelvic exams after 5 yrs of recurrence free follow-ups
CIN III Stage 0 cervical carcinoma in situ (CIS)
-Cancer cells that are confined to the surface of the cervix without growth to the deeper tissues
Medical Hx-nothing significant
Family Hx-mother-living with asthma, father-living with HTN, 5 siblings (2 sisters, 3 brothers)-all living and healthy, 2 daughters both healthy
Surgical/Hospitalization Hx-cesarean x2
OB/gyn Hx-G4P2022, c/s '10 and '12 for fetal intolerance to labor and repeat. Abnormal pap & HPV infection in 2011, hx of chlamydia with tx in '10, menarche @12 y/o, regular monthly menses for 5-7 days. Reports small amount of vaginal bleeding after intercourse. It's not painful and usually resolves on its own.
Social Hx-retail associate, 2 kids & partner live in a duplex, safe in relationship and environment, no regular exercise, eats mostly Hispanic foods with little vegetables or fruit, former/current smoker prior to her first pregnancy with 2-3 cigarettes/day.
Allergies-amoxicillin, ampicillin and pencillin
Sylvia is a 23 y/o Hispanic women who presents to establish well women care following a SAB at 5 wks, 3 months ago. She has recently moved from Chicago and her mother suggested she go to a CNM for her annual exam because they give the best care. After her initial SAB f/u she did not RTC because after 3 wks she did not experience any further complications and her period has returned. She mentions she is having a small amount of vaginal bleeding after intercourse and that is part of the reason she is here today. She was 18 when she had her last pap and she recalls the pap was abnormal and she had HPV. She says she had a Mirena IUD that was removed before a colposcopy. She also says they offered her a hysterectomy.
BP-118/60, HR-84, RR-18, Temp-97.8 F
Hgt-64in, Wgt-140lbs, BMI-24
Complete physical done with no significant findings
Pelvic and Pap
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Cervical cells that are most prone to cervical cancer are at the squamocolumnar junction of the cervix.
Cancer cells evade mortality by escaping cell death and are under the control of damaged DNA.
Squamous cell carcinoma represent ~90% of cervical cancers.
Though there are many different influences on cervical cancer, HPV, specifically 16 & 18, has shown to be the cause at least 2/3 of cervical cancers.
Abnormal vaginal bleeding
Abnormal vaginal discharge
Changes in menstrual bleeding
White change with acetic acid
Visible exophytic lesion
Cervical cell dysplasia
Incorporation of HPV DNA/RNA into normal cells