CERVICAL CANCER

Question 1

5 Signs and Symptoms

Answer 1

• Abnormal vaginal bleeding
• Intermenstrual spotting
• Menstrual periods lasting longer and heavier than normal
• Post menopausal bleeding
• Pain and bleeding after sex
• Pain in back / pelvis

Question 2

5 risk factors

Answer 2

• Immunosuppression (HIV, chronic steroid use)
• sexual activity at a young age <20
• multiple partners
• having partners with multiple intimate contacts
• Cigarette smoking
• Long term OCP
• Giving birth to multiple children

Question 3

Canadian Task Force Screening Guidelines: age, frequency and criteria to stop screening

Answer 3

• q3yrs for females starting at the age 25 IF they’ve ever been sexually active
• If >/3 tests in past 10 years, can stop at 70

Question 4

Next step If Pap lacks Transformation zone

Answer 4

continue at regular interval

Question 5

Next step if unsatisfactory Pap / sample

Answer 5

repeat in 3 months

Question 6

Frequency of screen if immunocompromised and SLE

Answer 6

annual screen

Question 7

Frequency of Pap if total hysterectomy

Answer 7

0 screening BUT If hx of HSIL, AIS or cancer – annual vault smear for life

Question 8

Frequency of Pap if Subtotal Hysterectomy w/ cervix intact

Answer 8

routine screening

Question 9

Frequency of PAP if pregnant, or ASCUS / LSIL and pregnant

Answer 9

regular screening

if ASCUS and LSIL found do not repeat until after 6 months postpartum

Question 10

Next steps if ASCUS and <30 y.o. / HPV testing not available:

Answer 10

• Repeat cytology in 6 mo.
o If result >/ ASCUC -> Colposcopy.
o If result negative -> repeat cytology in 6 months
o If negative -> routine screening q 3 yrs.
o If >/ ASCUS -> colposcopy.

Question 11

Next steps if ASCUS and >30:

Answer 11

• HPV DNA testing
o If results negative -> routine screen q 3 yrs
o If results positive -> colposcopy

Question 12

Next step if ASCUS and cervical abnormalities

Answer 12

• Colposcopy

Question 13

Next steps if LSIL and <50 y.o. / HPV testing not available

Answer 13

• Repeat cytology in 6 months
o Results >/ ASCUS -> colposcopy
o Results negative -> repeat cytology in 6 months
o Results >/ASCUS -> colposcopy
o Results negative -> routine screening q 3yrs

Question 14

Next step if LSIL and >/50 y.o.

Answer 14

• HPV DNA testing
o If results negative -> routine screen q 3 yrs
o If results positive -> colposcopy

Question 15

Next step if Atypical Squamous cells cannot exclude HSIL (ASH-H):

Answer 15

• Colposcopy – consider biopsy

Question 16

Next step if Atypical glandular / endocervical / endometrial:

Answer 16

• Colposcopy +/- endometrial sampling (if >/ 35 y/o + Hx of abnormal bleeding)

Question 17

Next step if High Grade Squamous Intraepithelial lesion (HSIL):

Answer 17

• Colposcopy – endocervical curettage + direct biopsy