Cervical Cancer screening

Question 1

Facts about HPV?

Answer 1

it is causative in 100% of cervical cancer cases
* HPV is everywhere
* risk correlates the lifetime # of sex partners
* 75-80% of sexually active patients will have aquired HPV by 50

Question 2

Who is HPV a big concern for?

Answer 2

• Immunosuppressed (HIV, transplant recpients)
• smokers

Question 3

describe pap collection

Answer 3

using brush & spatula combo
1. use the spactula
* collect from the ectocervix
* swirl 10 times inside the vial

2.use the cytobrush
* collect from the endocervix
* turn brush 180 degrees
* swirl 10 times inside the vial

Question 4

Pap screening guidelines for women 21-30

Answer 4

• Pap test alone every 3 years
• high rate of HPV in this population so HPV testing is not cost effective

Question 5

Pap screening guidelines for women 30-65

Answer 5

• Pap test every 3 years OR
• co-testing with HPV and Pap every 5 years
• HPV testing alone every 5 years

Question 6

when can you stop screening for HPV

Answer 6

age >65 with adequate screening history
* no increased risk (Non-smoker, no new partners, immunocompetent)
* 3 consecutive negative cytology results OR 2 consecutive negative co-tests within 10 years before cessation of screening
* if prior hisory to cervical dysplasia, continue screening
* no other HPV-related disease
* TOTAL hysterectomy

Question 7

What are abnormal cells on a pap smear? Which ones should you be weary of?

Answer 7

ASC-US, LSIL,ASC-H, AGC, AIS

Question 8

what is recommended with a patient age 21-24 with ASC-US or LSIL cells?

Answer 8

repeat pap in 1 year

Question 9

what is recommended in a patient 25+ with ASC-US or LSIL cells?

Answer 9

Check HPV
* if HPV(-), repeat pap in 1 year
* if HPV(+), get Colpo & Bx

Question 10

how do we check for HPV?

Answer 10

< 30: “reflex testing” for HPV
30+ “co-testing” for HPV

Question 11

for HSIL cells or higher what should be done

Answer 11

• ALL ages with HSIL or higer: Colpo & Bx

Question 12

what is recommended for all positive HPV tests (if no pap done)

Answer 12

Reflex cytology
*if subtype is 16/18 referral to colposcopy is reasonable

Question 13

who needs a colposcopy?

Answer 13

• ASCUS, +HPV (if >24 years old)
• HPV 16 or 18 postive
• atypical glandular cells (also endocervical curettage and endometrial biopsy)
• HSIL
• LSIL

Question 14

• used for sampling the endocervix
• consider for any glandular abnormality: AGC, AGC-FN, AIS
• Contraindicated in pregnancy
• also indicated if HSIL without visable lesion on colposcopy

Answer 14

Endocervical curettage

Question 15

signs and symptoms of cervical cancer

Answer 15

• irregular vaginal bleeding (classically, post coital)
• watery discharge
• pelvic pain
• dyspareunia
• bladder changes
• kidney failure

Question 16

Treatment for early stage (IA1,IA2) cervical cancer

microinvasive

Answer 16

Simple hysterectomy
cold knife cone

Question 17

Treatment for mid size lesions (IB1, IIA) in cervical cancer

Answer 17

radical hysterectomy
radical trachelectomy

Question 18

treatment for large lesions (IB2, IIB, IIIB) in cervical cancer

Answer 18

Chemotherapy
radiation

Question 19

what should you do in with the 21-24 year old population with either CIN 1 and CIN 2?

Answer 19

• it is okay to observe CIN1 and CIN2 in this population
• observe = pap and colposcopy every 6 months
• CIN 3 is always treated

Question 20

how do you manage negative cytology with no endocervical coponent?

Answer 20

• varies by age
• 21-29: repeat cytology in 3 years
• > 30: manage based on HPV result (if HPV testing was not done, then do it!)