3: Cervical Cancer Algorithms

Question 1

How do you follow up? Women with LSIL and negative HPV test (30+ age).

Answer 1

• Repeat cotesting at 1 year (preferred)
  
  • Negative: Repeat cotesting at 3 years
  • Positive: Colposcopy

or

• Colposcopy (acceptable)

Question 2

How do you follow up? Women with atypical glandular cells.

Answer 2

• All types except atypical endometrial cells: Colposcopy with endocervical sampling and if 35+ endometrial sampling.
• Atypical endometrial cells: endometrial and endocervical sampling.

Question 3

How do you follow up? Women with HSIL.

Answer 3

• Immediate loop electrosurgical excision

or

• Coloposcopy

Question 4

How do you follow up? Unsatisfactory cytology and HPV is positive (age 30+).

Answer 4

• Repeat cytology in 2-4 months

or

• Coloposcopy

Question 5

How do you follow up? Women with ASC-H

Answer 5

Colposcopy

Question 6

How do you follow up? Women with LSIL with no HPV test or positive HPV test.

Answer 6

Colposcopy

Question 7

How do you follow up? Unsatisfactory cytology and HPV is unknown (any age).

Answer 7

Repeat cytology in 2-4 months.

• Negative: Return to routine screening.
• Abnormal: Follow protocols.
• Unsatisfactory: Colposcopy.

Question 8

How do you follow up? ASC-US on cytology.

Answer 8

• Repeat cytology at 1 year
  
  • Negative: Routine screening
  • Positive: Colposcopy

or

• HPV Testing (preferred)
• Positive: Colposcopy Negative:
• Repeat cotesting at 3 years

Question 9

How do you follow up? Pregnant women with LSIL.

Answer 9

• Colposcopy (perferred)
• Defer colposcopy until 6 weeks postpartum

Question 10

How do you follow up? Women 30+ who are cytology negative but HPV positive.

Answer 10

• Repeat cotesting at 1 year
  
  • Negative: repeat cotesting in 3 years.
  • Positive: Colposcopy

or

• HPV DNA typing
  
  • Negative (16, 18): repeat cotesting at 1 year
  • Positive (16, 18): Colposcopy

Question 11

How do you follow up? Unsatisfactory cytology and HPV is negative (age 30+).

Answer 11

Same as for HPV unknown with unsatisfactory cytology. Repeat cytology in 2-4 months:

• Negative: Return to routine screening.
• Abnormal: Follow protocols.
• Unsatisfactory: Colposcopy.