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Cervical Intraepithelial Neoplasia

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Alana Perusse

on 5 March 2015

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Transcript of Cervical Intraepithelial Neoplasia

Cervical Intraepithelial Neoplasia
Alana Perusse
Tamara Mascarenhas
Aleena Rahat
Etiology and Risk Factors
The ultimate cause of CIN is not known.
However, most cases are caused by high risk HPV infections.
HPV types
Risk factors
HPV 16
HPV 18
HPV 31
HPV 33
HPV 34
HPV 39
HPV 45
HPV 51
HPV 52
HPV 58
HPV59
HPV 66
HPV 68
Sexual intercourse at an early age
Multiple sexual partners
Other STDs such as herpes, syphillis
Tobacco smoke
HIV
Giving birth at an early age
Low socioeconomic status
Long term oral contraceptive use
Prevalence
75% of Canadians will acquire at least one HPV infection in their lifetime
23% of women under the age of 21 have CIN
80% of CIN worldwide is in developing countries
An estimated 1,500 Canadian women are diagnosed with cervical cancer each year while 580 women die from cervical cancer
Worldwide, there are ~450,000 new cases and 250,000 deaths each year from cervical cancer, making it the fourth most common cancer in women.
Pathogenesis
Cervical Intraepithelial Neoplasia

HPV Structure
Treatment
Cervical Punch Biopsy
Cone biopsy
Cryotherapy
What is
CIN?
E6 and E7
pE7
pE6
LEEP Procedure
Diagnosis
How is it done?
The Bethesda System
f
Prognosis
Prevention
Cervical Intraepithelial Neoplasia
Gardasil® for the prevention of infection caused by HPV types 6, 11, 16 and 18

Cervarix™ for the prevention of infection caused by HPV types 16/18

Prognostic Risk Factors

• Women over the age of 45
• Women that smoke tobacco
• Women that have positive surgical margin post surgical intervention
• Women that have HPV-16 strain


CIN
The Pap Test
This test is named after Dr. George Papanicolaou, who developed the test
The procedure is the removal of a small sample of cells from the cervix, to be examined under a microscope
The Pap Test is the most common method of screening for precancerous conditions of the cervix and cervical cancer
References
Kafuruki, L., Rambau, P. F., Massinde, A., & Masalu, N. (2013). Prevalence and predictors of Cervical Intraepithelial Neoplasia among HIV infected women at Bugando Medical Centre, Mwanza-Tanzania. Infectious Agents and Cancer, 8(45).
Salvador, P., Bravo, V., Alvarez, C., Munoz-Hernando, L., Lorenzo-Hernando, E., Oliver, R., Maequeta-Marques, L., Seoane-Reuiz, J. M., Tejerizo-Garcia, A & Jimenez, J. S. (2014). Natural history of histologically moderate cervical dysplasia in adolescent and young women. OncoTargets and Therapy, 7, p. 2101-2106.
American Cancer Society: Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society, 2015.
Dunne, EF., Unger ER., Sternberg, M., McQuillan, G., Swan, DC., Patel, SS & Markowitz, LE. (2007). Prevalence of HPV infection among females in the United States. JAMA, 297(8), p.813-819.
Coltescu, F., Ioana, H., Carmen, R & C, R. (2012). Cytological, Histological Correlations and Human Papillomavirus Testing in the Diagnosis of Cervical Intraepithelial Neoplasia. Acta Medica Marisiensis, 58(4), p.216-219.
Nogara, P. R. B., Manfroni, L. A. R., Consolaro, M . E. L. (2013). Frequency of cervical intraepithelial neoplasia grade II or worse in women with a persistent low-grade squamous intraepithelial lesion seen by Papanicolaou smears. Arch Gynecol Obstet, 288, p.1125-1130.
Moscicki , A. , Ma , Y. , Jonte , J ., Miller-Benningfield , S. , Hanson , E. , Jay , J ., Godwin de Medina , C . , Farhat , S. , Clayton , L ., & Shibowski , S. (2010). The role of sexual behavior and human papillomavirus persistence in predicting repeated infections with new human papillomavirus types. Cancer Epidemiology Biomarkers and Prevention, 19(8), 2055–2065.
Coutlee , F., Ratnam , S., Ramanakumar , A. V., Insinga, R. R., Bentley , J., Escott , N., Ghatage , P., Koushik , A.., Ferenczy, A., & Franco, E. L. (2011). Distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia and invasive cervical cancer in Canada. Journal of Medical Virology 83, 1034–1041.
Sun, L., Cao, D., Yang, J., Bian, M., Wei, L., Shen, K. (2012). Value-based medicine analysis on loop electrosurgical excision procedure and CO2 laser vaporization for the treatment of cervical intraepithelial neoplasia 2. The Journal of Obstetrics and Gynaecology Research. 38(8), 1064-1070.
Gravitt, P. E. (2011). The known unknowns of HPV natural history. J Clin Invest, 121(12), 4593–4599.

References
Marcellusi, A., Capone, A., Favato, G., Mennini, F. S. , Balo, G., Haeussier, K. & Bononi, M. (2015). Health utilities lost and risk factors associated with HPV-induced diseases in men and women: the HPV Italian collaborative study group. Journal of Clinical Therapeutics 37(1), 156-167.
Erickson, B. K., Landers, E. E., Huh, W. K. (2014). Update on vaccination clinical trails for HPV-related disease. Journal of Clinical Therapeutics. 36(1) 8-16.
Kang, W. D., Choi, H. S., Kim, S. M. (2013). Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)? Gynecologic Oncology. 130, 264-268.
Public Health Agency of Canada. (2012). Update on human papillomavirus (HPV) vaccines. Canada Communicable Disease Report. 38(ACS-1). Retrieved from http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php
Public Health Ontario. (2012). Recommendations for human papillomavirus vaccination; provincial infectious diseases advisory committee on immunizations. Ontario Agency for Health Protection and Promotion. 1-12. Retrieved from http://www.publichealthontario.ca/en/eRepository/PIDAC-I_Recommendations_for_HPV_vaccine_2012_Eng.pdf
Guzman-Olea, E., Bermudez-Morales, V. H., Peralta-Zaragoa, O., Torres-Poveda, K., & Madrid-Marina, V. (2012). Molecular mechanism and potential targets for blocking HPV-induced lesion development. Journal of Oncology. ID 278312, 1-11.
Bernard, H. U., Burk, R. D., Chen Z., van Doorslaer, K., Hausen, H., & de Villiers, E.M. (2010). Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments. Virology, 401, 70–79.
Damjanov, I. (2012). Pathology for the Health Professions. St Louis, MO: Elsevier Saunders.
de Freitas, A. C., Coimbra, E. C., & Leitão, Mda. C. (2014). Molecular targets of HPV oncoproteins: Potential biomarkers for cervical carcinogenesis. Biochim Biophys Acta, 1845(2), 91-103.
Doorbar, J. (2005). The papillomavirus life cycle. J. Clin. Virol. 32, 7–15.
Finzer, P., Aguilar-Lemarroy, A., & Rosl, F. (2002). The role of human papillomavirus oncoproteins E6 and E7 in apoptosis. Cancer Lett., 188,15–24.
Jayshree, R.S., Sreenivas, A., Tessy, M., & Krishna, S. (2009). Cell intrinsic & extrinsic factors in cervical carcinogenesis. Indian J. Med. Res. 130, 286–295.
McLaughlin-Drubin, M. E., & Munger, K. (2009). Oncogenic activities of human papillomaviruses. Virus Res, 143,195–208.
Motoyama, S., Ladnines-Llave, C.A., Villanueva, S. L., & Maruo, T. (2004). The role of human papilloma virus in the molecular biology of cervical carcinogenesis. Kobe J. Med. Sci. 50, 9–19.
Snijders, P. J. F., Steenbergen, R. D. M., Heideman, D. A. M., & Meijer, C. J. L. M. (2006). HPV-mediated cervical carcinogenesis: concepts and clinical implications. J Pathol, 208, 152–164.
Inaba, K., Nagasaka, K., Kawana, K., Arimoto, T., Matsumoto, Y., Tsuruga, T., Mori-Uchino, M., Sone, K., Oda, K., Nakagawa, S., Yano, T., Kozuma, S., & Fujii, T. (2014). High-risk human papillomavirus correlates with recurrence after laser ablationi for treatments of patients with cervical intraepithelial neoplasia 3: A long-term follow-up retrospective study. The Journal of Obstetrics and Gynaecology Research. 40(2) 554-560.
Andrade, C., Scapulatempo-Neot, C., Longatto-Filho, A., Viera, M., Tsunoda, A. T., Silva, I., D., Humberto, J. & Fregnani, T. G. (2014). Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up. Nordic Federation of Societies of Obstertrics and Gynecology, 93, 941-948.
Abha, S., Bhavna, A., Vivek, A. (2011). LEEP verses cryotherapy in CIN. The Journal of Obstetrics and Gynecology of India. 61(4), 431-435.




Two year disease free survival rate
Picture references
http://genetics.thetech.org/ask/ask359
http://www.cancer-therapy.org/CT/v3/B/HTML/46.%20Jo%20and%20Kim,%20419-434.html
http://www.thelancet.com/cms/attachment/2007870159/2030138538/gr2.jpg
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/E/E7_Rb.gif
http://www.genpathdiagnostics.com/wp-content/themes/genpath/images/wh-gencerv-hpv-full.png
http://adiemarg.com/_images/pathology_final.jpg
http://almostadoctor.co.uk/node/355/revisions/7480/view
http://dxline.info/diseases/cold-knife-cone-biopsy
http://upload.wikimedia.org/wikipedia/commons/6/6f/Low_grade_squamous_intraepithelial_lesion.jpg
http://visual.ly/cervical-cancer-infographic
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17034.jpg
https://classconnection.s3.amazonaws.com/651/flashcards/1059651/jpg/90981fig21111334008594771.jpg
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