Didactics-Colposcopy and Management of Adenocarcinoma in situ of the Cervix

Video Transcription

Video Summary

The speaker discusses adenocarcinoma in situ (AIS) of the cervix, distinguishing it from squamous carcinoma by originating in endocervical glands. Unlike squamous carcinoma, AIS has large, dark nuclei but is characterized by an intact basement membrane, indicating it's not invasive. Diagnosis often includes HPV screening, as atypical glandular cells can be missed in Pap tests. The speaker highlights colposcopy and endocervical curettage (ECC) as essential steps in evaluation, stressing the importance of identifying atypical vessels and acetyl white lesions which may indicate AIS.<br /><br />The management includes a careful follow-up due to the potential severity, with a focus on the histological examination demonstrating P16 positivity for HPV-related cases. For those with margins showing AIS, a repeat excision is needed until negative margins are achieved. Hysterectomy is often recommended post-childbearing. The patient's age should guide additional assessments for endometrial biopsy, particularly for those over 35 or with risk factors.<br /><br />Close follow-up of up to 25 years is recommended, employing HPV-based testing to monitor potential recurrence, emphasizing the necessity for regular surveillance in managing those opting for fertility conservation.

Asset Subtitle

Alan Waxman
January 2025

Keywords

adenocarcinoma in situ

cervical cancer

HPV screening

colposcopy

endocervical curettage

histological examination

hysterectomy