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Case study

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catrina richardson

on 6 April 2015

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Transcript of Case study

Plan
Colposcopy
LEEP therapy
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
Diagnosis
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
References
Subjective cont.
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.
Medications-none
Allergies-amoxicillin, ampicillin and pencillin
Cervix
Subjective
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.
Case Study
Georgetown University
Catrina Richardson

Objective
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
Differential Diagnosis
Infections
Cervicitis
Cervical erosion
Endometrial carcinoma
Uterine carcinoma
Vaginal carcinoma
Iatrogenic
American Cancer Society (2015). Cervical cancer. Retrieved from http://www.cancer.org/acs/
groups/cid/documents/webcontent/003094-pdf.pdf
Boardman, C. H., & Matthews, K. J. (2014). Cervical Cancer. In W. K. Huh (Ed.), Retrieved
from http://emedicine.medscape.com/article/253513-differential
Castle, P. E., Shaber, R., LaMere, B. J., Kinney, W., Fetterma, B., Poitras,N., Lorey, T.,
Schiffman, M., Dunne, A., Ostolaza, J. M., McKinney, S., & Burk, R. D. (2011). Human
papillomavirus (HPV) genotypes in women with cervical precancer and cancer at Kaiser
Permanente Northern California. Cancer Epidemiology Biomarkers & Prevention, 20(5),
946–953. doi: 10.1158/1055-9965.EPI-10-1267
Cervical cancer (n.d.). Medline Plus (2013). Retrieved from http://www.nlm.nih.gov/
medlineplus/ency/article/000893.htm
Elit, L., Fyles, A. W., Oliver, T. K., Devries–Aboud, M. C., & Fung-Kee-Fung, M. (2010).
Follow-up for women after treatment for cervical cancer. Current Onclogy, 17(3): 65–69.
Jensen, K. E., Schmiedel, S., Frederiksen, K., Norrild, B., Iftner, T., & Kjær, S. K. (2012) Risk
for cervical intraepithelial neoplasia grade 3 or worse in relation to smoking among
women with persistent human papillomavirus infection. Cancer Epidemiology,
Biomarkers & Prevention, 21(11), 1949–1955. doi: 10.1158/1055-9965.EPI-12-0663
King, T., Brucker, M., Kriebs, J., Fahey, J., Gegor, C., & Varney, H. (2013). Gynecologic
Disorders. In Varney's Midwifery (5th ed., pp. 399-405). Burlington: Jones & Bartlett
Learning.
National Institutes of Health, National Cancer Institute. (2015). Cervical cancer treatment.
Retrieved from http://www.cancer.gov/cancertopics/pdq/treatment/cervical/
HealthProfessional
Schuiling, K.D., & Likis, F. E. (2011). Gynecologic Caners. In Woman’s Gynecologic Health
(2nd ed., p 707-730). Burlington: Jones and Bartlett Learning.
Takeda, N., Suzuki, T., Suzuki, M., Matsuura, M., Tanaka, R., Fujii, M., Ito, E., & Saito, T.
(2011). Evaluation of cervical conization as a definitive treatment for microinvasive
cervical carcinoma and cervical intraepithelial neoplasia grade 3. Archives of Gynecology
and Obstetrics,285(2), 453-457.
Xian Wen Jin, X. W. (2010). Cervical cancer screening and prevention. In W. D. Carey(Ed.),
Cleveland clinic: The Center for Continuing Education. Retrieved from http://
www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/
cervical-cancer/
THM
THM
Diagnostic criteria
Presentation
Treatment
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
Dyspareunia
Abnormal vaginal discharge
Changes in menstrual bleeding
Abnormal vascularity
White change with acetic acid
Visible exophytic lesion
Cervical cell dysplasia
Incorporation of HPV DNA/RNA into normal cells
Colposcopy
Biopsy
Surgery
Radiation
Chemotherapy
Follow-up
Pathophysiology
Full transcript