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Endo/Repro II Test 1 > 5. Pap Smear > Flashcards

5. Pap Smear Flashcards

1
Q

How has screening affected the incidence of cervical cancer?

A

Decreased incidence by more than 50% in the past 30 years.

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2
Q

Cervix has what kind of epithelium?

A
  • 1. Columnar
  • 2. Stratified nonkeratin squamous epithelia
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3
Q

Where does most cervical cancer occur and what causes it?

A
  1. 90% happens at squamocolumnar junction
  2. 90% caused by HPV
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4
Q

Most cervical cancer is __________ carcinoma.

A

Squamous cell carcinomas (80%)

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5
Q

Know the RFs for cervical neoplasia and cancer.

A
  1. Multiple sexual partners or partner w/ multiple
  2. Young age @ first intercourse or pregnancy
  3. Smoking
  4. HIV/STIs/Organ transplant
  5. DES exposure
  6. Infrequent or absent pap screening tests
  7. High parity
  8. Lower SES
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6
Q

List the pap smear/cytology screening guidelines.

A
  1. Start at 21
  2. 21-29: cytology (pap smear) alone every 3 years
  3. 30-65: HPV and cytology every 5 years
  4. 65 and older: no screening following adequate negative prior screening
  5. After hysterectomy: no screening
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7
Q

Know the management of a patient with an abnormal pap test.

A
  1. Pap smear or colposcopy
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8
Q

Describe the symptoms and PE findings of a patient with cervical cancer.

How does it spread?

A
  1. Symptoms:
    1. Post-coital bleeding (most common sx)
    2. watery vaginal bleeding
    3. intermittent spotting
  2. Spread by direct invasion and lymphatic spread
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9
Q

As we age, how does the SQJ and TZ change?

A

Neonate and postmenopausal: located inside; located out at other times

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10
Q

Which strains of HPV cause the majority of cancers?

A

HPV 16*, 18*, 31, and 45

* = 70% of cervical cancers

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11
Q

What are the pap smear screening guidelines following hysterectomy?

A

No screening

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12
Q

is cervical cancer hereditary

A

no

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13
Q

If 40 y/o patient had an HPV status that was unknown on her last pap result when would she need another pap?

A

3 years when unknown

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14
Q

What can the 2001 Bethesda System tell us about a pap smear?

A
    • Specimen type (conventional or liquid-based)
    • Specimen adequacy = satisfactory for eval or unsatisfactory (not enough cells)
    • General categorization: negative/abnormal/other
      1. - Organisms
      2. - Other non neoplastic findings: inflammation, radiation, IUD
      3. - Epithelial cell abnormalities
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15
Q

In the 2001 Bethesda System, what does general categorization tell us about the pap smear?

A
  1. Negative for intraepithelial lesions or malignancy
  2. Abnormality of epithelial cell: see interpretation/result for details
  3. Other: see interpretation/result (endometrial cells in a W older than 40YO)
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16
Q

What are common organisms that Bethsda system can detect?

A
    1. Trichomonas
    1. Fungal organisms consistent w Candida
  • 3. Bacterial vaginosis suggested by shift in flora
    1. Actinomyces bacteria
    1. HSV
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17
Q

What type of squamous epithelial cell abnormalties can 2001 Bethesda System detect?

A
  1. Atypical squamous cells (ASC-US/ASC-H)
    1. -US = undetermined significance
    2. -H: cannot exclude high grade
  2. LSIL (low grade squamous intraepithelial lesions)
  3. HSIL (high grade squamous intraepithelial lesions)
  4. Squamous cell carcinoma
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18
Q

What type of glandular epithelial cell abnormalties can 2001 Bethesda System detect?

A
  1. Atypical (endocervical, endometrial (favor neoplastic), glandular (favor neoplastic))
  2. Adenocarcinoma (endocervical, endometrial, extrauterine, not otherwise specified)
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19
Q

Cervical changes from NL => cervical cancer

A
  1. NL
  2. LSIL
  3. HSIL
  4. Cervical cancer
20
Q

Managment of a women w/ atypical squamous cells of undetermined significance (ASC-US) on cytology

A
  1. Repeat cytology at 1 year
    1. (-) => back to routine screening
      • ASC => + colposcopy
  2. Do HPV testing
    1. (-): repeat cotesting @ years
    2. (+; managed same as LSIL): coloscopy
21
Q

What are the guidelines for managment of a women w/ LSIL pap smear?

A
  1. LSIL with (-) HPV test
  2. LSIL with no HPV test
  3. LSIL with (+) HPV test
22
Q

What are the guidelines for managment of a women w/ LSIL and (-) HPV test?

A
  1. Repeat co-testing at 1 year (preferred), but colposcopy is acceptable
    1. @ co-testing:
      1. If cytology and HPV negative => repeat at 3 years
      2. If ≥ASC or HPV positive => then colposcopy
23
Q

What are the guidelines for managment of a women w/ LSIL and no HPV test or a (+) HPV test?

A

Colposcopy

24
Q

What are the guidelines for managment of a women w/ HSIL?

A
  1. Immediate loop electrosurgical excision
  2. Colposcopy (w/ endocervical assessment)
25
Q

Gold standard for diagnosis and treatment planning of abnormal pap smear

A

Colposcopy w/ directed biopsy;

cervix is washed w 3% acetic acid, which dehydrates cell and large nuclei of abnormal cell turns white (acetowhite changes)

26
Q

To be adequate, what must be seen on coloscopy?

A

SQJ

27
Q

What are the abnormalities you are looking for on Colposcopy?

A
  1. Acetowhite changes
  2. Punctuations (tiny blood vessels)
  3. Mosaicism
  4. Abnormal blood vessels
  5. Masses
28
Q

What is CIN for:

  1. Acetowhite changes
  2. Punctuations (tiny blood vessels)
  3. Mosaicism
  4. Abnormal blood vessels
  5. Masses
A
  1. Acetowhite changes: CIN 1
  2. Punctuations (tiny blood vessels/dots): CIN 2, maybe 3
  3. Mosaicism: BAD; almost always CIN 3
  4. Abnormal blood vessels
  5. Masses
29
Q

What is seen in high grade lesions (CIN 3)?

A
  1. LOTS of acetowhite changes
  2. Mocaicism
30
Q

What are the 2 main treatment options for abnormal pap smears?

Mark most common

A
  1. Ablative (cryotherapy or laser) = destroy cervical tissue
  2. Excisional (CKC or LEEP) ***
31
Q

What are the 2 types of exisional procedures?

A
    1. CKC = cold knife cone
    1. LEEP = loop electrode excisional procedure
32
Q

WHEN are excisional techniques done? (3)

A
  1. (+) ECC (endocervical curettage) => perform CKC
  2. Unsatisfactory colposcopy (NO SCJ)
  3. Discrepancy between pap and biopsy (High grade pap, but negative colposcopy)
33
Q

4 risks of with excisional procedures for cervical neoplasia?

A
  1. ↑ risk of cervical incompetence causing pregnancy loss in 2nd trimester
  2. ↑ risk of preterm premature rupture of membranes (PPROM)
  3. Cervical stenosis
  4. Operative risks (bleeding, infection)
34
Q

Median age of diagnosis of cervical cancer

When do precursor lesions precede invasive carcinoma?

A
  • 47 YO
  • 10 years before
35
Q

How is cervical carcinoma staged?

A

- Clinically by:

  1. PE
  2. Radiologic exams –> CXR and skeletal XR’s + intravenous pyelogram
  3. Cystoscopy
  4. Sigmoidoscopy
  5. Liver function studies
36
Q

How is microinvasive cervical carcinoma managed clinically?

Invasive?

A
  1. Cold knife cone or hysterectomy
  2. Radical hysterectomy w/ LN dissection
37
Q

Prevention of cervical cancer (4)

A
  1. Abstinence/ decrease partners
  2. Contraception
  3. Regular exams and pap smears (dec by 40%)
  4. HPV vaccine
38
Q

HPV vaccine recommendations

A
  • All M/F 9 to 45 YO
39
Q

How many injections are in a series of HPV vaccine and what is the recommendation for scheduling?

A

3 injections:

  • 1st dose
  • 2nd dose 2 months later
  • 3rd dose 6 months from the first (can still be given if interval varies)

In children <15 YO: give 2 doses separated by 6-12 month

40
Q

If a patient already has an abnormal pap can they receive an HPV vaccine; what about during pregnancy and breast feeding?

A
    • YES: abnormal pap or breastfeeding
    • NO: pregnancy
41
Q

What are the 2 Gardasil vaccines?

A
    1. 4 strain (6, 11, 16, 18): protects against 70%
    1. 9 strain (+ 31, 33, 45, 52, 58)
42
Q

What drug is NO longer on the market for girls 9-25 and protects against 16 and 18?

A

Cervarix

43
Q

List 6 AE’s associated with HPV vaccination?

A
  1. Syncope** (most common)
  2. Dizziness
  3. HA + fever + nausea
  4. Injection site rxns (pain, swelling, and redness)
44
Q

If a patient has a + pap smear (HSIL), but a (-) colopscopy, what do you do?

A

Exision

45
Q

If a patient has a unnsatisfactory colposcopy, and the SQJ cannot be be seen. What do we do?

A

Excisiojn

Endo/Repro II Test 1 (23 decks)

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