Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). Instructions: - Reply # 1: Consider discussing cervical cancer and discharge on your reply. - Reply

POST # 1 ANITA

NOTE: Consider discussing cervical cancer and discharge on your reply.

Cervical Cancer
In 2018, there was an estimated 570,000 new cases of cervical cancer and 311, 000 deaths worldwide (Frumovitz, 2020). Cervical cancer is the third most common gynecologic cancer and cause of death in the United States (Frumovitz, 2020). In countries that do not have access to screening and prevention programs, cervical cancer is a significant cause of cancer morbidity and mortality (Frumovitz, 2020). Human papillomavirus (HPV) is found in 99.7 percent of cervical cancers and is central in the development of cervical neoplasms (Frumovitz, 2020).
Early stages of cervical cancer are often asymptomatic (Frumovitz, 2020). When symptoms do develop, the most common presentation is irregular or heavy bleeding and post-coital bleeding (Frumovitz, 2020). Non-specific findings, which are often mistaken for vaginitis or cervicitis initially, include watery, mucoid, purulent or malodorous vaginal discharge (Frumovitz, 2020). In roughly half of the patients diagnosed with cervical cancer, the disease is localized, thirty six percent have regional disease spread, and fifteen percent have distant metastases (Frumovitz, 2020).
A physical and pelvic exam should be completed on any person whose sex at birth is/was female. The Papanicolaou (Pap) test is used to screen women for abnormal cells that can lead to cervical precancer or cancer (Feldman, Goodman, & Jeffrey, 2020). Pap tests often include testing for specific strains of human papillomavirus (HPV) which can cause cervical dysplasia (Feldman, Goodman, & Jeffrey, 2020). A Pap screening test at specific testing intervals to detect the early stages of precancer or cancer so that the patient can have a positive prognosis or outcome (Hubert & VanMeter, 2018). Further tests, such as a cervical biopsy is performed when there is cervical cell dysplasia (Hubert & VanMeter, 2018). The cervical biopsy, or colposcopy, helps determine if HPV is causing the dysplasia and the degree of cell alteration (Hubert & VanMeter, 2018). Predisposing factors for cervical dysplasia are sexual contact, as HPV is spread by direct skin to skin contact, including sexual intercourse, oral and anal sex, and other contact involving sexual contact (Feldman, Goodman, & Jeffrey, 2020). Other predisposing factors include having multiple partners, not using a barrier protection, increased age, smoking and being immunocompromised (Feldman, Goodman, & Jeffrey, 2020). The diagnosis of cervical cancer is made based on cervical cytology (Hubert & VanMeter, 2018). Cervical dysplasia, or atypical glandular cells on cervical cytology, are categorized based on the degree of cellular change (Goodman & Huh, 2020). The three main categories of cervical intraepithelial lesions (CIN) include: CIN-1 or lesser abnormalities, CIN 2 and CIN 3 (Goodman & Huh, 2020). CIN-1 or lesser abnormalities includes atypical cells of undetermined significance (AS-CUS) and low grade squamous intraepithelial lesions (LSIL) with HPV 16 or 18 infection, or persistent HPV infection (Goodman & Huh, 2020).
Following guidelines set forth by the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American College of Obstetricians and Gynecologists (ACOG), testing for cervical dysplasia varies depending on the degree of cellular change, age, if there was previous abnormal cytology (and degree of cellular change) and if the patient is within childbearing age (Goodman & Huh, 2020). Low grade CIN has a low potential to progress to malignancy (cancer) but high grade CIN has a high potential to develop into cancer (Goodman & Huh, 2020). Patients less than 25 years of age with low grade CIN are usually observed and retested within 6 months to one year (Goodman & Huh, 2020). If 25 or older with no previous abnormal cytology, ASC-US is monitored with co-testing in one year or test for HPV (Goodman & Huh, 2020). If the clinician opts to test for HPV, if HPV negative then the recommendation would be to repeat co-testing in 3 years. If HPV positive, manage like CIN 1 and HPV positive with a biopsy [colposcopy] (Goodman & Huh, 2020). If co-testing in one-year results in normal cytology and HPV negative, clinicians should resume Pap testing every 3 years (Goodman & Huh, 2020). If co-testing results in abnormal cytology or a positive HPV test, a colposcopy of the cervical tissue is recommended (Goodman & Huh, 2020). There have been studies that have demonstrated regression of CIN 2 and 3, and if the woman is within childbearing age, the clinician may decide to monitor and co-test in one year (Goodman & Huh, 2020). If 25 or older, if low grade CIN preceded high grade squamous intraepithelial lesion (ASC-H), CIN 2 or 3 the clinician can opt to co-test at 12 and 24 months if within childbearing age (Goodman & Huh, 2020). If negative upon retest, resume screening as age appropriate. If there is a positive cytology or HPV upon retest the recommendation would be to conduct a colposcopy (Goodman & Huh, 2020). The clinician may also choose to do a diagnostic excision procedure (conization) or review cytological, histological and colposcopy findings and manage per ASCCP guidelines (Goodman & Huh, 2020). 
Resources for clinicians include the guidelines set forth by the American Society for Colposcopy and Cervical Pathology (ASCCP), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventative Services Taskforce (USPSTF). The links for each is below:

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening

https://www.acog.org/patient-resources/faqs/special-procedures/cervical-cancer-screening

https://www.asccp.org/screening-guidelines
UpToDate is also a great resource for beginning clinicians to access guidelines, recommendations, presenting symptoms and treatment options (Appendix 1 for list of resources from UpToDate). 

Treatment options for cervical cancer vary on the degree of dysplasia, age, tumor and other patient factors (Straughn & Yasher, 2020). Some treatment options include modified radical hysterectomy, fertility sparing surgery, primary radiation therapy (with or without chemotherapy). Primary treatment with early stage cervical cancer is a modified radical hysterectomy (Straughn & Yasher, 2020). The prognosis for survival among those diagnosed with cervical cancer depending on a variety of factors including cancer stage, nodal status, tumor volume, depth of cervical stromal invasion, and lymph node invasion (Straughn & Yasher, 2020).
References
Frumovitz, M. (2020). Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. Retrieved from UpToDate: https://www.uptodate.com/contents/invasive-cervical-cancer-epidemiology-risk-factors-clinical-manifestations-and-diagnosis?search=cervical%20cancer&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
Feldman, S., Goodman, A., & Jeffrey, P. (2020, April). UpToDate: Cervical Cancer Screening . Retrieved from www.uptodate.com:https://www.uptodate.com/contents/cervical-cancer-screening-beyond-the-basics?search=cervical%20dysplasia&topicRef=8417&source=see_link
Goodman, A., & Huh, W. (2020, April). Cervical Cytology Evaluation. Retrieved from UptoDate: https://www.uptodate.com/contents/cervical-cytology-evaluation-of-atypical-and-malignant-glandular-cells?search=cervical%20dysplasia&topicRef=3215&source=related_link
Hubert, R., & VanMeter, K. (2018). Gould's Pathophysiology for the Health Professions (Vol. Sixth Edition). Elsevier.
Straughn, M., & Yasher, C. (2020). Management of early-stage cervical cancer. Retrieved from UpToDate: https://www.uptodate.com/contents/management-of-early-stage-cervical-cancer?search=cervical%20cancer%20treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2