C19 Intraepithelial Disease of the Cervix, Vagina, and Vulva

Cervical intraepithelial neoplasia CIN

Transformation zone? ??.

HPV 16/18(m/i), condyloma, flat wart
Smoking, immunodeficiency

P5 C193 Human Papilloma virus Infections

48hr ? douching, intercourse, tampon? ?????.
??? 51%, ???? 49% ? liquid-based pap?? ?? (up to 80%)

Atypical vascular pattern: invasive cervical ca.? ??

Progression is not inevitable. CIN 1 often regresses.

HSIL?? CIN 1 ?? ??? ??? punch Bx ??? ??
Glandular cell? ??? (AGUS) endometrial, cervical ca.? ?? ? ?? ?? Bx, ECC ??!

Colposcopy? 12? ?? ???? ??. Repeat Bx? ?????? invasive? ??
???: HSIL????? Colposcopy
???: LSIL/HSIL? Bx ?? colposcopy. But ??? ?? ? 6??? ?? ? ??.

Indication
- Colpo: ??? ? ??? ?, SCJ? ?? ?, invasive ca. ??? ? ?? ?
- ECC: CIN2/3, Cytology-Bx-Colppo ??? ???? ?? ?.
Procedure
- Cold knife – using scalpel
- LEEP – via electrocautery. ‘loop electrosurgical excision procedure’
Complications
- Cervical stenosis
  - d/t scar tissue
  - May impede menstrual flow and cause secondary dysmenorrhea or amenorrhea, impaired fertility.
- Cervical incompetence
- Preterm delivery

??	??? ?? ??? RTx, ??? RTx ??? ??
??	Microinvasive cancer: 2?? ??? conization ? f/u LVSI(+) or stage Ia2: ? ?? ???? c/s. ?? ? ?? hysterectomy
CCRT Indication	IIB~: primary CCRT Ia2~IIa: at high risk post-op. patient (margin +, LN meta, parametrial invasion)

Prognostic factor
Size
Depth
Parametrial spread
LVSI
LN (m/i)

?? CIN? ??. Pap?? screening + colpo Bx? ??.
VAIN 1, HPV: ??x
VAIN 2: � ablation
VAIN 3: laser therapy

Lower 2/3: spread to inguinal nodes
Upper 1/3: spread to regional iliac nodes

??? ?? ?? ???
Lump – m/c
Vulvar pruritus, ulceration, bleeding.

VIN1
- ???? ??? ??? ????
VIN2
- ??? ?? ?? ? ??.
VIN3
- Simple excision, laser ablation, superficial vulvectomy
- Resection margin (+) or LVSI (+)? ?? wide local excision.
Microinvasive cancer (1mm ?? ?? & 2cm ?? ??)
- Excision of small foci.
1mm?? ?? ? or ??? 2cm ??
- ??? inguinofemoral LND