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Essentials - Gynecology > 9. Cervical cancer screening > Flashcards

9. Cervical cancer screening Flashcards

1
Q

Is carcinoma of the cervix a preventable disease?

A

Yes

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2
Q

Up to 90% of cervical CAs are what? (2)

A
  • squamous cell carcinomas and the remainders are adenocarcinomas
  • Rarely, cervical CAs have features of both squamous cell carcinomas and adenocarcinomas (i.e., adenosquamous carcinomas).
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3
Q

How to detect abnormal cells on the cervix?

A

The Pap cytologic test (“Pap test”) is the only way to

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4
Q

Describe Epidemiology of Cervical Cancer (6)

A
  • Cervical CA is the second most common CA in women < 50 yr.
  • The median age at Dx of cervical CA is 47 yr.
  • The median age at death from cervical CA is 60 yr.
  • The 11th most common CA in women and 13th most common CA-related cause of death.
  • From 1981 to 2002, the incidence of cervical CA ↓ by approximately 50% in Ontario, due to Pap smear screening.
  • Other causes for abnormal Pap smears, other than the HPV virus, are unknown
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5
Q

Name HPVsubtypes according to risk

A
  • Low risks: 6, 11, 41, 44
  • Intermediate risk: 31,33,35
  • High risk: 16 ,18 ,45 ,56
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6
Q

Describe: HPV transmission (3)

A
  • HPV is transmitted sexually and is the most common STI.
  • Condoms do not fully protect against transmission of HPV.
  • HPV can be transmitted without penetration.
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7
Q

Describe 1° Prevention of Cervical CA (4)

A
  • Pap smear: the mainstay of screening for precancerous lesions
  • HPV vaccine
  • Colposcopy
  • Rx of precancerous lesions
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8
Q

Name RFs for Cervical CA (10)

A
  • HPV infection with high-risk subtype
  • First intercourse at a young age (early coitarche)
  • Multiple sexual partners
  • Cigarette smoking
  • Multiparity
  • Long-term use of OCP (inconclusive evidence)
  • Immunocompromised status
  • Low socioeconomic status
  • High-risk sexual partners (i.e., partners whose previous sexual contacts have developed cancerous or precancerous lesions of the cervix)
  • Presence of other STIs
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9
Q

Describe Epidemiology HPV (5)

A
  • HPV is one of the most common STIs.
  • 75% of Canadians have had one or more HPV infections.
  • 95% of squamous cell carcinomas have HPV oncogenic types as do 60% of cervical adenocarcinomas.
  • There are 20 HPV types that have been identified as carcinogenic.
  • Types 16 and 18 are found most commonly in malignant lesions.
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10
Q

Name types of cervical Pap smears (2)

A
  • Liquid-Based Smear
  • Traditional Pap Smear
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11
Q

Describe: Liquid-Based Smear (2)

A
  1. Specimen is collected by wiping cells from the cervix and endocervix.
  2. The cells are suspended in liquid to remove blood and mucus.
    • Decreased unsatisfactory Pap test results, but increased cost. Evidence so far shows equivalent clinical outcomes.
    • Improved Dx of low and high grades SIL
    • Can be used to identify HPV subtypes
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12
Q

Describe: Traditional Pap Smear (3)

A
  • A wooden spatula is used to wipe cells from the surface of the cervix.
  • A brush is used to wipe cells from the endocervical canal—(may cause bleeding; should be avoided in pregnancy).
  • These cells are spread onto a slide that is fixed for cytologic exam.
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13
Q

True or False

The liquid-based cytology screen has been found to be less sensitive and is associated with more unsatisfactory specimens.

A

False

The liquid-based cytology screen has been found to be more sensitive and is associated with fewer unsatisfactory specimens.

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14
Q

The transformation zone undergoes transformation from glandular cells to what? (1)

A

squamous cells (i.e., metaplasia).

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15
Q

What are the most susceptible site for infection by HPV, and subsequent development of cervical CA?

A

Areas of active metaplasia

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16
Q

When should population screening for CA start? (3)

A
  • There are slight differences among each province
  • Should begin within 3 yr of initiating sexual activity or over age 21, whichever is later
  • Should be conducted annually until three consecutive negative Pap tests
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17
Q

Describe: Pap smear descriptive conventions (Figure)

A
18
Q

Name Pap smear result possibilities (12)

A
  • Unsatisfactory/inadequate sample
  • Normal
  • Benign atypia (infection, reactive Ds)
  • Cervical Intraepithelial Neoplasia (CIN)
  • Atypical Squamous Cells - Uncertain Significance (ASCUS)
  • Atypical Squamous Cells - Possible HSIL (ASC-H)
  • Low-grade Squamous Intraepithelial Lesion (LSIL)
  • High-grade Squamous Intraepithelial Lesion (HSIL)
  • Carcinoma in situ (CIS)
  • Atypical Glandular Cells of Uncertain
  • Significance (AGUS)
  • Invasive cervical cancer (rarely)
19
Q

Name these structures

A
20
Q

Describe Approach to cervical CA screening (Figure)

A
21
Q

Describe frequencies of pap tests (4)

A
  • continue screening q2–3 yr
  • should continue until the age of 69 yr, if there has been adequate screening over the past 10 yr
  • If there has been no Pap smear for 5 yr, begin annual Pap tests until three consecutive negative Pap tests, then should continue q2–3 yr
  • Discontinue screening at age 70 if > 3 normal Pap tests in the last 10 yr
22
Q
A
23
Q

Describe: CA Screening in Special populations (5)

A
  • Women with HIV/immunocompromised should receive annual screening.
  • Discontinue screening for women who have undergone a total hysterectomy for benign reasons and no Hx of cervical dysplasia or HPV.
  • Women who have undergone a subtotal hysterectomy (i.e., cervix intact) should continue routine screening.
  • Screening frequency in pregnancy is the same as in nonpregnant women.
  • Women who have sex with women should follow the same screening protocol as women who have sex with men.
24
Q

Pap smear carries a false-negative rate of __% for invasive CAs.

A

15% to 40%

25
Q

Colposcopy provides magnification and illumination of the cervix to do what? (3)

A
  • Further assess abnormalities on the cervix
    • Confirm Dx by biopsy
  • R/O invasive disease
  • F/U after Rx
26
Q

Describe colposcopy procedure (4)

A
  • Magnification to first inspect the transformation zone visually, then after application of 3% to 5% acetic acid, then Lugol solution
  • Biopsies are performed of abnormal-appearing epithelium.
  • Colposcopically directed biopsies carry an accuracy of 85% to 95% .
  • Endocervical curettage can be performed to R/O dysplasia within the cervical canal.
27
Q

Name: HPV Vaccine (1)

A

Gardasil

28
Q

The quadrivalent HPV vaccine protects against what HPV type? (4)

A

types 6, 11, 16, and 18.

29
Q

The quadrivalent HPV is given when? (2)

A
  • at zero, 2 mo, and 6 mo intervals.
  • It is most effective when given before the onset of sexual activity.
30
Q

National Advisory Committee on Immunization (NACI) recommends immunization for HPV for who? (6)

A
  • For the prevention of cervical CA, adenocarcinoma in situ (AIS), vulvar, vaginal, anal CAs and their precursors, and anogenital warts:
  • Females 9 through 26 yr of age
  • For the prevention of anal intraepithelial neoplasia, anal CA, and anogenital warts:
  • Males between 9 and 26 yr of age
  • May be administered to females or males over 26 yr of age
  • Not recommended < 9 yr of age as no immunogenicity or efficacy data are available in these groups
31
Q

Should women who receive the vaccine should continue to get screened regularly for cervical CA?

A

Yes, since they may still be exposed to or infected with other types of HPV.

32
Q

Peak incidence for cervical CA begins when? (1)

A

at 45 yr.

33
Q

Name stages of cervical CA (5)

A
  • 0: CIS, preinvasive carcinoma No stromal invasion
  • I: Invasive carcinoma con ned to the cervix
  • II: Extends beyond the cervix but not onto the pelvic wall ± upper 2/3 of vagina
  • III: Extends to the pelvic wall or involves the lower 1/3 of the vagina
  • IV: Extends beyond true pelvis, or has clinically involved the mucosa of the bladder or rectum
34
Q

Describe RX of stage 0 Cervical CA (4)

A

Localized Rx:

  • cryotherapy
  • LEEP
  • laser Rx
  • conization
35
Q

Describe RX of stage 1 Cervical CA (1)

A

Conization or radical hysterectomy ± radiation (Depending on lesion size and patient preference)

36
Q

Describe RX of stage 2 Cervical CA (1)

A

Radiotherapy± concurrent chemotherapy

37
Q

Describe RX of stage 3 Cervical CA (1)

A

Radiotherapy± concurrent chemotherapy

38
Q

Describe RX of stage 4 Cervical CA (1)

A

Radiotherapy± concurrent chemotherapy

39
Q

From the detection of cytologic abnormalities to invasive CA takes how many years? (1)

A
40
Q

Invasive carcinoma of the cervix is usually preceded by what? (2)

A
  • a spectrum of preinvasive disease, which can be detected by a Pap smear.
  • It usually takes up to 10 yr for abnormal cells to turn into CA.

Essentials - Gynecology (14 decks)

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