3 - Cervical cancer Flashcards
What is the most common type of cervical cancer?
expect to be on test
SCC
What are the risk factors for development of cervical cancer?
1) young first intercourse
2) multiple partners
3) smoking
4) HPV infection (high risk strains)
5) STD’s
Early cervical cancer is typically asymptomatic. What s/s would raise a red flag?
post-coital bleeding, vaginal/pelvic pain, vaginal d/c
What tests could you order to investigate cervical cancer?
cytology, bx
What preventative measures should you always recommend for cervical cancer?
1) Regular cervical cytology (PAP’s)
2) HPV vaccine (quadrivalent)
3) Safe sex
What is the typical technique for getting a cytologic screening?
Use a spatula for exocervix, cytobrush for endocervix, and twirl in liquid medium (thin prep). And for the love of god, don’t be shy. Collect enough specimen. Nobody likes coming back for a repeat PAP
Your 19 year old patient reports her first intercourse was age 15. When should she have her first PAP screening? Why?
Age 21. Regardless of sexual practice.
(Do not test earlier b/c it will likely be HPV+ and lead to expensive dx tests and procedures that may carry risk to patient/fertility, etc. HPV often clears on its own)
For all females between 21 and 29, what should you order for routine female wellness exams? How often should this be done?
Order a PAP with reflex to HPV. Q3years.
(Meaning, the lab will only test for HPV is the PAP smear is abnormal. If the PAP is normal, no HPV test will be performed)
For all females between 30 and 65, what should you order for routine female wellness exams? How often should this be done?
Order a PAP with HPV screening Q5years. (If last 3 PAPs were normal)
Patients older than 65 can discontinue screening if last 3 tests were normal.
Your 35 year old patient’s report comes back with a negative (normal) PAP, but she is HPV+. What should you do next?
Nothing. HPV is not concerning if there is no dysplasia of the cervical cells. She can schedule her next screening in 5 years.
What PAP results are concerning and should warrant a referral to OBGYN?
1) ASC-US (atypical squamous cells of undetermined species) with HIGH risk HPV
2) LSIL/HSIL (low/high grade intraepithelial lesion)
3) CIN-grade 2+ (cervical intraepithelial neoplasm)
What should you know about the HPV vaccine?
1) Series of 3 immunizations (0 months, 2 months, and 6 months)
2) Duration uncertain, but proven effective for 3.5 years.
3) Costs apprx $500
What is the purpose of a PAP? (Ryan!! step away from the Keurig)
cytology screening for cervical dysplasia/cervical cancer
You have a post-menopausal woman who’s PAP report notes the presence of endometrial cells, but no squamous abnormalities. Should you be concerned? What will you do?
Yeah, you shouldn’t see endometrial cells (inner lining of uterus) in a women who no longer menstruates. You should get a bx.
