cervical abnormalities Flashcards
what are the classifications for cervical intraepithelial neoplasia (CIN)?
- CIN1- equivalent to LSIS
- CIN2- if p16 neg then LSIS, if p16 pos then HSIS
- CIN3- equivalent to HSIS
pathogenesis of CIN
- 99% from HPV d/t sexual contact
- older age= less likely to clear infection
- longer the infection persists= longer it takes to clear
what is the transformatino zone
- site of carcinogenesis by infx of HPV
what type of cells are found in ectocervix
- squamous cells
what type of cells are found in endocervix
- columnar
what are the low risk HPV variants
- HPV 6
- HPV 11
what are the high risk HPV variants
- HPV 16
- HPV 18
latent HPV infection
- without manifestations
- HPV DNA just in cytoplasm
active HPV infection
- HPV undergoes replication
- NOT integrated into genome
- DNA just in cytoplasm
neoplastic HPV transformation
- DNA gets integrated into host genome
cofactors in HPV pathogenesis
- immunosuppression
- cigarette smoking
- herpes, chlamydia
- OCPs
what is HPV cotesting
- perform pap and HPV testing at the same time
what is HPV reflex testing
- aka triage
- HPV test only if cytology shows ASC-US
how is HPV prevented
- vaccine
- usually gardasil 9
ages of female HPV vaccination
- 9-26
ages of male HPV vaccination
- 9-21
- can vaccinate up to 26 if MSM or immunocompromised
what are the subtypes of atypical cervical squamous cell abnormalities
- ASC-US (undetermined significance)
- ASC-H (cannot exclude high grade lesion)
invasive cervical cancer risk factors
- early onset sexual activity
- multiple partners
- high risk sexual partners
- hx of STI
- hx of VIN or cancer
- immunosuppression
how does cervical cancer spread
- lymphatic spread
- direct extension to adjacent pelvic organs
clinical manifestations of cervical cancer
- irregular or heavy bleeding
- post-coital bleeding*
what is included in the clinical staging of cervical caner
- PE
- cervical bx
- endoscopy
- imaging- PET is best
what LN are most important to assess in cervical cancer
- pelvic
- paraaortic
cervical cancer in pregnancy
- same prognosis as non-pregnant women
- ASC-US -> colposcopy 6 weeks pp
- ASC-H -> colposcopy with hx
- curettage c/i
why are pap smears used
- reduce mortality from cervical cancer by 80%
what is the traditional/ conventional method of pap
- smear samples on a slide
- slide fixed with preservative
what is the thin-prep method of pap
- cells from sample released into vial of liquid
- lab produces slides
when should pap smears be started and stopped?
- start at 21
- stop at 65 if no recent abnormal pap
how often do you get a pap if ages 21-29
- every 3 years
how often do you get a pap if over 30 years old
- choose one of the following methods:
- pap every 3 years
- hrHPV testing q 5 years
- cotesting q 5 years
what is the tx for HSIL
- excision and ablation of transformation zone
what is the tx for recurrent CIN
- hysterectomy
what are the excisional treatment options
- cone biopsy/ cervical conization
- LEEP
- laser conization
what are the ablative therapy options
- cyrotherapy
- laser
management of ASC-US in ages 21-24
- repeat pap in 12 mo
- if cytology is neg, ASC-US, or LSIL then repeat pap yearly for 2 years
- if cytology is ASC-H, HSIL, or AGC then get colposcopy
management of ASC-US in ages 25+
- get reflex testing
- if HPV neg and ASC-US do cotesting in 3 years
- if HPV pos and ASC-US get colposcopy
management of ASC-H in ages 21-24
- cytology and colposcopy q 6 mo for 12 mo
- if abnormally persists for 1 year -> repeat bx
- if abnormally persists for 2 years -> treat
management of ASC-H in ages 25+
- get colposcopy
- if n CIN1 then cotest in 12 and 24 months, coloposcopy if abnormal result
- if CIN 2 or 3 treat
management of CIN1
- follow up required
- if persists for 2 years then f/u or treat
- if CIN 2 or 3 then treat
management of CIN 2 or 3
- treatment required
